Shin splints / medial tibial stress syndrome

Medial tibial stress syndrome

Medial Tibial Stress Syndrome (MTSS), commonly known as shin splints, is a condition characterized by pain along the inner edge of the shinbone (TIBIA). It is caused by repetitive stress on the tibia and the tissues attaching the muscles to it.

Cause = repetitive stress without adequate healing. 

Contributing factors of MTSS: 

Overuse and Repetitive Stress

• High-impact activities (runners, dancers, military personnel)
• Sudden increases in training intensity, frequency, or duration.

Biomechanical Factors

• Overpronation
• Flat feet (pes planus) or high arches (pes cavus) → Alters shock absorption, increasing strain.
• Muscle imbalances or weakness → Leads to improper force distribution.

Poor Footwear and Training Surfaces

• Worn-out or unsupportive shoes fail to provide adequate shock absorption.
• Running on hard surfaces -> increases impact forces.
• Frequent changes in terrain adds stress to the tibia.

Improper Training Techniques

• Sudden changes in running distance, speed, or intensity.
• Inadequate warm-up or stretching, 

Anatomical Factors

• Increased tibial bowing→ Alters force distribution. Tight calf muscles → Reduces flexibility, increasing strain on the tibia.

SHIN SPLINTS PHYSIOLOGY:

1. Bone Stress and Remodeling Imbalance

• Remodeling repairs microdamage from repetitive trauma in the tibia.
• In MTSS, excessive mechanical stress exceeds the bone’s ability to repair, leading to microdamage accumulation.
• If the stress is not alleviated, it can progress toward stress fractures.

2. Periosteal Inflammation

• The periosteum (outer layer of the bone) contains pain-sensitive nerve endings.
• Excessive pulling by muscles leads to periosteal irritation and inflammation.
• This inflammation is responsible for the dull, aching pain characteristic of MTSS.

3. Muscle Dysfunction and Overload

• The deep posterior compartment muscles help absorb impact forces during activities like running and jumping.
• Weakness, fatigue, or improper biomechanics cause excessive strain on these muscles, leading to increased traction stress on the tibia.

4. Vascular and Hypoxic Factors

• Some studies suggest vascular insufficiency in the periosteum may contribute to MTSS.
• Hypoxia (low oxygen) in overloaded muscle tissue can lead to localized ischemia and pain.

Preventing shin splints:

Gradual progression in training

• Increase intensity slowly
• Cross-training

Proper footwear and orthotics

• Wear supportive shoes.
• Replace worn-out shoes: around every 480-800 km
• Consider orthotics

Strengthening and conditioning

• Strengthen the lower legs
• Improve core and hip stability
• impact training

Recovery and rest

• Listen to your body
• Ice therapy
• Massage and elevation

Managing shin splints:

Reduce inflammation:

• • Ice 
  • NSAIDS

Massage and soft tissue release

Strengthen, stretch and mobility work. 

Graded return to activity 

Supportive footwear and orthotics if needed 

Rest and Activity Modification

Why see a Physio:

Diagnosis: Making an accurate diagnosis is imperative to know how to manage your condition

Manual Therapy: We can release structures that are tight and contributing to your condition.

Exercise Prescription: We will give you exercises that are specific to you to assist in your recovery. 

Educate: Identify your contributing factors – both internal and external.

Strapping: Strap the leg to assist in offloading the muscle around the tibia.

Graded return to activity: Help develop a graded return to activity to prevent re-injury.

Running Analysis: Assess your gait and running Analysis to determine what changes may need to be made. 

Book an appointment with BRH Physiotherapy to address your biomechanics and running style today!