Medial Tibial stress syndrome

A common exercise related injury often seen in the world of athletics and sport is known as Medial Tibial Stress Syndrome (MTSS) aka shin splints. MTSS is an overuse injury that occurs through repeated exercise or physical activity. MTSS is characterized by symptoms of pain felt along the posteromedial tibial border or the medial side of the lower leg above the ankle. MTSS can occur in any place along this border, but usually affects the distal two-thirds of the bone. In the acute stage, pain is often described as a dull ache following exercise, which can last several hours or days, depending on the severity. While it may seem like a minor inconvenience, if not treated properly MTSS can progressively lead to more serious conditions. This blog post will dive into the causes, symptoms, and treatment options for MTSS.

To better understand and effectively manage MTSS, it's important to understand the anatomy of the lower extremity. The lower leg region is composed of four muscle compartments (anterior, lateral, deep posterior, and superficial posterior) which are separated by the tibia, fibula, and dense fascial layers. The primary muscles within this region are the anterior tibialis, posterior tibialis, soleus, and flexor digitorum longus; they are all primarily responsible for stabilizing the lower leg/foot and aid in pushing off while running/walking. MTSS involves inflammation and micro-tears in the aforementioned muscles and tendons surrounding the shin bone caused by repetitive trauma or stress to the area.

There are a variety of contributing risk factors, both intrinsically and extrinsically that can increase the likelihood of MTSS. Intrinsic factors are an individual’s physical fitness, and anatomical variations such as exercise experience, running/jumping mechanics, body mass index (BMI), injury history, decreased strength, poor flexibility, poor muscular endurance, poor proprioception, and muscular imbalances. Extrinsic contributing risk factors to MTSS include the type of sport/activity, the environment (surface or terrain where activity/sport is played), and the footwear an individual is using for the activity. Understanding the risk factors can help you take proactive measures to prevent shin splints and keep your exercise activities pain-free.

When it comes to managing shin splints, there are several effective treatments and preventive measures you can take depending on the stage of the injury. In general rest/activity modification are essential for proper recovery, allowing the muscles and tendons in your shins to heal. Additionally, applying heat or cryotherapy to the affected area can help reduce pain and inflammation. Exercise/activity intensity that initially caused injury should be reduced to prevent exacerbation. A great way to continue exercising and not compromise fitness level is to cross-train which is a protocol using different forms of exercise outside of an individual’s main exercise requiring different demands from the body. For example, instead of running/jumping, one can choose to go swimming, biking, or use of an elliptical machine; which are all low impact and can aid in the healing process. Finally, wearing supportive shoes, using orthotics, and can also help prevent shin splints from occurring.

In summary, MTSS is an overuse injury caused by excessive running and jumping causing micro trauma stress to your shins. One can take preventative measures in training properly for their activity or sport. It's important to listen to your body, understand signs/symptoms of overtraining, and seek professional advice when necessary to avoid injury exacerbation.

Written by Courage Jacobs, SPT

References

Crous, Z. (2021). A systematic review of the conservative treatment options and their effectiveness in the treatment of medical tibial stress syndrome (MTSS) (Doctoral dissertation).

Becker, J. A. M. E. S., Nakajima, M. I. M. I., & Wu, W. F. (2018). Factors Contributing to Medial Tibial Stress Syndrome in Runners: A Prospective Study. Medicine and science in sports and exercise, 50(10), 2092-2100.

Griebert, M. C., Needle, A. R., McConnell, J., & Kaminski, T. W. (2016). Lower-leg Kinesio tape reduces rate of loading in participants with medial tibial stress syndrome. Physical therapy in sport, 18, 62-67.

McClure, C. J., & Oh, R. (2019). Medial tibial stress syndrome.

Winkelmann, Z. K., Anderson, D., Games, K. E., & Eberman, L. E. (2016). Risk factors for medial tibial stress syndrome in active individuals: an evidence-based review. Journal of athletic training, 51(12), 1049-1052.

Yamasaki, S. (2019). A Review of the Treatment and Prevention Options for Medial Tibial Stress Syndrome.