From the Research
Medial tibial stress syndrome (MTSS), commonly referred to as "shin splints," is a common overuse injury of the lower extremities affecting a large percentage of athletes, characterized by diffuse palpable pain and tenderness along the posteromedial edge of the tibia. This condition typically occurs from overuse during physical activities like running or jumping, especially when training intensity increases too quickly or when exercising on hard surfaces 1. Symptoms include dull, aching pain along the inner shin that may worsen during exercise, often alleviated by resting. The pain is often described as a dull ache following exercise, and athletes may complain of tenderness along the posteromedial edge of the tibia and pain along the middle to distal third of the posteromedial border of the tibia following an exercise session.
Causes and Risk Factors
The cause of MTSS is often multi-factorial, involving training errors and various biomechanical abnormalities, such as overtraining, poor footwear, muscular imbalances at the ankle, overtight or weak triceps surae muscles, imbalances at the thoracolumbar complex, and a body mass index (BMI) above 30 1, 2.
Diagnosis and Treatment
Diagnosis of MTSS can be distinguished from other overuse injuries, such as stress fractures, by clinical presentation, including diffuse tenderness along the length of the posteromedial tibial shaft and a lack of edema 3. Treatment involves rest, ice application for 15-20 minutes several times daily, over-the-counter pain relievers like ibuprofen (400-600mg every 6-8 hours with food), and gentle stretching 4, 5. Prevention strategies include proper footwear, gradual training progression, cross-training, and running on softer surfaces. Most cases resolve with conservative treatment within 2-4 weeks, but persistent pain should prompt medical evaluation to rule out stress fractures or other conditions 1. Returning to activity should be gradual, starting at about 50% of previous intensity and increasing slowly as pain allows.
Prevention
To prevent MTSS or shin splints, it is essential to avoid excessive stress, and repetitive stress should be avoided 1. This can be achieved by implementing prevention strategies, such as proper footwear, gradual training progression, cross-training, and running on softer surfaces. By understanding the causes, symptoms, and treatment options for MTSS, athletes and clinicians can work together to prevent and manage this common overuse injury.