Medial Tibial Stress Syndrome

it sounds horrific. Splitting of the shins? Although the reality of the injury is not quite that graphic, to a runner it can definitely feel like your shins are under attack. Especially if it's stopping you from running! It is, unfortunately, a very common and debilitating overuse injury in runners.

The medical name of this injury is called Medial Tibial Stress Syndrome (MTSS) and is an injury which causes pain along the bottom 2/3rds of the tibia (shin bone). Although its not classified as a serious injury, if left untreated it can lead to more complicated injuries such as stress fractures (Galbraith & Lavalle, 2009). The theories behind what actually causes the pain are controversial and unclear. Previous theories suggested that it was caused by periostitis ( inflammation of the connective tissue surround the bone) of the tibia as a result of direct excessive loading (Tweed et al, 2008). However, other research indicated that there are a number of possibilities causing the pain, including the tibialis posterior muscle, tibialis anterior muscle, soleus and peroneal dysfunction (weakness), tendinopathy, periostitis and stress reactions of the tibia (Galbraith & Lavalle,2009).

What does it feel like? 

The pain is often described as deep, diffuse and difficult to pin point along the bottom two thirds of the tibia (shin), commonly along the inside of the border edge of the bone (Maul, 2011). After warming up, the pain will often decrease for a period of time, but will gradually return after, or later on into exercise. As the injury worsens, pain will often be felt with less activity and sometimes at rest (Galbraith & Lavalle, 2009). There can be tenderness along the entire length of the tibia or even a small porition, likely near the bottom section of the bone. Swelling is not uncommon (Tweed et al, 2008).

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Why did I get it? 

Risk factors associated with the development of medial tibial stress syndrome are both internal and external variables.

External risk factors:

• Increasing running load quickly ( too much too soon)
• Increasing training intensity ( frequency and or speed)
• Running on harder surfaces
• High impact sports ( jumping sports such as basketball) 
• Repeitive loading sports ( Such as running)

Internal risk factors:

• Females ( lower bone density (Galbraith & Lavallee 2009, Sharma et al 2011)
• muscle wekaness
• inflexibility
• leg length discrepancy and foot alignment (Maul, 2011)

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As with all running related injuries, the key to successfully treating medial tibial stress syndrome lies first in identifying the root cause of the injury and this needs to be done on a case by case basis.

What can I do about it?

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Modified rest in the early stages of the injury is recommended in order to reduce the micro-trauma. Fitness can be maintained by partaking in low impact activities such as swimming, cycling and cross training. It is also important to address the underlying cause of the injury in order to prevent it from reoccurring. Depending on the root cause, strengthening the muscles that cross the ankle joint and stretching the calf muscles have both been shown to be effective conservative treatments for those who present with weakness and tightness in the lower leg. However, if it is found that the problem originated from further up, hip strengthening might also be recommended. As is the case for all running related overuse injuries, the fact that they are multi-factorial(likely caused by a number of variables) means that effective treatment programmes must be prescribed on an individual basis.

How can Run3D help?

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Like most overuse injuries, it is unlikely that only one thing has lead to the development of your medial tibial stress syndrome. Biomechanical abnormalities,such as increased knee movement or excessive foot pronation, muscular tightness and weakness have all been identified as risk factors for this condition(Galbraith & Lavallee, 2009). In fact a study by Oguz et al. (2011) found that an imbalance of muscle strength at the foot contributed to creating abnormal biomechanics at the ankle, which might have led to the development of medial tibial stress syndrome. Run3D measures all aspects of your biomechanics, strength, flexibility and alignment in an objective and scientific way in order to establish the root cause of your injury and provide you with a long term solution to the problem. Our advanced assessment using state-of-the-art infrared technology and the world's largest biomechanical database is exclusive to Run3D. All the measurements we collect enable us to identify exactly what has caused your injury so that we can provide you with a rehabilitation programme to help sort it out.

References

‍Galbraith, M., & Lavallee, M. 2009, “Medial tibial stress syndrome :conservative treatment options”,Current Review of Musculoskeletal Medicine,Vol. 2, pp. 127-133.

Mual, D. 2011, “ The role of lower extremity biomechanics &the etiology of the medial tibial stress syndrome”, [internet] available at:http://www.logan.edu/mm/files/LRC/Senior-Research/2011-Aug-23.pdf (accessed May9, 2013). Oguz, Y., Ozgurbuz, C., Ergui, M., Islegen, C., Tskiran, E., Denerel,N., et al. 2011, “Inversion/eversion strength dysbalance in patients withmedial tibial stress syndrome”, Journal of Sport Science & Medicine,Vol.10, pp. 737-742.

Sharma, J., Golvy, J., Greeves, J., & Spears, I. 2011, “Biomechanical and lifestyle risk factors for medial tibial stress syndrome inarmy recruits: A prospective study”, Gait and Posture, Vol. 33, pp. 361-365.

Tweed, J., Avil, S., Campbell, J., & Barnes, M. 2008,“Etiologic factors in the development of medial tibial stress syndrome”,Journal of American Podiatric Medical Association, Vol. 98, pp. 107 -111.

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