MEDIAL TIBIAL STRESS SYNDROME - SHIN SPLINTS

Medial Tibial Stress Syndrome (MTTS), commonly known as "Shin Splints," is an overuse injury affecting the tibia, frequently observed in runners. This condition is debated to be a stress reaction in the distal third of the tibia (Shin bone) or inflammation at the muscle-bone interface.

Causes

Bone stressors for the tibia can be mechanical, hormonal or dietary. Mechanical stressors when running include the impact of when your foot hits the ground and the muscle pulling on the bone. Hormonal factors can impact bone mineral density and diet can impact the amount of circulating calcium, which is very important for healthy bones. When these stresses surpass the bone's recovery capacity, it gradulally enters a state of stress and MTTS can slowly develop. If ignored, it can eventually devlop into a stress fracture. 

Risk Factors 

Risk factors are multifaceted, with notable considerations for amateur runners experiencing a significant increase in load. Other factors include being female, a history of MTSS, high BMI, navicular drop, reduced hip external rotation range of motion, calf muscle weakness, running biomechanics, and footwear. 

Clinical Presentation

The common clinical presentation involves exercise-induced shin pain and tenderness on palpation of the lower inner shin. Sometimes the pain can warm up with exercise and then worsens post. This discomfort can last for hours or days afterward. Movements that are explosive tend to be more provocative e.g. hopping, jumping vs calf raises or walking. 

Management Strategies

Modify Load

Unlike tendinopathies, complete rest is typically recommended initially for MTTS. Once hopping is nearly pain-free, a return-to-run program would commence.

Improve Muscular Strength 

Enhancing the strength of the soleus and surrounding musculature, including the tibialis anterior, peroneals, and flexor hallucis longus, is crucial, as these muscles commonly exhibit reduced strength and endurance in MTTS.

Biomechanical Analysis

Runners with MTTS often exhibit a large stride and low cadence. Modifying cadence can be pivotal in reducing impact forces.

Osteogenic Activity

Activities that encourage bone strengthening such as jumping, drop jumps, skipping, and bounding, are essential as soon as tolerated.

Nutrition & Vitamin D

Ensuring adequate caloric intake, calcium, and vitamin D is crucial for bone health and recovery.

Get Professional Help for Medial Tibial Stress Syndrome

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