About Shin Splints

Overview

Medial tibial stress syndrome (MTSS), also known as shin splints, is a common condition known by widespread pain along the inner edge of the shinbone (tibia). It typically occurs in individuals who engage in repetitive high-stress activities, such as runners and athletes. The pain is usually felt over a broad area of the shin rather than at a specific point. MTSS is considered a stress response injury, where the repeated stress placed on the shin bone causes inflammation and microdamage to the bone and surrounding tissues. While the exact cause is not fully understood, it is thought that how the body moves and imbalances in how the bone repairs itself may play a role in its development. Diagnosis is usually based on clinical examination, but imaging techniques like MRI (magnetic resonance imaging) or CT (computed tomography) scans may be used to evaluate more severe or atypical cases. Treatment typically involves rest, ice, stretching, strengthening exercises, and gradual return to activity.

Causes and Risk Factors

The underlying causes of MTSS include:

Excessive force on the shin bone and surrounding tissues
Swelling that increases pressure on the bone
Inflammation of the periosteum (the connective tissue covering the bone)

Non-modifiable risk factors for MTSS, which are factors that cannot be changed or controlled to reduce the risk of developing the condition, include:

Age: Younger athletes are more likely to develop shin splints.
Foot structure: People with flat feet or abnormal lower leg structure have a higher risk of developing MTSS.
Gender: Women are more prone to developing MTSS.
Genetics: A family history of shin splints or related conditions may predispose someone to the injury.

Modifiable risk factors for MTSS, which are factors that can be influenced or changed to reduce the risk of developing the condition, include:

Occupation: Athletes and dancers who engage in high-impact activities have a higher risk of developing MTSS.
Muscle weakness in the upper legs: Weak muscles in the thighs can lead to poor running form and strain on the lower legs.
Increased body mass index (BMI): A higher BMI means more weight, which can put extra stress on the legs during running.
Fewer years of running experience: Runners with less experience may have weaker muscles or improper form, increasing the risk of injury.

Consult with your healthcare professional for a thorough evaluation and guidance regarding your specific situation and risk factors for developing shin splints

Symptoms

The most common early symptoms of medial tibial stress syndrome (MTSS) include:

Pain along the shin bone (tibia)
Swelling at the injury site
Varied intensity of pain, ranging from sharp discomfort to dull or throbbing sensations
Pain that starts during or shortly after exercising or physical activity
Increased pain when touching specific spots on the lower leg

As MTSS progresses or becomes more severe, additional symptoms may occur:

Pain that worsens with movement and improves with rest
Discomfort that persists even at rest
Dysesthesia (abnormal sensation) and radiation of pain to the foot
Pain during percussion (tapping) and hopping
Mild edema (swelling) and thickening of the subcutaneous tissue along the tibial line

It's important to note that these symptoms can also be seen in other overuse injuries and stress fractures. Therefore, it's crucial to consult a healthcare professional for an accurate diagnosis and appropriate treatment.

Diagnosis

To diagnose medial tibial stress syndrome (MTSS), the following examinations, tests, and procedures are commonly performed:

Physical examination: A healthcare provider will perform a physical exam to look for physical signs of MTSS, such as pain and swelling in the shin.
Medical history: Your healthcare provider will gather information about your medical history, including any previous diagnoses and activities that may contribute to MTSS.
Imaging studies: Imaging studies like X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans may be used to evaluate the bones and soft tissues in the lower leg. These tests can help rule out other conditions and assess the severity of MTSS.
Clinical procedures: Depending on your symptoms and examination findings, your healthcare provider may recommend additional clinical procedures to help diagnose MTSS. These may include pressure algometry (measuring pressure sensitivity) or other specialized tests.

To determine the severity of MTSS, additional examinations, tests, and procedures may be considered:

Functional assessment: A healthcare provider may evaluate your gait (walking pattern) and assess biomechanical factors, such as how your muscles and joints work together during movement, to identify potential causes of the condition.
Biomechanical analysis: This involves analyzing your foot structure, alignment, and movement patterns to identify any abnormalities that may contribute to MTSS.
Grading systems: Some healthcare providers use grading systems to categorize the severity of MTSS based on symptoms, physical findings, and imaging results. This helps guide treatment decisions and monitor progress over time.

It's important to note that these examinations, tests, and procedures should be conducted by a healthcare professional experienced in diagnosing and managing MTSS.

Treatment Options

The goals of treatment for medial tibial stress syndrome (MTSS) are to relieve pain, promote healing, prevent further injury, and restore normal function. The following are recommended treatments and how they work to achieve these goals:

RICE method: This includes Rest, Ice, Compression, and Elevation. Resting helps with healing and reduces the risk of worsening the injury, applying ice reduces pain and inflammation, compression bandages reduce swelling, and elevating the leg also helps reduce swelling.
Stretching exercises: Stretching the muscles in your calf, including the soleus (a muscle deep in the lower leg) and the gastrocnemius (the large muscle on the back of your lower leg), can help relieve pain and prevent shin splints from recurring. This promotes flexibility and improves muscle strength.
Review footwear: Wearing supportive shoes during exercise helps reduce the risk of worsening MTSS.
Health behavior changes: Making changes to activities such as gradual increase in activity, switching to low impact exercises, and focusing on strengthening the lower leg muscles and core, may help to reduce stress on the shins.
Surgery (in extreme cases): If the pain is severe or the injury persists for several months despite non-surgical treatments, surgery may be required to treat MTSS.

Remember to consult with your healthcare professional for personalized advice on the right treatment for you.