Preamble
Having been at Exeter Tri Club
since August 2015 and leading one of the running groups at the track on a
Friday night for several months now, I’d heard a number of people complaining
about suffering from “shin splints”. I thought some of you may find it useful
to have some information on this condition: what it is; how it occurs; and
perhaps most importantly its management and prognosis.
Before I go any further a little
disclaimer: I have put this information together using a combination of my
clinical knowledge and experience, academic articles/texts, and my own
experience as a runner/triathlete. I have provided a couple of references but
not an exhaustive list. It is intended to be read in an educational capacity
and if you have any doubts or concerns about your injuries please make sure you
seek out a full assessment from a qualified professional.
What is it?
Medial Tibial Stress Syndrome,
also known as MTSS or “shin splints” is one of most common lower limb
complaints seen in athletes, particularly runners. It is a term used to cover a
range of presentations from slight pain in the shin due to tightness in the
calves to the extreme end of stress fractures in the tibia (shin bone). It is
an overuse or repetitive strain injury on the medial (or inside) area of the
tibia.
Although it is not usually
serious, it can be quite debilitating and can certainly ruin a training plan,
race, or even a whole season and beyond if not managed well.
Anatomy
The lower leg is the area between
the knee and the foot and is made up of the tibia and fibula. There are several
important muscles that act to control the foot and ankle, as well as contribute
to the function of the knee.
The main muscles concerning MTSS
are:
- Soleus, whose function is plantar-flexion of the ankle- pointing the foot downwards or lifting the heel from the ground. It attaches to the Achilles tendon and the medial border of the tibia. It is often neglected in stretching and strengthening exercises.
- Tibialis posterior turns the foot “inwards” and also contributes to plantar flexion (to a much lesser degree. It attaches to the tibia and fibula, travelling down into the foot on the medial side. Some people suffer from tibialis posterior dysfunction which can also affect the control of the foot and ankle.
Tibialis anterior is the muscle on the front of
the shin bone and is responsible for dorsi-flexion as well as inversion, or
pulling the ankle upwards and inwards. It attaches to the lateral, or outer,
side of the tibia and travels downwards to the medial side of the foot.
How does MTSS present?
Typically athletes will
experience a diffuse pain down the front and inside of the shin bone. Initially
the symptoms will be worse at the start of exercise but subside during the
activity or upon stopping. However, if left unchecked the pain can be more
persistent, intense, and even be present at rest. If the athlete continues to
train this will most likely only get worse.
Why does it occur?
There are several factors that can
contribute to MTSS, the most common of which are likely to be:
- A sudden increase in training load
- Over-training
- Poor technique
- Muscle tightness
- Muscle weakness
- Poor biomechanics
- Running on hard surfaces
- A previous history of lower limb injuries
It is likely that if you are
suffering from MTSS then you have more than one of the above.
Diagnosis
A detailed history need to be
taken- how it started, how it behaves, any other pathology- first of all. A
thorough physical examination of the whole lower limb: its range of motion;
function; stability; strength, should be conducted- including the ankle, knee,
hip, and potentially lower back should then be conducted to identify any
deficiencies.
It is unlikely that any x-rays or
scan need to be performed as these will usually show nothing abnormal. However,
if the symptoms do not improve with appropriate management they may be
appropriate.
Treatment and management
Unfortunately rest can often be
an important and essential part of managing MTSS. However, as an athlete it is
unlikely you will want to (or be willing to) stop completely, so the term
“relative rest” is perhaps more useful- this involves modifying your training
rather than complete cessation.
Specific stretching and
strengthening of the appropriate muscle groups- particularly the calf but also
including the glutes and functional (or core) stability- is vital in both
managing the current problem and reducing the risk of recurrence. Soft tissue
massage can be useful in symptom management but remember that it won’t get rid
of the problem for you.
Prognosis
If managed well, athletes will
most likely recover fully from MTSS. However it may require a dedication to an
exercise regime and a reduction in training load that many of us are loathe to
do. However, failure to take the right course of action may well lead to more
intense and persistent pain as well as a much longer lay-off from the things
you love.
References:
Medial tibial stress syndrome: conservative
treatment options. Curr Rev Musculoskelet Med. 2009 Sep; 2(3): 127–133. 2009, R. Michael Galbraith and Mark E. Lavallee
Principles of Anatomy and
Physiology, Tortora and Grabowski
www.physiowizz.co.uk
