Shin Splints / Medial Tibial Stress Syndrome (MTSS)
MTSS or shin splints is one of the most common causes of lower leg pain in athletes. It’s an exertional, repetitive-stress type injury that can be very debilitating if not diagnosed and treated correctly. Symptoms will present as pain down the medial posterior border of the tibia (pain down the shin). Initially the pain may be present on commencement of training then dissipate settle during the session, however if left untreated pain will persist through training and even become problematic when at rest.
Diagnosing MTSS starts with a thorough client history, including medical history, training programs, and physical assessment. X-rays or scans may also be required to rule out more serious conditions.
Complications that need to be ruled out
- Stress fracture of the tibia
- Compartment syndrome
- Peripheral vascular disease in older and diabetic athletes
- Muscle tears, fascial defects
- Peroneal nerve entrapment
- Popliteal artery entrapment syndrome
These conditions are less common, however may quickly turn into a major medical problem and require a different treatment protocol, so it’s important to rule them out.
The pathophysiology (cause of the pain)
- Periostitis inflammation of bone covering
- Tendinopathy inflammation of the muscle-tendon
- Periosteal remodelling, a stress reaction of the tibia
Causes of shin splints / MTSS
- Increased intensity and duration of activities, especially high impact activities such as running.
- Hard or uneven surfaces and downhill running can contribute to the condition.
- Poor biomechanics through the hips and ankle.
- Weak core stabilization.
- Inadequate or poorly-fitted footwear.
- Muscular imbalances in lower extremities (soleus, tibialis posterior, tibialis anterior, plantaris).
Treatment options for shin splints / MTSS
The first step is to rest and ice the affected leg, then incorporate soft tissue manipulation techniques to enhance the healing process. Once the acute phase has passed and the pain has settled, a more accurate biomechanical assessment can be made and a corrective stretch and strengthen program can be implemented. In some cases prescription orthotics may be required.
The rest period for an injury of this nature may be anywhere from 2 to 6 weeks depending on causal factors and the severity of the problem.
You should not return to full training until all painful symptoms have fully resolved, normal range of motion has been restored, biomechanical errors have been addressed, and a suitable return training plan has been developed.