Shin Splints / Medial Tibial Stress Syndrome

What is it?

Shin splints is a general term relating to the discomfort felt along the shin area whilst exercising.  This catch-all term is often incorrectly used to describe many different lower limb exercise related pains. A specific and more appropriate term would be medial tibial stress syndrome (MTSS).  This is a condition which causes discomfort along the mid - lower inside shin bone and is often felt by runners and those who partake in jumping type sports (basketball, ballet dancers).  The early sign of this problem is pain at the beginning of a run which may resolve as the exercise continues only to return afterwards.  This can progress so that pain becomes sharper and more persistent and may even occur whilst walking or at rest.  It is thought that as the condition progresses the lining of the bone becomes inflammed (periostitis) as the overlying muscles exert an excessive pulling force on the bone. This can lead to a problem of abnormal bone remodelling (healing) which in chronic states can lead to the development of a stress fracture. 

Causes

The causes of MTSS can be categorised into intrinsic (relating to the individual) and extrinsic ( relating to the environment) groups.

Intrinsic:

• History of a previous injury in the area

• Anatomical malalignments i.e. poor foot shape / posture

• Muscle Imbalances i.e. changes in the length or strength of the calf muscles

• Restricted movement in the ankle joints

• Reduced bone mineral density

Extrinsic:

• Changes to training methods i.e. sudden increase in frequency, duration or intensity of exercise

• Changes to the training surface i.e. running on uneven ground or a cambered/banked surface

• Type of footwear used i.e. inappropriate footwear such as that not designed for the specific activity, footwear lacking stability, control and cushioning or old, worn out footwear

   

Treatment

Following a thorough examination and assessment of the presenting problem, advice and treatment may include the following.

• Advice to rest from the aggravating activity

• Local ice massage to reduce swelling and inflammation

• Taping or orthotics to restore normal alignment

• Electrotherapy i.e. Ultrasound, Laser to promote healing and reduce pain

• Acupuncture to reduce pain and normalise muscle tone

• Joint and soft tissue mobilisation to restore normal alignment and biomechanics

• Tailored graded exercise plan to strenthen, stretch and restore normal muscle balance and function

• Training advice and tips to prevent injury relapse through poor training management