What Is Medial Tibial Stress Syndrome?

Diagnosing Medial Tibial Stress Syndrome

Shin splints tends to be used as a catch-all label for pretty much all lower leg pain occurring below the knee in the shin area. A shin splint diagnosis is usually based on medical history and physical examination, often without any need for investigations. The nature of shin splints medically known as medial tibial stress syndrome, is that it can most often be explained with just four words: “too much, too soon”.
Shin splints will often plague individuals who are new to running, or a hiatus of some length do to injury or otherwise. In these situations they fail to build up their mileage gradually enough, allowing time for their tissues to adapt causing overload (the “too much, too soon” situation). Aside from this overload reason in new runners, seasoned runners who abruptly change their workout regimen, for example adding too much mileage to quickly, changing training surface from a soft to harder running surface, going from running flats to hill training, changing shoe pitch or stability type… are all at risk of developing shin pain.

With medial tibial stress syndrome there will frequently be:

• Tenderness, soreness, or pain with palpation along the inner part of the lower leg.
• Mild swelling in your lower leg in the region described above may also be present.

At first pain associated with medial tibial stress syndrome may only be present when running and disappears when running, or exercise ceases. However, progression of the condition is such that eventually the pain may become continuous, with the end game being that the shin pain is present even at rest.
The presence of shin pain doesn’t always indicate that the individual has medial tibial stress syndrome, it might be a sign of another problem causing a similar presentation, stress fractures, tenosynovitis and compartment syndrome are a few other potential causes of shin pain that need to be excluded when confirming the diagnosis of shin splints.

• An X-ray, MRI, bone scan, or other investigations such as a compartment pressure test can help identify or exclude other potential causes for shin pain. These medical tests can aid in accurately diagnosing the cause of your shin pain and aid in the implementation of appropriate treatment. Investigations as previously mentioned are frequently unnecessary, but may be useful in circumstances where presentation is unusual or diagnosis unclear following any in-clinic assessment.

Differential Diagnosis Of Shin Splints

There are a couple of common conditions that have a similar presentation of pain to medial tibial stress syndrome, conditions that may cause misdiagnosis of shin pain and therefore lead to non-ideal management. Alternative diagnoses include, as mentioned above anterior compartment syndrome, tenosynovitis and tibial stress fractures.

Anterior Compartment Syndrome: Pain experienced on the anterior (front outside) part of the lower leg may be compartment syndrome. Compartment syndrome is a condition where the expansion of muscles during activity as they swelling with increased blood circulation within a closed compartment, creates a pressure increase within the compartment and ultimately causes 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. The presentation of this pain typically differs to shin splints and compartment syndrome has a crescendo type pain where it builds and builds throughout the run and then on caseation of activity with usually promptly dissipate.

Tibial Stress Fractures: Shin pain may also be the presence of a stress fracture. As a rule stress fractures need to be managed more carefully than medial tibial stress syndrome, an X-ray, MRI or bone scan are useful in the diagnosis of stress fractures and help differentiate between some of the possible causes of shin pain.

Tenosynovitis: Tendon sheath inflammation is typically the result of injury to the tendon, or surrounding muscle or bone. Tenosynovitis in the front of the shin area can equally present as a cause of shin pain and be confused with medial tibial stress syndrome.

Treatment Of Medial Tibial Stress Syndrome

The first step in treating shin splints is more than likely resting from any of the activities that cause the discomfort, thus giving your body a chance to heal. This is carried out whilst ideally continuing lower impact exercise alternatives that don’t aggravate the shin pain, activities including swimming, aqua jogging, cycling and sometimes elliptical trainer or rowing… Doing this enables the athlete maintain their fitness throughout the rehabilitation process.

• The use of ice therapy applied to the shins regularly each day can help with reducing pain and swelling, in some situations combining this with nonsteroidal anti-inflammatory medications such as ibprofen, or voltaren can be a very effective way in reducing pain and swelling in the acute situation.
• All return to sport should be resumed gradually, it is important not to rush back to the same level or activity/training/competition. A physiotherapist can help guide you with regard to when to return to training and equally guide you on other therapeutic or training options to help with your recovery.

After discussion the history of events associated with the shin pain and any physical assessment your physiotherapist may suggest a footwear change and/or the use of inner soles (orthotics). These adjustments would be with the intention of help improve lower limb biomechanics and off load any aggravated tissues. Such changes coupled with specific stretching and strengthening exercises to help your body move more efficiently and place less stress on your shins when exercising are a common approach to managing shin pain. Some individuals may also find the application of taping techniques and wearing of shin splint supports useful in managing pain associated with shin splints.

• Dry needling and shockwave therapy are useful physiotherapy adjuncts in the rehabilitation of shin splints, things I would commonly consider with my city physio clientele.

Preventing A Recurrence Of Shin Splint Pain

Once you have suffered shin splint pain there is a likelihood that the shin pain may come back to haunt you again in the future, certainly if you don’t take appropriate precautions this can ring true. Some basic precautions for the prevention of medial tibial stress syndrome include:

• When changing your training load, 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, as well as significant footwear changes try not to exceed a change greater than 10% load increase per week. Small incremental changes like this allow your body the necessary time to adapt to the new demands.
• If prone to developing medial tibial stress syndrome, then it is a good idea to pay special attention to regular stretching of your calf muscles and Achilles tendon as a preventive measure.
• Changing your shoes regularly before they start showing signs of significant wear will help maintain good biomechanics whilst active and potentially reduce the stress transmitted on your shins and the rest of your body.
• Consider having a running assessment from a sports podiatrist as this can help address any glaringly obvious technique flaws that may be placing extra strain on the shins/other areas.

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.