Medial Tibial Stress Syndrome (Shin Splints)

Shin Splints

What is Medial Tibial Stress Syndrome (Shin Splints)?

Shin splints is a term used to describe pain in the front of the lower legs, which often occurs at the beginning of the exercise or just after exercise. The term ‘shin splints’ is a general description of the area where the pain is located, but is not a diagnostic term. Medically, the condition is known as Medial Tibial Stress Syndrome (MTSS). MTSS is caused by excessive stress on the shin bone (tibia) and surrounding muscles, and is one of the most common causes of exertional leg pain in athletes.

Categories of MTSS

MTSS are commonly split into three categories:

  • Inside of shin pain (Medial)
  • Front of shin pain (Anterior)
  • Bone pain (Tibial Stress Syndrome)

Signs and Symptoms of MTSS

The most common complaint amongst patients with MTSS is vague, diffuse pain in the lower extremity, along the lower third of the shinbone (tibia) and is often brought on by physical exertion. In the early stages of MTSS, the pain usually develops gradually without a history of trauma. It is often worse at the beginning of the exercise and gradually subsides during training, but can recur within minutes of cessation of exercise. As the injury progresses, however, pain commonly presents with less activity and may occur at rest. If left untreated, MTSS can progress to stress fractures of the shinbone.

Causes and risk factors of MTSS

MTSS is caused by repetitive loading or stress on the shin bone (tibia) and surrounding muscles. Training errors appear to be the most common risk factor for developing MTSS; this is particularly common amongst athletes who attempt to do ‘too much, too fast’. Common training errors include a recent or sudden onset of increased activity, intensity, duration, or change in running terrain. Other risk factors include:

  • excessive pronation due to flat feet (ankle rolling in)
  • excessive supination due to high arch feet (ankle rolling out)
  • calf weakness and/or tightness
  • poor lower limb biomechanics
  • muscle dysfunction
  • decreased ankle mobility/flexibility
  • increased hip range of motion (both internal and external rotation)
  • worn out or improper shoes (poor shoe design/support)
  • excessive fatigue
  • low bone mineral density
  • surface style – running on hard or uneven surfaces
  • reduced bone load tolerance
  • higher body mass index

Prognosis of MTSS

With the correct treatment, full recovery from MTSS is often achieved. However, if the underlying causes of MTSS are not identified and addressed correctly, recurrence is common.

Treatment for MTSS

The best outcomes for people living with MTSS are achieved through early diagnosis and early treatment. It is important that MTSS is not left untreated as the condition can progress to a stress fracture of the tibia. At OnePointHealth we will perform a comprehensive assessment that involves taking a detailed history of your weekly physical activity routine (such as your running distance, intensity, pace, terrain, and footwear, with careful attention to recent changes in training regimens), along with a thorough musculoskeletal examination. This level of detail allows us to develop highly successful treatment plans that are specific to you. The following suggests key recommendations and strategies for the management of MTSS:

  • Activity modification: An initial change to your exercise regime or daily activities may be needed to avoid the condition getting worse. The introduction of a low-impact alternate activity may also be of benefit, such as swimming or cycling.
  • Anti-inflammatories: Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, naproxen, or aspirin, will help with pain and swelling as per GP instructions.
  • Ice: To ease pain and swelling. Do it for 20-30 minutes every 3 to 4 hours for 2 to 3 days, or until the pain is gone.
  • Compression: Compression bandages help to reduce swelling that may be associated with MTSS.
  • Elevation: Raising the foot above the level of the heart helps to reduce swelling.
  • Strength and Plyometric training: It is important that the strength in your legs is addressed when managing MTSS, so that the affected area can tolerate more load over time. This is done initially with isometric loading to load up the affected area in a pain-free way. When pain has reduced, a strengthening program will be prescribed. Once adequate strength has been gained, plyometric exercises such as jumping and hopping will be introduced.
  • Appropriate footwear: Supportive footwear may also be recommended to stabilise the foot and ankle which reduces the stress placed on the surrounding muscles.
  • Manual therapy: Soft tissue techniques such as a massage can help with areas of tightness or focal thickening. Joint mobilisation can help increase ankle/foot range of motion. Manual therapy can be used to control several biomechanical abnormalities.
  • Taping/Bracing: Taping or bracing can help to stabilise the surrounding structures to reduce the excessive stress of the surrounding muscles.
  • Orthotic therapy: A custom orthotic device placed inside the shoe can help to stabilise the foot, assist with shock absorption, and address possible causative factors such as flat feet.
  • Injections: Prolotherapy injections and platelet-rich plasma injections can help to accelerate the healing process.
  • Surgery: In cases that are non-responsive to conservative treatment, surgical intervention may be required.