Medial tibial stress syndrome (MTSS) is exercise-related pain in the shins. It may be caused by an irritation of the tendons and muscles near the shin bones. MTSS is commonly known as shin splints. This injury is most often seen among runners.
The exact cause is unknown. MTSS is called an overuse injury. It most commonly occurs from repetitive motion or stress at the shins. Causes may include:
Acute inflammation of structures in the calf
Chronic compartment syndrome
Chronic trauma to structures in the calf
These factors increase your chance of MTSS. Tell your doctor if you have any of these risk factors:
Participation in repetitive, high-impact sports
Female runners with amenorrhea (absent menstruation) and osteoporosis
Pronation of feet (feet turn inwards), or other leg or foot abnormalities
Poor (hard) running surfaces
Overtraining or recent increase in workout or miles run
Heel cord tightness
If you have any of these symptoms do not assume it is due to MTSS. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
Shin pain at a very specific point
Pain when running which gets more severe with continued exercise
Pain when bearing weight on the leg
Pain after changing workout intensity or running surface
Symptoms may not go away with rest
Your doctor will ask about your symptoms and medical history. A physical exam will be done. The diagnosis can be made by the classic history and physical exam.
You may be referred to a specialist. For example, a sports medicine physician focuses on sport injuries.
Your physician may prescribe physical therapy. Depending upon the severity of your injury, your physical therapy treatment may include:
Pain reduction: The RICE principle is the first step to recovery (rest, ice, compression, and elevation). Manual therapy and Kinesiotaping may also be used to speed up recovery and reduce swelling.
Gait and footwear analysis: An analysis of how a person walks and runs in an important part of treatment. The wrong mechanism of walking can transmit a great deal of force through the shin to the knee and hip. In such situations, physical therapists will correct gait patterns and recommend footwear with shock absorbing capacity.
Muscle stretches and strengthening: The tibial and peroneal muscles are attached to the shin and must be stretched adequately before any form of exercise. Physical therapy includes various stretches of the goot that will help stretch and warm up these muscles. Strengthening damaged muscles can also help.
Activity modification: Physical therapists may suggest alternative activities to minimize stress on the shinbones. These can include swimming and cycling.
Increase Range of Motion (ROM): Exercises for the hip, knee, ankle and foot improve blood circulation, reduce inflammation and relieve pain. A home exercise program may also be implemented.
Arch support: The absence or collapse of a normal foot arch can lead to shin splints. Physical therapists will recommend appropriate orthotics that can be custom made for the patient and provide the appropriate amount of arch support.
Return to sport: If you are an athlete, your therapist may tailor exercises that are specific to strengthening the areas needed to perform your sport. Modified use of your muscles may also be discussed and implemented. Return to your sport may be gradual to prevent re-injury.
The Recovery Phase
The recovery phase varies and typically takes between 3 weeks to 6 months. It's time to take it easy and work back into favorite activities with the guidance of a physical therapist. Shin splints are healed when
The affected limb has regained strength and flexibility and is now comparable to the unaffected limb.
There is no pain while jogging, sprinting and jumping.
X-rays reveal healed stress fractures.
To help reduce your chance of getting MTSS, you may try the following steps:
Wear shock-absorbing insoles when running or during other high-impact exercise.
Stretch before and after exercising.
When starting a new sport or increasing your workout, do so gradually.
Choose footwear that is best for the activity and your foot.
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