Medial tibial stress syndrome

What are shin splints?

Medial Tibial Stress Syndrome (MTSS), commonly known as “shin splints,” is a condition characterized by pain along the inner (medial) aspect of the shinbone (tibia). It often occurs in athletes, particularly those involved in activities that involve repetitive stress on the lower leg, such as running and jumping. MTSS is considered an overuse injury, and it is associated with inflammation of the periosteum (the outer layer of the bone) and surrounding tissues.

Medical Management

1. Rest and Activity Modification
The primary initial treatment is to rest and avoid activities that exacerbate the symptoms. This may involve reducing or modifying training intensity, duration, or frequency.

2. Ice and Anti-Inflammatory Medications
Ice therapy can help reduce inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may also be recommended to manage pain and inflammation. However, these should be used under the guidance of your doctor.

3. Orthotics and Footwear
Proper footwear and the use of orthotic inserts may help in providing support and correcting biomechanical issues that contribute to MTSS.

4. Compression
Compression sleeves or wraps may be used to help reduce swelling and provide support to the affected area.

Physiotherapy Management

1. Stretching and Strengthening Exercises
Physiotherapy often includes a structured program of stretching and strengthening exercises for the muscles surrounding the shin, especially the calf muscles. In many cases the calf needs to be strengthened and good ankle movement maintained. The program should be aimed at improving flexibility, balance, and strength to support the lower leg.

2. Gait Analysis
A physiotherapist may conduct a gait analysis to identify any abnormalities in walking or running patterns that could contribute to MTSS. Addressing these biomechanical issues may help prevent recurrence.

3. Manual Therapy
Hands-on techniques, such as massage and myofascial release, may be used to alleviate muscle tightness and improve tissue mobility. Mobilisation of the ankle may also be effective.

4. Biomechanical Assessment
A thorough assessment of the individual’s biomechanics, including foot and ankle alignment, may be conducted to identify factors contributing to MTSS. Customized exercises or orthotic interventions may be recommended based on this assessment.Your physiotherapist can recommend the appropriate referral if this is the case.

5. Gradual Return to Activity
Physiotherapists often guide individuals through a gradual return to their regular activities, ensuring that they progress at a pace that allows for healing and minimizes the risk of recurrence. Generally total rest is not advised. A graduated exercise program that enables activity to continue is usually preferred.

It’s important for individuals with MTSS to seek professional advice from a healthcare provider, such as a physiotherapist, or sports medicine physician, for a comprehensive assessment and tailored treatment plan based on their specific needs and condition.