Shin Splints (Medial Tibial Stress Syndrome)
Shin Splints or Medial Tibial Stress Syndrome (MTSS) presents as exercise-induced pain along the posteromedial tibial border (bottom third of the inside of the tibia) caused by repetitive loading stress during running and high impact activities.
Overuse/overloading structures and poor single leg biomechanics.
Overloading examples including increasing training loads too quickly, change in training surfaces & footwear, inadequate rest time between training sessions
Biomechanical factors include foot pronation, poor calf strength, decreased ankle mobility (in particular dorsiflexion), knee valgus during dynamic loading (‘knocked knees’) and poor hip & trunk (gluteal & ‘core’ strength) control during dynamic loading.
Signs & Symptoms
Pain is exercise induced from activities such as running and jumping.
Dull ache at start of exercise and can often subside during exercise before increasing following exercise once cooled down.
As the injury progresses pain can often become sharp with increase weight bearing movements such as when the foot strikes the ground in running and landing from jumping.
Pain can be provoked on palpating along the tibial border.
Bone Stress - stress reaction or fracture
Chronic exertional compartment syndrome
Popliteal Artery Entrapment
How to Manage
Education & advice surrounding correct loading. This will be dependent on sport for example a detailed return to running program for runners.
Manual therapy to improve ankle range of movement & decrease muscle tightness where warranted.
Comprehensive rehabilitation program designed to improve single leg biomechanics and functional strength specific to clients functional loading demands.
Management may also include referral to Sports Doctor for review for any further medical intervention.
Lohrer, H., Malliaropoulos, N., Korakakis, V., & Padhiar, N. (2019). Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. The Physician and sportsmedicine, 47(1), 47-59. Winkelmann, Z. K., Anderson, D., Games, K. E., & Eberman, L. E. (2016). Risk factors for medial tibial stress syndrome in activ individuals: an evidence-based review. Journal of athletic training, 51(12), 1049-1052.
PROmotion Assessment and Outcomes Measures
Loading & exercise and injury history.
Lower limb muscular strength.
Functional lower limb control in aggravating activities.
Foot biomechanics if appropriate; advice regarding footwear and/or referral to Sports Podiatrist