Medial Tibial Stress Syndrome (MTSS) aka ‘shin splints’ in runners
What is it?
Medial tibial stress syndrome (MTSS), commonly known as “shin splints,” is a frequent overuse injury of the lower limb and one of the most common causes of lower limb pain in recreational and elite runners.
Often, there are many different causes of MTSS which involve training errors and various biomechanical abnormalities. Training errors include changes in the training program, such as an increase in speed, distance, intensity and duration. Running on a hard or uneven surface and bad running shoes (like a poor shock absorbing capacity) could be one of the factors related to the runner. Biomechanical abnormalities as foot arch abnormalities, hyperpronation of the foot, unequal leg length, are also common factors.
Essentially the treatment should focus on: (a) reducing stress; (b) relieving pain; (c) reintegration of the runner into activity.
Most literature supports ‘rest’ as the most important treatment in the initial phase of MTSS. Other therapies such as sports massage, dry needling and use of a foam roller are often helpful for the return to activity quickly and safely. Ice can also be applied to the affected area directly after exercise for approximately 15–20 min.
Decreasing weekly running distance, frequency, and intensity by 50% is stated to improve symptoms without completely stopping activity, runners are encouraged to avoid running on hills and uneven or very firm surfaces.
Studies have widely supported a regimen of calf stretching and eccentric calf exercises and also strengthening core hip muscles to prevent muscle fatigue.
Single leg Calf stretch to reduce tissue tension in the Calf complex
Bent knee calf raises off a step (beginning position). This exercises helps to strengthen the calf complex, particularly the Soleus. In MTSS, the Soleus is thought to be particularly important as it helps to reduce the bending force that the tibia experiences during impact which is thought to be key to development of MTSS.
Bent leg calf raise (top position). Ensure that your knee remains bent.
Straight leg calf raise (bottom position) – these will strengthen both Gastroc and Soleus. As indicated above a strong calf complex is important in reducing bone load in MTSS.
Straight leg calf raise (top position).
As mentioned in a previous BodyWorks blog, developing core stability with strong Gluteal and hip muscles can improve running mechanics and prevent overuse injuries.
Step ups – Simple but very effective! Step ups achieve high levels of Glute Max activity as well as working Glute Med.
Hip Hike/Hitch – again working the Glutes, primarily the Medius, to try and increase muscular endurance and prevent poor running form through fatigue and therefore overoading the anterior lower leg.
Lower your pelvis and drop your leg towards the floor. Lift the pelvis and leg back up so the pelvis returns to a level position.