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Shin Splints

What is Medial Tibial Stress Syndrome? (Shin Splints) – Blog By Christian Bonello

Medial Tibial Stress Syndrome (MTSS) or “shin splints” is a condition of the lower limb, precisely involving the tibia or shin bone. The term “shin splints” has often been used by athletes as general reference to such shin pain or by health professionals. The condition is caused by an increased stress on the inner and rear aspect of the tibial bone during walking and running motions. This loading causes chronic traction on the periosteum (outer surface) of the tibial bone by the soleus muscle, leading directly to MTSS. Due to its location, the flexor digitorum longus muscle has also been implicated in this condition and to a lesser extent the tibialis posterior muscle.

The incident of MTSS is between 4-35% in sportspeople and military personnel.


An athlete presenting with shin splints will often report diffuse pain along the inner portion of the shin bone. This usually occurs in the upper two thirds of the shank and occurs after running or exercising. The athlete’s pain decreases after warming up and they can generally complete the training session however as the condition progresses the pain can occur during running or activity. In more severe cases, ascending stairs may also be aggravating. In addition, the pain gradually returns post exercise and is often worse the following day.

Risk Factors:

A number of risk factors may contribute to the onset of medial tibial stress syndrome. These commonly include:

– Excessive foot pronation (flat feet)

– Training load errors

– Poor shoe design

– increase surface type

– Muscle weakness and/or dysfunction

– Fatigue

– Reduced ankle range of motion or muscle length

– increased body max index

– increased hip internal and external rotation

– reduced lean calf girth

– use of orthotics

– history of stress fractures

– lower bone mineral density

There is also a three time greater prevalence of MTSS in females then male counterparts.


Diagnosis of Shin Splints is usually made based on subjective reports by the patient in terms of location and severity of pain, reported symptoms and exercise activity patterns. Diagnostic radiographs are rarely used as X-rays are routinely negative for patients with medial tibial stress syndrome; however occasionally periosteal reactions and/or localised swelling may be seen. Radiographs may however be useful to distinguish a medial tibial stress syndrome from a tibial stress fracture.

Treatment and Physiotherapy:

Often patients presenting with shin splints have a long history of complaints and have tried numerous stretches, cold therapy and/or medicines to manage their symptoms. 
Your physiotherapist will guide you on the recovery plan and anticipated timeframes. Often this begins with a period of relative rest, ice and analgesic relief as required. The implementation of pain-free cross training activities such as swimming and cycling can also be prescribed to maintain fitness levels for the athlete.
identify the underlying risk factors and to treat the underlying pathology.

Depending on the causative risk factors (described above), physiotherapy intervention may include:

– the prescription of shock absorbing insoles

– the prescription of appropriate shoe wear

– taping techniques to address foot alignment and walking biomechanics

– soft tissue techniques/massage addressing muscle fibres of soleus, flexor digitorum longus or tibilias posterior

– ankle flexibility exercises

– muscle strengthening of the lower limb and/or

– proprioceptive neuromuscular facilitation (PNF) stretching

At Total Physiocare Heidelberg, Reservoir, Camberwell and Footscray, we are highly experienced in treating athletes and weekend warriors presenting with shin pain.


Book an appointment today for your assessment!

Blog by Christian Bonello (Physiotherapist)

Plantar Fasciitis

What is Plantar Fasciitis? – Blog By Emily Shortal

This common foot condition is pronounced – “Plan-tar   fash–ee-eye-tus”.

Plantar fasciitis is the most common cause of heel pain. Repetitive stress to the plantar fascia can cause pain. It is a thick, fibrous ligament on the sole of the foot running from the toes to the heel bone. This ligament supports the arch of your foot and helps absorb shock when walking. The plantar fascia is not very elastic, hence when too much repetitive stress or traction is placed on it, micro-tearing can occur and result in pain and inflammation.



What is a heel spur?

A heel spur (or osteophyte) is a calcium deposit causing a bony protrusion on the bottom side of the heel bone. Heel spurs are commonly associated with plantar fasciitis.


What are the symptoms?

Heel pain is more intense with the first steps in the morning or after a period of sitting. The plantar fascia tightens and shortens during rest, but then is placed on traction and stretched once weight-bearing. This pain is usually sudden and sharp, often described as a stabbing pain. After a period of walking, the plantar fascia loosens and the pain can change to a dull ache, or disappear completely. However after walking or standing for a prolonged period the pain will return.


What are the risk factors?

