Diagnosing Medial Tibial Stress Syndrome
Shin splints, tends to be a catch-all term for lower leg pain that occurs below the knee in the shin area and are usually diagnosed based on your medical history and a physical examination. The nature of shin splints known as medial tibial stress syndrome most often can be explained in just four words: “too much, too soon”. Shin splints often plague individuals new to running or returning to running and not build their mileage up gradually enough. Otherwise medial tibial stress syndrome commonly occurs in more seasoned runners who abruptly change their workout regimen, for example adding too much mileage to quickly or changing from a soft to harder surface or going from running flats to hills…
With medial tibial stress syndrome there will frequently be:
- Tenderness, soreness or pain along the inner part of your lower leg.
- Mild swelling in your lower leg in the same region described above.
At first, the pain associated with medial tibial stress syndrome may only be present when running and disappear when you stop running or exercising. However the progression of the condition is such that eventually the pain may become continuous with the end game being pain is present even at rest.
Shin pain doesn’t always mean you have medial tibial stress syndrome, it might be a sign of another problem causing a similar pain. Stress fractures and compartment syndrome are two possible common causes of shin pain that need to be considered when making a diagnosis of shin splints.
- In some cases, an X-ray or other investigation studies such as compartment pressure testing can help identify other possible causes for your pain, and aid in accurately diagnosing the cause of your shin pain.
Differential Diagnosis Of Shin Splints
There are a couple of common conditions that have a similar presentation of pain to medial tibial stress syndrome and may cause misdiagnosis of shin splints and therefore lead to non ideal management of the pain, these alternative diagnoses include as mentioned above anterior compartment syndrome and tibial stress fractures.
Anterior Compartment Syndrome: Pain felt on the anterior (front outside) part of the lower leg may be compartment syndrome where swelling of muscles during activity within a closed compartment creates a pressure increase within the compartment causing pain. A compartmental pressure test is used to help diagnose this condition, and sometimes surgical treatment to release the compartment is required to resolve the condition if prior conservative measures such as physiotherapy treatment are unsuccessful.
Tibial Stress Fracture: Pain in the lower leg could also be a stress fracture. Stress fractures need to be managed more carefully than medial tibial stress syndrome and an X ray or bone scan are useful in the diagnosis and help in differentiating between the possible causes of shin splint pain.
Treatment Of Medial Tibial Stress Syndrome
The first step in treating shin splints is resting from activities that cause discomfort thus giving your body a chance to heal whilst ideally continuing lower impact exercise that doesn’t aggravate the shin pain such as swimming or aqua jogging and cycling so you can maintain your fitness.
- The use of ice applied to the shins regularly each day can help with reducing pain and swelling and in some situations combining this with nonsteroidal anti-inflammatory medications such as ibprofen or voltaren can be a very effective way in further reducing pain and swelling.
- Any return to sport needs to be resumed gradually, it is important not to rush back into your sport. A physiotherapist can help guide you regarding when to return to training and any other things you could consider to help with your recovery.
After discussion and assessment a physiotherapist may suggest a footwear change and/or the use of inner soles (orthotics) to help improve your biomechanics, as well as suggest specific stretching and strengthening exercises to help your body move more efficiently and place less stress on your shins when exercising. Some individuals find taping techniques and shin splint supports can be useful in managing the pain associated with shin splints.
- Dry needling and shockwave therapy can be quite useful adjuncts to the rehabilitation of shin splints and something your physiotherapist can help with.
Preventing Shin Splints Coming Back
Once you have suffered with shin splints previously there is a good likelihood that they may come back to haunt you again in the future if you don’t take precautions. Here are some basic precautions for preventing medial tibial stress syndrome:
- When altering your training, meaning starting training after a hiatus or increasing training intensity or frequency including adding any variation to your training such as a surface or gradient changes try not to exceed a change greater than 10% per week. Small incremental changes like this allow your body the necessary time to adapt to the new demands.
- If you are prone to developing medial tibial stress syndrome, then it is a good idea to pay special attention to regular stretching of your calves and Achilles tendon as a preventive measure.
- Also changing your shoes regularly before they start showing signs of significant wear will help maintain good biomechanics and reduce the stress transmitted on your shins and the rest of your body.
Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on What Is Medial Tibial Stress Syndrome? should consult his or her general practitioner, podiatrist, physiotherapist or otherwise appropriately skilled practitioner.