Medial Tibial Stress Syndrome (MTSS), or ‘Shin Splints’, is an overuse or repetitive strain injury of the lower leg. It involves the muscles around the shin: the Tibialis Anterior, Tibialis Posterior, and the Soleus. It is the most common injury seen in runners, and more often affects women over men.
Initially when shin splints start to present, symptoms are mild, and pain might just occur towards the end of a run or training session. However, once the condition progresses, even the impact caused through the lower leg from walking can be painful.
MTSS is most often caused by a combination of factors that occur together;
In the clinic, we see a higher number of shin splint presentations around this time of the year; at the start of a new sports season when there is a sudden increase in running volume and intensity. This is generally what sets it off; the lower leg isn’t used to the high level of load and sudden increase of running required in a sports preseason, and the muscles sustain a repetitive strain injury.
When we look a little deeper, we often find that the biomechanics of the foot, ankle, knee and hip are not optimal, and a lack of strength in the lower body means the ability to shock absorb decreases. Additionally, sometimes new and more supportive shoes are needed, running surfaces are too hard, and load is just too much.
So, what can actually help with shin splints?
Initially, the best thing you can do is stop the repetitive strain by stopping running. Icing can help, and maybe opt to ride the bike or swim to maintain some cardio fitness.
The answer to treating shin splints is multifactorial. A physio will help you by:
- Relieving the overworked muscles by using massage and maybe dry needling.
- Sometimes supporting the muscles around the shins with taping can provide some relief.
- Assessing foot, ankle and knee posture, and probably refer to a podiatrist for additional support.
- Assessing calf and lower body strength, and the ability to shock absorb. This sometimes means implementation of a strength program during your recovery.
- Assessing your running shoes – they might be due for an upgrade to something more supportive!
- Guide you through a graded return to running or sport once symptoms have settled down.
A graded return to running would only occur once symptoms of MTSS have nearly or completely gone after a period of rest. A graded return to running most often happens in conjunction with or after a period of strengthening, and will involve a progressive increase in running distance and volume. Some simple changes like running on grass rather than hard surfaces can also make a big difference.
If you know you are susceptible to shin splints with an increase in running volume, then prevention is better than cure. Addressing lower body biomechanics, strength and load with a physio is an excellent means of avoiding having to have time off sport or running from shin splints. Having an assessment with a physio is also important to rule out other conditions. If shin splints are left untreated, they can progress to stress fractures of the lower limb, which is a much greater recovery.