"Shin splints" or " Medial Tibial Stress Syndrome" (MTSS) refers to pain along the shin bone, which is one of the common injuries in cheerleading, dance, and sports. It is generally caused by repetitive stress to the lower limb and may develop into a stress fracture if left untreated. Let's dive into more details below.
Anatomy/ Pathophysiology
The lower leg is made up of 2 bones- the tibia and the fibula.
The periosteum is the membrane of blood vessels and nerves that surrounds the bones.
The tibialis anterior is a muscle that runs along the tibia into the foot. Its action is to lift the foot up when we are walking/ running.
Although the pathophysiology of MTSS is unclear, it is thought to be due to repetitive strain to the lower limb, causing periostitis of the tibia (inflammation of the periosteum), and inflammation to surrounding muscles and tendons- i.e. the tibialis anterior.
Risk Factors
A sudden increase in the training load
Jumping/ impact activities on a hard surface
Poor footwear
Muscular imbalance at the ankle- tightness/ weakness at the calf
Pes planus (flat-footed)
BMI above 30
Inadequate warm-up before exercises
Symptoms
Dull ache along the inner shin
Shin pain that worsens with exercise/ activity
Widespread tenderness along the shin on touching
Mild swelling along the shin
Management
Conservative management - With Physio guidance!
Offloading: Initially, taking a few weeks off from activities that cause pain will help with your symptoms. You can consider some lower-impact activities, such as cycling or swimming, to maintain your fitness.
NSAIDS and ice to reduce swelling and inflammation.
Lengthening: Calf stretches release any tension in the lower leg. Some studies suggest that foam rolling/ cupping can also be used to release myofascial tension.
Strengthening: Calf raises and toe raises can improve strength only if they can be done with pain below 2/10. You can consider starting these exercises in a seated position initially to reduce the load going through your shins.
Return to sports:
You should be pain-free for at least 5 consecutive days to 2 weeks with normal daily activities before returning to training.
You should reduce the intensity and the frequency of training initially and gradually build up
Warm up before exercising/ training.
Take rests and reduce your training intensity when pain is above 2/10
Other things to consider
Footwear:
Avoid training in bare feet. Shoes with good cushioning can reduce stress on the shins.
Orthotics:
Insoles might be helpful for shin splints if you have flat feet. They can support and improve your foot and ankle biomechanics, to offload the shins.
Flooring:
Utilizing mats and springs for shock absorbance can prevent MTSS.
When To Consult Medical Advice
Due to the similarities in symptoms, we can sometimes misdiagnose a stress fracture as MTSS. Furthermore, MTSS can develop into a stress fracture if mistreated. Further investigations should be done if:
Your pain does not improve with rest
You have pain with daily activities
Your pain is localized at one specific spot on the shin
Swelling is persistent and does not improve with ice and NSAIDs
Pain does not improve with the management mentioned above
Conclusion
MTSS can be frustrating but can usually be managed conservatively with rest, gradual loading and adaptations to your training environment. A key to rehabilitating MTSS is to not ignore pain. Remember, always seek medical advice should pain persist or if you are in doubt.
References
Bhusari, N., & Deshmukh, M. (2023). Shin Splint: A Review. Cureus, 15(1), e33905.
Deshmukh, N. S., Jr, Phansopkar, P., & Wanjari, M. B. (2022). A Novel Physical Therapy Approach in Pain Management and Enhancement of Performance in Shin Splints Athletes: A Case Report. Cureus, 14(7), e26676.
Warden, S. J., Edwards, W. B., & Willy, R. W. (2021). Optimal Load for Managing Low-Risk Tibial and Metatarsal Bone Stress Injuries in Runners: The Science Behind the Clinical Reasoning. The Journal of orthopaedic and sports physical therapy, 51(7), 322–330.
Our blogs and articles are not designed to replace medical advice. If you have an injury, we recommend seeing a qualified health professional. We offer both in-person assessments and online consultations!
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