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.
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
– 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
Blog by Christian Bonello (Physiotherapist)