Often incorrectly described as "shin splints", Medial Tibial Stress Syndrome (MTSS) is an overuse injury usually caused by running. The condition is characterized by pain and tenderness in the lower leg, usually along the front medial edge of the shin. There are many different opinions as to the specific cause of tibial stress, including:

 changing training techniques

 overuse and increased load or BMI

 problematic footwear or flat feet

 decreased flexibility 

 fatigue

 the shape and structure of the leg and hip (increased calf girth, abnormal hip angles)

 training surface (or change in training surface).

Signs and Symptoms

 Pain and tenderness developing along the front medial edge of the shin where the muscles are attached. Pain can occur before, during, and/or after          exercise.  Symptoms may get worse with increased resistance.  

 Symptoms generally subside with warm up and exercise but tend to flare up after exercise and in the mornings following exercise

 Swelling and discolouration are seldom noted but have been seen along the posterior medial border of the tibia (shin).

On-Site Management

Rest, ice and analgesia are immediate treatment options of decrease any swelling and tenderness.  Cross training with non-impact, pain free sports are an option for many athletes to relieve continuous stress placed on the legs. Treatment should always be referred to a practicing physician.  The physician may recommend changes in foot wear, shock absorption techniques or taping strategies to relive symptoms.  

Refer for a Correct Diagnosis.

It is important to seek a physician’s diagnosis in order to rule out other possible mechanics of injury and decide on the most beneficial treatment plan.  A sport medicine practitioner will take a history of the injury, conduct a physical examination of the injured area, and undertake a biomechanical assessment of the athlete's lower extremity (looking for anatomical abnormalities). If warranted, selected diagnostic tests may be ordered such as X-rays, bone scans, etc.

Rehabilitation and Treatment

Physicians will often prescribe anti-inflammatory medication and therapists can apply various electrical modalities that will assist in controlling inflammation and returning the area back to optimal function. Rest and anti-inflammatory medication alone do not heal. Therapists may use active release therapies, cupping, massage, electrical stimulation, ultrasound, and PNF stretching to relieve tension on muscles in the calf and foot and promote healing. Sport specific agility, strength, speed and skill drills should be gradually incorporated into the athlete's program as healing progresses. 

Premature return to activity is a common mistake and can exacerbate the pain and injury.

Some effective methods for preventing Medial Tibial Stress Syndrome include: supportive footwear, improving running technique and biomechanics, addressing any training errors (frequency, intensity, duration), and paying attention to playing or training surfaces. Taping can sometimes be helpful.

Prevention

 Adequate warm-up, including stretching before activity.

 Pre-season strengthening and stretching.

 Appropriate footwear

 Appropriate progression of activity and loading

Brukner, P. and Khan, K. Brukner and Khan's Clinical Sports Medicine Brukner, P. and Khan, K. (2007) Brukner and Khan's Clinical Sports Medicine. 4th ed. North Ryde: McGraw-Hill.

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