Medial Tibial Stress Syndrome (MTSS) AKA Shin Splints
Medial Tibial Stress Syndrome is amongst the most common injuries experienced by runners. It is often misdiagnosed and confused with other lower leg problems. The pain experienced is due to the development of an inflammatory reaction along the inside border of the tibial shaft (shin bone) where a group of the lower leg muscles attach via fibrous connective tissue. If you are getting pain on the outside of the shin we are dealing with a different problem. When we run, these muscles have to contract repeatedly causing a pulling action of this fibrous attachment on the shin bone. Certain foot and leg mechanics result in more of this type of movement. If this load is excessive or the body does not get a chance to recover it can result in a continuum of stress, inflammation and pain to the area.
MTSS typically presents as pain/ tenderness or a dull ache along the inside, lower 2/3 of the shin bone. The pain is usually only present during exercise and often resolves after a period of rest. Initially the pain may be worse at the beginning of activity and improve after warming up. In more severe cases the pain can be constant or present even with light activity such as walking. In these cases there is cause to suspect the presence of a bony stress reaction or stress fracture.
Foot and leg mechanics are usually the main culprits for the development of MTSS with excessive foot pronation (the foot rolling towards the middle of the body and the arch lowering during the weight phase) being a leading cause. During pronation the foot collapses and rolls inwards, causing the muscles that act to reduce and control this movement to repeatedly contract and pull at their fibrous attachments to the shin bone. If this load is excessive, or these tissues receive inadequate recovery time, an inflammatory process can initiate in the area. Alternatively a lack of foot pronation (stiff high arched feet) can also contribute to medial tibial stress syndrome as they are not as efficient at absorbing shock which is consequently transmitted into the shin and muscle of the lower leg as the foot strikes the ground.
Other important contributing factors include, running technique (overstriding can increase ground reaction force which is then transmitted to the tibia and surrounding muscles) and training surface (concrete and bitumen are very poor shock absorbing surfaces). In addition, training load management (frequency, distance and intensity) and appropriate recovery are very important to ensure the body has enough time between activities to repair used or damaged tissues. Recovery also includes ensuring you release any stiff or tight muscles and make an effort to improve on joint mobility and functional strength around the hips, ankles and knees. Using a foam roller can be helpful with this. Excessive body weight also increases the shock and load through the lower limb and may play a part.
Treatment of MTSS is usually multidirectional and involves addressing all contributing factors to best ensure a quick recovery, and prevent future injury:
- Pain and inflammation can be addressed in the short term with ice and anti-inflammatory medications.
- Strapping tape can also be an effective short term pain reliever if applied correctly.
- It is important to reduce training load (frequency, distance and intensity) to allow adequate recovery (as explained above).
- You may want to have a coach or trainer assess your training program to ensure you have appropriate load management and recovery time.
- Have your running technique assessed to help optimise efficiency and reduce excessive ground reaction forces.
- Ensure that you have appropriate footwear that have been fitted by a running shoe specialist or podiatrist and that these are replaced regularly.
This picture is a representation of training load. It shows that the left foot has excessive load between the second and fourth toes whilst the right foot exhibits good load. This load can be measured using our ParoTec in-shoe pressure measurement system and custom orthotics developed to alter the load.
If you are experiencing pain and your at-home treatment is not working it is important to be assessed by a Podiatrist who can determine whether your foot and leg mechanics are contributing to your injury. If appropriate your podiatrist can prescribe you custom functional orthotics to put into your running shoes that will control foot and leg mechanics and reduce stress on these tissues. Additionally, your podiatrist can address any muscular weakness or tightness that may be contributing and advice on an appropriate stretching and strengthening program.
If you think you need help working out what is causing your pain click here to choose either an 8 point information sheet for in-home treatment or fill out a FREE online diagnostic survey. A podiatrist will email you the most likely diagnosis for what you describe and how to deal with it.
Case study: David Alley – World Record Holder – Race Around Australia
2 marathons every day for 175 days!
In November 2014 Podiatry Point heard of David Alley who was about to attempt to become the fastest person to run around Australia. We approached David and learnt that he was struggling with stress fractures in his tibia (shin splints) and injury was threatening to derail the event. We offered to give David an assessment using the Parotec equipment. It allowed us to identify landing issues in David’s technique and provide him with improved orthotics. After several weeks of adjustments for David’s feet and some rehabilitation, he was up and running again. David credits the ability to watch himself run on video and the accuracy of the Parotec as the single difference in making this round of training a success.
David set out in April 2015 and in October became the fastest person ever to run 10,000km & break the magic 13,383km mark in world record time!
Check out one of his facebook post talking about his orthotics.