There are a number of conditions that may cause lower leg pain. In this post I discuss medial tibial stress syndrome (MTSS) and to a lesser extent, tibial stress fractures. The two conditions are now thought to be on a continuum and share similar signs and symptoms.
MTSS was for many years was thought to be caused by inflammation of the tissue surrounding the tibia. More recent research indicates that MTSS is more likely caused by a spectrum of tibial stress injuries, including tendinopathyn (tendon injury), inflammation, tissue remodeling, and stress reactions in the bone. The pain is normally felt along the inside of the shin bone and is better with rest and worse with activity.
Bone normally strengthens with load but in cases of overload the bone is unable to recover. This can lead to inflammation around the bone and potentially a stress fracture to the bone itself. In the early stages an athlete may be pain free but as the damage worsens the pain may stop an athlete from training. The pain is normally felt at a focal point on the lower inside portion of the shin bone. An x-ray may be done but it is not always a definitive way to get a diagnosis. If a stress fracture is diagnosed by your physiotherapist or doctor you will not need a cast but you will need a period of rest to allow the bone to heal. Depending on the severity of an athlete’s MTSS or tibial stress fracture, the rehab may be very similar.
Although on a spectrum MTSS goes throught a slightly different process from a stress fracture. Instead of periosteal inflammation leading to the development of an actual stress fracture, in MTSS the progression leads to a hyper-metabolic state. This means that the bone is constantly being broken down and remodeling, causing inflammation and pain.
Potential Causes (abnormal repetitive loading appear to be the cause)
1. Poor hip control
2. Poor knee mechanics
3. Non-optimal trunk / core control
4. Increased muscle tone in the lower leg: calf muscles
5. Poor foot mechanics and/or foot strength
6. Female triad – loss of weight, irregular menstruation, and loss of bone mass
7. Non-optimal running technique
Potential External Factors
1. Poor foot wear
2. Increased training loads
3. Surfaces: concrete, angled, firm
Best practice to reduce symptoms in the short term
1. Reduce the load of running
2. Do not run on hard surfaces
3. Try cross training with a different sport
4. Use ice to help with pain and inflammation
5. See a phyiscal therapsist to have the body assessed to determine the root cause of the shin splints.
Long term solutions
1. identify cause of MTSS: foot, calf muscles, hip, pelvis, trunk?
2. Strengthen appropriate areas
3. Lengthen and release appropriate tissues
4. Make necessary training changes
5. Consider better footwear
6. Taping techniques