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Medial Tibial Stress Syndrome (AKA Shin Splints)

For most people who participate in any sport that involves running they would have experienced the dreaded condition known as shin splints. For some people they almost seem inevitable, particularly during pre-season. This condition can be very annoying as if not treated early can lead to a constant dull pain in the front of the shin that can last for several weeks. So what is this condition, why is it so common and what causes it?

What is Shin Splints?

Shin Splints refers to multiple different types of conditions that cause shin pain. There are different types of shin splint 'classifications' depending on the location of pain, but the most common one is 'Medial Tibial Stress Syndrome.' Pain is generally located along the middle/posterior of the tibia bone. It is an overuse injury that occurs when high amounts of stress is placed on the muscles, tendons and joints in the lower leg. It accounts for 10-15% of running injuries and 60% of leg pain injuries.

What are the Risk Factors for MTSS?

For most people there will be a combination of factors causing their shin splints. Here is a list of a few of the most common factors.

  • Runners without enough shock absorption (i.e. poor or worn out shoes, incorrect running shoes).

  • Running on cement or uneven surfaces (i.e. pre-season in summer on hard grounds)

  • Training errors (sudden increase in training intensity and duration)

  • Running >30 kms/week

  • Hill training early in the season

  • History of previous lower extremity injuries

  • Over-pronation or increased internal tibial rotation.

Symptoms of MTSS

Symptoms of MTSS are generally very common among all individuals.

  • Vague, diffuse pain along middle-distal tibia that will decrease with running in the early stage of injury.

  • There will be an earlier onset of pain with more frequent training in the later stages of injury.

  • Generally there will be tenderness along the posterior/medial border of the tibia approximately 4cm from the medial malleolus extending possibly to 12cm up the tibia.

  • There will also possibly be a tight achilles tendon, 'pes planus' or flat foot.

  • There will be pain on resisted plantar flexion.

Treatment for MTSS

Depending on the severity of symptoms an X-Ray may be requested to rule out the possibility of a stress fracture. Generally, treatment is conservative and involves a period of reduced activity to let inflammation settle before building training up to pre-injury levels.

Initially, the first line of treatment will involve activity modification

  • Decreasing running distance, frequency and intensity by 50%

  • Use low-impact and cross-training exercises during rehab period

  • Regular stretching and strengthening exercises

  • Running on a synthetic track

  • Avoid running on hills, uneven or hard surfaces

  • Shoe modifications - Possibly orthotics and changing running shoes every 300-600km run as worn out shoes lose shock absorbing capacity.

Physiotherapy Interventions that can be used generally involve

  • Massage and dry-needling

  • Therapy focusing on strengthening of the invertors and evertors of the ankle

  • Strengthening of the calf to help with shock-absorption.

Why is early treatment important for MTSS?

If left untreated, MTSS can become very painful and debilitating. In the worst cases, it can result in a constant dull ache that can become sore whilst walking. If left untreated for long enough a stress fracture can also occur due to constant overuse resulting in longer time off from your chosen sport. After treatment, a recurrence of shin splints is extremely common as loads increase, getting treatment in the early stage of the injury can help to reduce the chance of recurrence.

With spring and summer gradually approaching, ovals and surfaces will begin to become harder and running outdoors will become more frequent. If you begin to experience shin pain as you start your training it is important to get it looked at by a professional to reduce the chance of a significant long-term injury.

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