Medial Tibial Stress Syndrome, aka Shin Splints

MTSS is a term that many may not be familiar with, however I am sure almost everyone has heard of its more common name: Shin Splints. Shin splints are by far one of the most common injuries that can occur in runners. In fact, they make up 15% of all running injuries.

There are many factors that play into the development of MTSS, but by far mileage is the most significant. Shin splints are a common side effect of, what runners like to call, the “Terrible Too’s”. Too much, too soon, too long. Runners who increase their mileage dramatically develop this syndrome most frequently. Athletes running more than 20 miles a week are at highest risk for developing MTSS, however many people can do this successfully, and pain-free. The key is to build up your mileage gradually and allow the body time to adapt to additional stresses.  The main reason is because MTSS is a cumulative trauma injury. Every stride you take while running has an impact on your body, much of which is absorbed into your lower leg. While the body can handle significant stress, it also needs time to adapt. If you increase your mileage or speed without working up to it, your body is unable to adapt to the new stress, often resulting in injury.

“Shin Splints” have become a “catch all” diagnosis for anyone suffering from pain on the anterior portion of their shins, but it tells us very little about the root cause of your pain. There are various different tissues that can be injured, all with varying degrees of severity. The most common is the strain of the muscles sitting adjacent to your tibia (shin bone.) Due to the repetitive contraction of the muscles with running, they can become strained and inflamed leading to pain and discomfort.

Another type of injury under the “shin split” umbrella can involve the bone itself. Muscles and connective tissue all attach to the bone. When these tissues are constantly being pulled, they can begin to cause inflammation of the top layer of the bone. This is called periosteal inflammation or also known as a bony stress reaction.

The final and most severe concern when evaluating MTSS is the risk of a stress fracture. In severe cases, when excessive miles are being run without adequate preparation, the risk increases of sustaining a stress fracture. A stress fracture is not technically MTSS, however many runners assume they have shin splints when they indeed have a fractured bone.

This distinction is important to make because if you have a stress fracture and continue to run through the pain, it can lead to a much more serious injury. A proper medical evaluation by your sports chiropractor will help guide you to the proper care and management.

Stress fractures can be difficult to diagnose even for medical professionals. This is because they may not show up on x-rays if they are relatively new injuries. Some signs that your MTSS may in fact be a stress fracture rather than a mild shin splint are:

• More focused pain. MTSS tends to diffuse pain throughout the anterior leg rather than pinpoint an area.
• Tenderness over the tibia bone itself can indicate more osseous involvement.
• Any signs of swelling in the area may indicate a stress fracture is present.  A single leg hop test may be performed in office. This test causes pain in just under half of patients suffering from MTSS, however it will elicit pain in 70-100% of patients suffering from a stress fracture.

If you are suffering from MTSS or a stress fracture, the first step to recovery is rest. This can be difficult for many athletes as injuries tend to occur when they are ramping up training for a race or an event. Unfortunately, if we do not remove the insult to the tissue it will not have a chance to recover. One option for many of these athletes to stay in shape is cross training. Often, we recommend spending increased time on a bike, swimming or under water training.

Another reason why working with a skilled chiropractor can benefit runners is to improve their running biomechanics. Increased mileage is the main factor leading to MTSS, however improper running mechanics can also predispose someone to developing the syndrome.

Muscle imbalances can be caused by tight and weak muscles throughout the kinetic chain.   A proper functional examination can help identify and target which muscles require work. A treatment plan can be implemented and directed to each individual’s needs. This may include myofascial therapy, rehabilitation exercise, and a developed return to running program. A return to running program should progress an individual back into the sport gradually, only increasing the mileage by a ¼ mile every time the patient has two consecutive pain free workouts. It is also recommended that MTSS patients begin their return to running on softer surfaces. The impact on concrete or asphalt can be enough to exacerbate their symptoms and encourage the development of inflammation in the tissue again.

Finally, avid runners need to pay close attention to the footwear they are using. Even the best shoes breakdown. Studies show that shoes tend to lose roughly half of their shock absorption ability after 300-500 miles. In this range all runners should consider replacing their footwear.

MTSS is a very common injury in running but should be taken seriously. It is not an injury that responds well to fighting through the pain and being ignored. A proper evaluation by a sports doctor is required to determine the severity of the injury and how to properly move forward. Rest and conservative treatment are the best tools at your disposal while recovering from MTSS.