Medial Tibial Stress Syndrome (MTSS), also known as shin splints, refers to the repetitive stress and microtrauma placed along the inner border of the tibia (shin bone).
It is commonly known as an overuse injury and typically occurs in athletes who engage in activities involving repetitive impact, such as running, jumping, and dancing. While the exact nature of MTSS remains unclear, it is believed to result from a combination of biomechanical factors, including excessive foot pronation, muscle imbalances, and inadequate training loads.
CAUSES OF MTSS
Though the exact cause for MTSS is not currently known, here are some evidence-based reasons as to why it can be occurring.
1. Training Load: Rapid increases in training intensity, duration, or frequency without adequate rest and recovery can overload the tibial tissues, predisposing them to injury.
2. Biomechanical Factors: Individuals with excessive foot pronation or flat feet are more susceptible to MTSS due to altered lower limb biomechanics, leading to increased stress on the tibial structures.
3. Muscle Weakness and Imbalance: Weakness or imbalance in the muscles surrounding the tibia, particularly the anterior tibialis and calf muscles, can contribute to abnormal loading and stress distribution along the shinbone.
4. Footwear and Surface: Inappropriate footwear or training on hard surfaces can exacerbate the impact forces transmitted to the lower limbs, increasing the risk of MTSS development.
There are also other conditions that provoke similar pain to MTSS which need to be cleared for to ensure the correct management of the injury. Here are some to be aware of:
1. Tibial stress fractures: Typically presents with pain upon running.
2. Anterior Tibial Stress Syndrome: Vague, diffuse pain along anterolateral tibia, worse at beginning of exercise that decreases during training.
3. Exertional Compartment Syndrome: Symptoms begin 10 minutes into exercise and resolve 30 minutes after exercise. Some individuals experience pins and needles or numbness as well.
CLINICAL CHARACTERISTICS
There are a few hallmark signs to look for when we are assessing for MTSS.
Key symptoms and signs include:
- Pain along the distal posteromedial border provoked over an area of five centimetres (if less than five centimetres it could be a tibial stress fracture).
- Exercise-induced pain along the tibial border.
- Easing or disappearance of pain with relative rest.
- Single leg hop test: Used to distinguish between medial tibial stress syndrome and a stress fracture: a patient with medial tibial stress syndrome can hop at least 10 times on the affected leg where a patient with a stress fracture cannot hop without severe pain.
- Swelling and Inflammation: Mild swelling and tenderness over the affected area may be present, indicative of tissue irritation and inflammation.
TREATMENT STRATEGIES
Effective management of MTSS involves a comprehensive approach aimed at reducing pain, promoting tissue healing, and addressing underlying biomechanical factors. Treatment strategies may include:
1. Rest and Activity Modification: Temporary cessation or modification of high-impact activities to alleviate symptoms and prevent further tissue damage.
2. Ice Therapy: Application of ice packs to the affected area for 15-20 minutes, several times a day, to reduce pain and inflammation.
3. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Short-term use of NSAIDs, under medical supervision, to alleviate pain and inflammation.
4. Stretching and Strengthening Exercises: Implementation of stretching exercises to improve flexibility and strengthening exercises to address muscle imbalances and enhance lower limb stability.
5. Orthotic and Podiatry Interventions: Custom orthotic devices or supportive footwear to correct biomechanical abnormalities and reduce excessive pronation.
6. Gradual Return to Activity: Gradual progression of activity levels and implementation of proper training techniques to prevent the recurrence of MTSS.
Are you struggling with the symptoms of Shin Splints or similar? Ready to take action to return to performance?
Call us on 1300 116 227 or head to m-cap.com.au to schedule a consultation with our Physio or Podiatrist to return to your athletic potential!
