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Shin Splints Medial tibial stress syndrome

Medial tibial stress syndrome (MTSS), commonly known as shin splints, is a common condition characterised by pain along the inner edge of the shinbone or tibia. It typically occurs during or after physical activity, especially activities that involve repetitive stress on the legs such as running, jumping, or dancing. MTSS is believed to be caused because of overuse or repetitive stress on the muscles, tendon, and bone tissue in the lower leg. Key factors which can contribute to the development include overuse, particularly when engaging in repetitive activities without proper conditioning or allowing adequate rest, biomechanical issues, improper footwear, training errors, or running technique.

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Symptoms

1.Pain and tenderness along the inner edge of the shinbone, usually occurring during or after physical activity.
2.Mild swelling or inflammation in the affected area.
3.Pain that improves with rest but returns with resuming activity.
4.Discomfort when touching the affected area or applying pressure to the shinbone.

Treatments

MTSS can be treated using a wide variety of methods, and your physiotherapist will be able to identify which treatments will benefit you most based on your symptoms.
Depending on symptoms, initial treatment for MTSS during the acute stages may involve a combination of ice and relative rest, with the duration of rest dependent on the severity of the individuals’ symptoms (1).
Stretching and strengthening exercises are also often employed by physiotherapists to treat MTSS. These will aim to address any biomechanical abnormalities. Calf stretching in the sitting and standing position may be utilised, whilst strengthening of the calf muscles to prevent muscle fatigue are vital (2). Other exercises which strengthen the tibialis anterior and ankle invertors and evertors will also be employed to improve stability of the ankle and force distribution (2).
Activity modification has also been indicated to have an important impact on MTSS, with changes in training frequency and length of training session shown to significantly impact injury incidence (3). A gradual return to activity programme is also vital to ensure individuals remain symptom free and prevent flare ups.
In individuals where biomechanical issues around the foot are present, particularly overpronation or pes planus (flat feet), customised orthotics provided by a podiatrist have been found to both reduce incidence of developing MTSS and improve symptoms during recovery (4,5).
When symptoms of shin splints become chronic or they do not respond to other conservative treatments including rest, stretching, and strengthening, then extracorporeal shockwave therapy (ESWT) treatment may be beneficial. ESWT is a treatment that aims to stimulate the natural formation of new blood vessels which assists in tissue repair and regeneration (6). Multiple studies have reported that ESWT reduces pain and time to recovery in MTSS, particularly when combined with other conservative treatments such as a graded return to activity programme (7).

References

1.Alfayez SM, Ahmed ML, Alomar AZ. A review article of medial tibial stress syndrome. Journal of Musculoskeletal Surgery and Research. 2017 Jan 1;1:2.
2.Galbraith RM, Lavallee ME. Medial tibial stress syndrome: conservative treatment options. Current reviews in musculoskeletal medicine. 2009 Sep;2:127-33.
3.Deshmukh NS, Phansopkar P, Deshmukh Jr NS. Medial tibial stress syndrome: a review article. Cureus. 2022 Jul 7;14(7).
4.Loudon JK, Dolphino MR. Use of foot orthoses and calf stretching for individuals with medial tibial stress syndrome. Foot & ankle specialist. 2010
5.Naderi A, Bagheri S, Ahoor FR, Moen MH, Degens H. Foot orthoses enhance the effectiveness of exercise, shockwave, and ice therapy in the management of medial tibial stress syndrome. Clinical Journal of Sport Medicine. 2022 May 1;32(3):e251-60.
6.Auersperg V, Trieb K. Extracorporeal shock wave therapy: an update. EFORT open reviews. 2020 Oct 26;5(10):584-92.
7.Forogh B, Karimzad Y, Babaei-Ghazani A, Janbazi L, Cham MB, Abdolghaderi S. Effect of extracorporeal shockwave therapy on medial tibial stress syndrome: A systematic review. Current Orthopaedic Practice. 2022 Jul 1;33(4):384-92.
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