The following factors increase the risk of plantar fasciitis:

  • Sports: especially repetitive impact activities such as running and jumping places excess strain on the arch of the foot. Ballet, and dancers in general are also prone to plantar fasciitis for this reason.
  • Foot biomechanics: particularly those who are flat footed or with a naturally high arch, whereby there is a great degree of tightness in plantar fascia. Additionally, having pronated (rolled in) feet.
  • Ageing: plantar fasciitis is most common amongst the over 50’s demographic due to muscle weakness and tightness in the ligaments. Additionally over time the natural protective fat pad under the heel thins.
  • Overweight: excess weight places greater tractional forces on the plantar fascia, causing more trauma overtime.
  • Pregnancy: from both increased weight and ligament laxity due to pregnancy hormones
  • Occupation: those who are on their feet for prolonged periods because of work, particularly if standing on hard surfaces or with unsupportive footwear.


How do I get rid of my plantar fasciitis?

No single treatment works best for every case of plantar fasciitis, as differing contributing factors must be addressed. Hence attending Physiotherapy to identify and address these factors is crucial.

Common treatment methods include:

  • Anti-inflammatory techniques, ice
  • Stretching and massage
  • Exercises to strengthen the plantar fascia
  • Shoe recommendations; good arch support is essential!
  • Taping, shoe inserts or orthotics to support your plantar fascia
  • Gel cups to cushion the heel bone
  • Strassbourg sock/night splint to prevent tightening overnight
  • Cortisone injection: a powerful anti-inflammatory, usually only recommended once less invasive treatment has been unsuccessful. Bear in mind that a cortisone injection does not address the root cause of the condition, hence your symptoms can often return if the contributing factors are not addressed are supported with other treatment methods.

Our team at Total Physiocare in Reservoir, Heidelberg, Camberwell & Footscray are ready to help rid you of heel pain once and for all!

Book an appointment today for your assessment!

Blog By Emily Shortal (Physiotherapist)


Stress Fractures

What are stress fractures? – Blog By Rhian Davies

A stress fracture is an overuse injury where there is an overload of stress to the bone resulting in a tiny crack.  This occurs when the stress of repetitive loads overwhelms the ability of the bone to repair itself and these cracks begin to occur within the bone structure.


Stress fractures are often the result of increasing the amount or intensity of an activity too rapidly. Can also be due to an impact of an unfamiliar surface, improper equipment or increased physical stress.

Where do stress fractures occur?

Weight bearing bones of the body such as:

  • Metatarsal bones of the foot
  • Navicular bone in the foot
  • Calcaneus (heel bone)
  • Tibia (shin bone)
  • Femur (thigh bone)
  • Pelvis
Common bones where stress fractures occur


Most common in the weight-bearing bones of the lower leg and foot with more than 50% of all stress fractures occurring in the lower leg.

Risk Factors:

  • Repetitive sporting activities ie. Running, Basketball, Tennis, Dancing
  • Sudden increase in activity ie. Intensity, duration or frequency of training sessions
  • Poor foot posture ie. Flat feet or high arches
  • Females more likely than males
  • Osteoporosis or weakened bones
  • Previous stress fractures
  • Lack of nutrients ie. Lack of Vitamin D and calcium



  • Symptoms can vary widely but a common complaint is pain with activity which subsides with rest.
  • Pain that gradually worsens over time when continuing the aggravating activity.
  • Swelling and tenderness may also be present around the area of pain.



A stress fracture can sometimes be diagnosed through a subjective and physical examination but often imaging is needed to confirm the diagnosis.

  • MRI: Can visualize stress fractures within the first week of injury
  • Bone Scan: Can detect problems in bones but not specific to stress fractures
  • X-ray: Not seen on regular x-rays for at least several weeks up to over a month from the initial onset of pain.



If diagnosed with a stress fracture, your physiotherapist will be able to prescribe the correct management specific to you and your needs. In most cases, the initial management will include a period of rest to allow the stress fracture to heal, this may involve the use of crutches or wearing a weight bearing boot in moderate to severe cases, to reduce the bone’s weight bearing loads.

Rehabilitation and strengthening as well as a gradual return to activity are extremely important to prevent or reduce the likelihood of re-injury. Your physiotherapist will be able to develop a specific program to enable you to safely and efficiently return to your activity or sport.


Tips to help prevent stress fractures:

  • Proper footwear for specific type of exercise
  • Gradual build up when starting a new exercise program
  • Walk/warm up prior to running
  • Stretch + strengthen calf muscles
  • Cool down properly after exercise

At Total Physiocare we specialise in the accurate diagnosis, management and return to activity or sport for clients presenting with stress fractures.

Book an appointment today for your assessment!

Blog By Rhian Davies (Physiotherapist)