What are they? ( Medial Tibial Stress Syndrome)
- Signs and Symptoms
- Pain on the front and inner surface of middle to lower part of lower leg. This pain extends down at least 5 cm in length and is increased when the muscles that point the toe are resisted (ex calf raise)
- Usually but not always seen on both legs.
- Pain on the front and inner surface of middle to lower part of lower leg. This pain extends down at least 5 cm in length and is increased when the muscles that point the toe are resisted (ex calf raise)
Severity (How bad is it?)
- Early stages of dysfunction – Pain only with the beginning of running which then resolves after “warm-up”
- Pain is diffuse/dull pain – will progress with severity
- Middle stage of dysfunction – Pain onset with running which resolves after exercise ends.
- Later stage of dysfunction – Pain which begins with running and continues some time after exercise ends.
- Advanced dysfunction – Pain with walking and normal non-exercise activities
- Pain has increased from diffuse/dull to sharp and very painful
- Stress fracture – pain all of the time
Physiology of problem (why does it hurt?)
- The cause is not as clear as with issues like fractures/tears/ etc;
- The most agreed upon cause is that the outermost surface of the bone (where it connects to muscle) has been strained due to repeated impact (running) on poor foot and ankle mechanics.
Differential diagnosis (what else it could be)
- Acute Compartment Syndrome – (Go to the DR if you suspect this!!)
- Usually 1 sided, often following a blow or some kind of trauma. Swelling compared to the opposite side, and change in coloration. Pain will be constant and increasingly severe.
- Cancer
- More common > 55 years of age, history of cancer (especially prostate cancer), rapid and unintentional weight loss.
- Stress-fracture
- Consistent pain, increased with exercise but not completely resolved with rest. Night pain
- Anterior Tibial Stress Syndrome
- Pain is more on the outer side of the leg (see picture at top) and pain is increased if patient were to walk on their heels (pulling top of foot toward front of shin)
- Treated basically the same as MTSS
Risk Factors
- Younger age – teens- 30’s.
- Women > Men
- Athletes or persons who play sports that involve a lot of running, sudden increase in load bearing physical activity (very common in military recruits during bootcamp)
- Persons with poor fitting/or worn foot wear
- Persons with flat feet or with arches that collapse
Treatment / what do you do?
- REST!
- This is one of those injuries where you should immediately stop doing aggravating activities. Running on shin-splints will only make them worse and can lead to stress fractures of the lower leg which will take much longer to heal
Change to a non-impact alternatives for cardio.
- Address foot mechanics (what caused the problem in the first place)
- External Support
- Chances are, your arches are collapsing when you run.
- Make sure you have new(ish) footwear. Add in an orthodic that is meant to address “pronation” and try a shoe that is considered a “stability” (<– link for examples).
- I personally like the “Powerstep” insert.
- Chances are, your arches are collapsing when you run.
- Internal Support (addressing the foot and ankle)
- Mobility
- Getting the heelbone (calcaneous) to move the way it is supposed to.
- Getting muscles in the calf stretched out
- Strength
- Mobility
- External Support
- Gradually add exercise back in
- Warm up gradually first and then do progressive stretching (especially of the calf muscles)
- Slowly increase the intensity and duration of exercise.
- Cool down after exercise with light stretching.
- Run on a softer surface such as grass, dirt, or certain outdoor tracks. Add harder surfaces like road back in gradually.
Resources
- http://www.rheumatologynetwork.com/pain/evaluating-shin-pain-active-patients/page/0/2
- https://www.youtube.com/watch?v=0Q5Jp_lPaoA
- https://www.youtube.com/watch?v=dVDMUuWtX00
- https://www.youtube.com/watch?v=zfDGpWrK_8Q
- Calvagna M. Shin Splint. Health Library: Evidence-Based Information[serial online]. December 2014;Available from: Nursing Reference Center Plus, Ipswich, MA. Accessed August 14, 2017.
- Jovicić M, Jovicić V, Hrković M, Lazović M. Medial tibial stress syndrome: case report. Medicinski Pregled [serial online]. July 2014;67(7-8):247-251. Available from: MEDLINE Complete, Ipswich, MA. Accessed August 15, 2017
- Kellicker P. Medial Tibial Stress Syndrome. Health Library: Evidence-Based Information [serial online]. December 2014;Available from: Nursing Reference Center Plus, Ipswich, MA. Accessed August 15, 2017.
- Granado M. Medial Tibial Stress Syndrome. CINAHL Rehabilitation Guide [serial online]. January 20, 2017;Available from: Rehabilitation Reference Center, Ipswich, MA. Accessed August 15, 2017.
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