Medial Tibial Stress Syndrome MTSS or “Shin Splints”

February 21, 2024

Often incorrectly described as “shin splints”, Medial Tibial Stress Syndrome (MTSS) is an overuse injury usually caused by running or jumping. The condition is characterized by pain and tenderness in the lower leg, usually along the front medial edge of the shin. There are many potential causes of this overuse syndrome including:

  • A change in training surface, such as starting to run on the road vs on gravel or grass. Sometime it can be a change from grass to artificial turf as well.
  • A rapid or unplanned increase in training load.  This can include a poorly managed run program that increases distances too aggressively, or does not plan for adequate rest.
  • One of the most common causes of this syndrome is poor or worn-out footwear that do not adequately support the foot with running, or a mismatch of foot type and footwear which results in a lack of support or too much of the wrong type of support.
  • decreased ankle mobility or calf flexibility
  • the function and control of the lower chain (hip, knee, and ankle) resulting in poor mechanics and load absorption.

 

Signs and Symptoms

 

  • Pain and tenderness developing along the front medial edge of the shin, or the top anterior shin where the muscles are attached. Pain can occur before, during, and/or after exercise.  Symptoms may get worse with increased activity.
  • Symptoms generally subside with warm up and exercise but tend to flare up after exercise and in the mornings following exercise. If significant, the pain will limit the athlete’s ability to run or jump.
  • There is often very little swelling and discoloration (bruising)

 

Tibialis Anterior                                                 Tibialis Posterior

 

Immediate Care

Rest, ice and analgesia are immediate treatment options to manage any swelling and tenderness.  Often, the athlete can continue to train by minimizing the impact of running (e.g.  Running in a pool, or riding a bike). Sometimes there are some taping techniques that provide temporary relief.  If the syndrome does not resolve in 1-2 days, the athlete should see a health care practitioner for further assessment.

 

If the pain does not resolve with basic care:

It is important to see a health care practitioner that has experience in managing this condition (sportsmed physician, sport physiotherapist, sport chiropractor, or athletic therapist).  They will perform a thorough assessment of the foot and ankle, footwear, running mechanics etc., to determine the cause of the problem.  If warranted, and a stress fracture is suspected selected diagnostic tests may be ordered such as X-rays, bone scans, etc.

 

Rehabilitation and Treatment

Once the injury cause has been determined, a management strategy is developed.  This can include footwear modification, orthotics if necessary, massage and manual therapy, modalities such as muscle stimulation, ultrasound, etc., and exercises.  MTSS often takes 4-6 weeks to recover with treatment

It is imperative to complete the rehabilitation and progress back to running or jumping in a patient manner, allowing you to build endurance as you recover.

 

Prevention

– Adequate dynamic warm-up before activity

– Pre-season strengthening and stretching, to be adequately prepared for training.

–  Ensuring you have the proper footwear for your foot type, as well as ensuring your shoes are in good repair.

– Appropriate progression of training and loading, including patient progression and adequate recovery from long training days.