What are Shin Splints AKA Medial Tibial Stress Syndrome?
Shin splints is often an umbrella term used for diffuse pain located along the inside of the shin bone (the tibia), more specifically this condition is called Medial Tibial Stress Syndrome (MTSS).
This is fairly common in athletes and military personnel with incidences reported between 4% to 35%. In runners, this has been identified as the most common related musculoskeletal injury.
Generally athletes notice that the pain starts at the beginning of the workout, but seems to reduce during the training session, but will gradually increase after exercise and may be present for days afterwards.
Other forms of shin pain:
It’s important to differentiate between other conditions that may be contributing to pain. Two conditions that can be mistaken for MTSS are stress fractures and compartment syndrome which have very different management strategies. Stress fractures, which are far more serious than MTSS tend to be painful in a specific location in the shin, will get worse as you exercise, and feels better in the morning after resting. Compartment syndrome is another condition where swelling increases within a compartment in the leg, which can lead to pain, abnormal nerve sensation and muscle weakness.
Your physiotherapist can help correctly diagnose your shin pain and work with you to return to activities you love as safely, and quickly as possible.
What may be causing MTSS?
This commonly occurs in athletes when they suddenly increasing their training load (increase in distance, intensity, or duration), running on hard or uneven surfaces, or old running shoes with poor shock absorbing capacity. Biomechanically, overpronation of the foot, unequal leg length and reduced flexibility in calf muscles are some risk factors for developing MTSS. Other risk factors include; female sex, increased body mass index, greater hip internal and external range of motion, and previous history of stress fractures or orthotics.
Will physiotherapy help with my MTSS?
Yes! Physiotherapists commonly see individuals with MTSS. We will get a detailed description of what is triggering your shin pain and create a plan to safely participate in your exercise. Part of the assessment will include a biomechanical examination of the hip, knee, and ankle assessing range of movement and strength abnormalities. Careful assessment of foot alignment and gait assessment is crucial for successful management. If applicable, a running assessment can be completed to further assess gait and motor control.
Treatment will therefore be targeted towards your specific needs. Soft tissue release through tight structures, such as the calves, and tibialis posterior and flexor digitorum muscles are often useful in improving symptoms. Taping techniques to reduce foot pronation can also be helpful to reduce symptoms. Occasionally, orthotics may be recommended. Stretching, strengthening, balance work, and education regarding load management has been seen effective for long term management.
What can I do to help?
Rest from the aggravating activity may be necessary to settle symptoms down initially. Ice and analgesia has also been shown to be effecting in the short term. Cross training, such as swimming and cycling can be a great way to keep you active. For runners, changing your shoes every 400-800 kilometres to prevent re-injury as shoes can lose up to 40% of their shock absorption capacities at that stage. Sometimes owning two or more pairs of running shoes are ideal if you are doing multiple longer distance runs during a week, to allow the foam to recover in between runs. A gradual increase in training load is required to prevent re-injury.
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