Medial Tibial Stress Syndrome (Shin Splints)

Medial tibial stress syndrome (MTSS) is a common overuse injury of the shin provoked following weight bearing activities including exercise [1-3]. MTSS is characterised by pain along the bottom two thirds of the inside of the shin bone [1, 3-5]. This condition is a common cause of pain and dysfunction amongst athletic populations, particularly those involving repetitive dynamic or impact based loads such as running, dancing or jumping [1, 3, 6, 7] and is something that we regularly treat at Avenues Physio-Fitness. This debilitating condition is very painful and distressing for many young athletes. Pain and dysfunction often limits training participation and impairs competition performance. Recovery can take several weeks or even months, with the potential to impact on an athletes entire season [6]. It is essential that an athlete is treated by a team of therapists with extensive knowledge in lower limb biomechanics, training factors and the pressures on the body with dynamic sport.

MTSS is one of the most common causes of leg pain following exercise [3]. It accounts for 10-20% of running injuries, and up to 60% of overuse injuries of the leg [7].  So what causes shin splints? Overall, the evidence is varied and the causes appear to be multi factorial. There are three main factors that our physiotherapists will explore with you to diagnose and help treat your shin pain. These factors simply are muscle imbalances or lower limb biomechanics, training errors/ equipment errors or body mass [4].

Biomechanics

Lower limb biomechanics are associated with the kinetic chain. The kinetic chain is a series of interconnected joints with forces and movement transferred between levels. During running there are approximately 600 foot contacts per kilometre. With every heel strike impact is transferred through the kinetic chain. Any faulty motion and force will influence lower limb pain. These altered mechanics can occur at the hip/pelvis, knee or foot will place additional pressure on the shin bone [4]..

Normal leg muscle function is required when walking or running to generate appropriate biomechanical force during propulsion as well as reduce impact to the shin bone during ground contact [2]. There also needs to be adaptability within the lower limb including the foot to adjust to any changes. This includes factors such as arch control of the foot, calf muscle strength, muscle flexibility and power.

Training errors or extrinsic factors

Extrinsic risk factors include training errors, inappropriate footwear, environmental conditions, hard or uneven training surfaces, rapid progression, reduced physical conditioning, reduced training/running experience or excessive training loads [3, 6, 8].

Footwear is something our therapists will always assess. Adequate shock absorption important function of footwear. This is lost after approximately 500-880km running mileage. Worn shoes become a risk for development of overuse injury including MTSS [7].

How do we treat it?

As noted above, MTSS or shin splints is multi-factorial, so all of the above factors will be explored by our experienced team. Importantly, the quicker that you seek an assessment, the quicker we can get you moving freely again. There is multiple taping options, hands on physiotherapy techniques and acupuncture that can initially manage your painful symptoms. But importantly, for long-term successful treatment, any biomechanical or training factors will need to be assessed for remaining pain free. Furthermore, like many injuries, prevention is the best cure. Our team is passionate about assisting in biomechanical screening for all athlete levels to limit the impact this condition and many others have on your training capacity. So book in for an assessment to prevent getting sore!

Written by Amanda Meys October 2018

 

References

  1. Plisky, M.S., et al., Medial tibial stress syndrome in high school cross-country runners: incidence and risk factors. journal of orthopaedic & sports physical therapy, 2007. 37(2): p. 40-47.
  2. Rathleff, M.S., et al., Inverse relationship between the complexity of midfoot kinematics and muscle activation in patients with medial tibial stress syndrome. Journal of Electromyography and Kinesiology, 2011. 21: p. 638-644.
  3. Yüksel, O., et al., Inversion/eversion strength dysbalance in patients with medial tibial stress syndrome. Journal of Sports Science & Medicine, 2011. 10(4): p. 737-742.
  4. Loudon, J.K. and M.P. Reiman, LOWER EXTREMITY KINEMATICS IN RUNNING ATHLETES WITH AND WITHOUT A HISTORY OF MEDIAL SHIN PAIN. International Journal of Sports Physical Therapy, 2012. 7(4): p. 356-364 9p.
  5. Noh, B., et al., Structural deformation of longitudinal arches during running in soccer players with medial tibial stress syndrome. European Journal of Sport Science, 2015. 15(2): p. 173-181.
  6. Yagi, S., T. Muneta, and I. Sekiya, Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners. Knee Surgery, Sports Traumatology, Arthroscopy, 2013. 21(3): p. 556-563.
  7. Couture, C.J. and K.A. Karlson, Tibial stress injuries: Decisive diagnosis and treatment of ‘shin splints’. Physician & Sportsmedicine, 2002. 30(6): p. 29-52 10p.
  8. Tweed, J.L., J.A. Campbell, and S.J. Avil, Biomechanical risk factors in the development of medial tibial stress syndrome in distance runners. Journal of the American Podiatric Medical Association, 2008. 98(6): p. 436-444.