Medial Tibial Stress Syndrome: formerly known as ‘shin splints’

Medial Tibial Stress Syndrome (MTSS) is a common musculoskeletal condition associated with running and walking activities. Recovery times in MTSS range greatly, but tend to be long – 4 weeks to 18 months in some cases. For this reason, it is something to spot and treat early.
Let’s look at MTSS more closely: The tibia bone is the larger of the two bones in your lower leg; Medial refers to the inside part of the leg; and Stress refers to the forces, or loads, applied to the body. Quite simply, MTSS is thought to be a consequence of mechanical overload; when the capacity of the tissues (the tibia bone for example) is outweighed by the load and demands placed upon it: causing injury.
The phrase ‘shin splints’ has been used for a long time to describe pain vaguely localised around the shin. Interestingly, ‘shin splints’ is a term that in fact doesn’t help our understanding of lower leg pain at all – not only has it been used to describe MTSS, it also refers to other similar clinical presentations of pain, such as: stress fractures of the tibia or fibula; chronic compartment syndrome; and ischemic shin pain, to name a few. ‘Shin splints’ can contribute to confusion in understanding the cause or causes of MTSS, which doesn’t help those researching it – so it may well be a phrase of the past quite soon.
MTSS is often reported to include strain on the muscles and other tissues around them (myofascial strain), inflammation of the tibia bone itself (periostitis) and bone stress. Pain usually comes on suddenly linked with an increase in training load, is worse with exercise, and is alleviated with rest. The pain is usually localised to the medial bottom third of the tibia, spreading at least 5cm in distance. MTSS is debilitating and can be a frustrating condition to get over, with no ‘gold standard’ treatment identified as of yet, but there are certainly things we can do.
Running is an enjoyable, liberating form of exercise that only requires some basic tips to help steer away from potential injuries like MTSS. Here’s one of my favourite tips for runners:
Monitor 3 key training variables: distance; speed; and incline.  Gradually increase one variable at a time and slowly build your body’s capacity to do more. Be mindful that doing too much, too quickly, can be a risk factor for MTSS and over conditions.
The team here at Physioimpulse can help advise how to prevent, treat and manage Medial Tibial Stress Syndrome, with hands on techniques and rehab whilst also exploring your training plans and assessing for load:capacity mismatches.
Good luck and stay active!
Chris, PhysioImpulse

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Bath Physio 01225 683007

References
Becker, J., James, S., Wayner, R., Osternig, L. and Chou, L.S., 2017. Biomechanical Factors Associated With Achilles Tendinopathy and Medial Tibial Stress Syndrome in Runners. The American journal of sports medicine, 45(11), pp.2614-2621.
Newman, P., 2016. Medial Tibial Stress Syndrome (Doctoral dissertation, University of Canberra).
Winters, M., Backx, F.J.G., Franklyn, M., Moen, M.H., Weir, A. and Bakker, E.W.P., 2016. The medial tibial stress syndrome score: item generation for a new patient reported outcome measure. South African Journal of Sports Medicine, 28(1), pp.11-16.
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