Medial Tibial Stress syndrome (MTSS) or shin splints is a common cause of pain along the inside of the tibia.
Pain is usually felt along the lower 1/3 of the tibia with a gradual onset, beginning as a dull ache along the tibia at first but can progress to more intense pain felt with exercise, even walking if left untreated.
Historically MTSS was though to be caused by tight, overworked muscles pulling on and overloading the outside layer of the bone.
The problem with this is that the attachment sites of these muscles don’t exactly line up with where the pain is commonly felt with MTSS.
Recent research has suggested that the pain may instead be related to a bending moment in the tibia caused during weight-bearing activities like walking or running.
The tibia bone naturally has a slight curve to it (some more so than others). When a curved structure like the tibia is loaded from both above and below the resultant forces try to bend it.
(You can try this at home, get a ruler and push from both ends and it will want to bend in the middle!)
The result of this bending moment is a large amount of stress placed along the bone.
In bending structures like the tibia, force is highest at the point with the lowest cross sectional area or area or with smallest width. For the tibia, this is the lower 1/3 of the bone, which explains why the pain is commonly felt in this area along the bone and not others
But why can some cope with this load and some can’t?
In the majority of cases this is explained by a mechanical overload to the area, where the load on the bone outweighs the ability of the tibia to handle load.
An easy way to think about this is with the example of water and a bucket.
Think about the water as load and the bucket as capacity of the tissue.
If we fill our bucket too much too quickly the water will begin to overflow.
This is the same with exercise, if we push ourselves too hard or increase the amount of exercise we are doing too quickly then we drastically increase our load without improving our capacity to deal with load. This causes an overflow of our bucket potentially resulting in injury
Instead or rapidly filling, it is important to gradually fill your bucket slowly and steadily to prevent overflow or overload of the tissue. This will also over time increase your load capacity to allow your body to deal with more load.
And while our bodies react well to consistently loading with gradual increase, there is also a reverse effect if we do not fill our buckets at all.
If we fail to regularly load our tissue, over time your load capacity will shrink. (This can happen in as little as a few weeks!). So when we then go back to completing the same amount of exercise before we may be overloading our tissue as our capacity has reduced.
While load management is important, there are other factors that can also increase the risk of MTSS. Some of these include:
- Tight calf muscles
- Weak calf muscles
- Inappropriate footwear
- Flat feet
- Overweight
- Poor running technique
Treatment:
Initial stages of treatment usually involve an initial reduction in load.
This usually involves a rest from aggravating activities but can also include other treatment modalities including:
- Footwear advice
- Strapping
- Massage
- Dry needling
- Orthotics
- Exercise program
- Running retraining
From here once the area has settled down your health professional can then guide you to slowly start to slowly reintroduce the load back into your training.
If you have any questions or would like to see if we can help you call our clinic or book in with one of our Podiatrists today
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