Shin Splints - Medial Tibial Stress Syndrome

Shin Splints Explained

Shin Splints is a common term for shin pain during running. It can be a misleading term and most sports medicine professionals try to avoid using it. This is because shin pain and 'Shin Splints' can be due to several different conditions. One of the most common shin conditions that is frequently labelled 'Shin Splints' is Medial Tibial Stress Syndrome.

Medial Tibial Stress Syndrome has been reported to occur frequently in military recruits, distance runners, dancers, football (soccer) players and gymnasts. Medial Tibial Stress Syndrome has been classified into two distinct types, which affect specific tissues on the inside of the shin:

• Type One
  This is characterised by a stress reaction on the inside border of the shin bone. A stress reaction is a preceding stage to a stress fracture.
• Type Two
  This is characterised by irritation of the outer surface (periosteum) of the inside of the shin bone at the point where the Soleus and Tibialis Posterior muscles attach.

Regardless of the type, Medial Tibial Stress Syndrome is largely caused by over-use, with those who run regularly on hard or uneven surfaces being particularly affected. However, there are a number of factors, such as altered foot, knee and hip posture, which can make a person susceptible to the syndrome.

Shin Splints Signs & Symptoms

People suffering from Medial Tibial Stress Syndrome will feel pain on the inner border of the shin (medial Tibial border) during and following exercise. It is important to distinguish Medial Tibial Stress Syndrome from other causes of shin pain ('shin splints') such as Compartment Syndrome or a Tibial Stress Fracture. This can require a complex run through of investigations, such as bone scans and compartment pressure tests under the supervision of a sports physician or orthopaedic doctor.

Shin Splints Treatment

For the immediate treatment of symptoms ice therapy is a very effective form of pain relief (never apply ice directly to the skin). The PRICE protocol – protection, rest, ice, compression and elevation can relieve the symptoms of a painful shin. Ice packs for a period of twenty minutes every couple of hours may help with the pain, but pain-relieving medication and anti-inflammatory gel may also be necessary.

Most patients respond well to non-operative treatment. This involves rest, strengthening and stretching exercises, followed by a gradual return to running after symptoms subside. In order to help prevent recurrence of the condition, a bio-mechanical analysis (an analysis of posture at rest and during walking and running) with a physiotherapist or podiatrist can be very useful. This will pick up any factors that may be making a person susceptible to Medial Tibial Stress Syndrome, so that they can be corrected before a return to activity.

Muscle imbalance and leg length inequality are frequent causes of mal-alignment that can be picked up during the physiotherapy assessment. A common cause of Medial Tibial Stress Syndrome is pes planus (flat feet) or pronated foot position (a lowered arch during running). These would be identified during bio-mechanical analysis. Over pronation is the uncontrolled lowering of the arch of the foot during running. This puts increased strain on the Tibialis Posterior muscle which pulls on the inside of the shin and can produce pain. Arch supporting orthotics insoles can be very effective in remedying this problem.

All cases of pain in the shin should be properly assessed by a registered physiotherapist or an orthopaedic consultant as shin conditions can be made worse by continuing with exercise. The best way of maintaining fitness during this time is to use non weight bearing exercises in the swimming pool. Running without touching the bottom of the pool while wearing a buoyancy belt is a great method of maintaining fitness while allowing the injury to heal.

Your local IPA physiotherapist will be able to explain and demonstrate these exercises as part of your rehabilitation. Simply phone 1300 PHYSIO to be transferred directly to their practice.

In cases of shin pain that have been investigated by a doctor and found to be a soft tissue problem, many people find that a compression sleeve can be an effective treatment that allows them to run. Compression sleeves work by restricting the pull of muscles in the shin, which can reduce the stresses on the shin during running. Without being a cure for Shin Splints, they can effectively reduce symptoms, allowing runners to get round.

In some persistent cases of Medial Tibial Stress Syndrome that are resistant to conservative treatment, surgery may be necessary.

Shin Splints Prevention

As with all over-use injuries, Medial Tibial Stress Syndrome is caused by doing too much, too soon. When beginning or changing an exercise programme, any increases in activity must be gradual. For example, an increase from running 2 miles per day one week to running 10 miles per day the next week cannot be undertaken without putting the body at risk of a number of problems. Maintaining a Running Log can resolve this problem.

The amount of stress being placed on the shins can be minimised by wearing good quality, supportive running shoes with shock absorbing insoles. Medial Tibial Stress Syndrome can be prevented by correcting problems such as flat feet and fallen arches.