Medial tibial stress syndrome (MTSS), tibial periostitis along with many other diagnosis are collectively known as “shin splints”.

Symptoms

This condition is characterized by pain in the lower part of the leg (tibia or shin bone). MTSS injuries are caused by repeated trauma to the connective muscle tissue surrounding the tibia. Ignoring this injury may result in a more serious condition such as a stress fracture of the bones.

Causes

• Overloading the muscles of the leg (increasing activity, intensity, and duration too quickly)
• Overloading the bones (tibial bone-remodeling capabilities are overloaded eg. Stress fracture)
• The impact may be made worse by running uphill, downhill, uneven terrain, or hard surfaces.
• Overloading the Periosteum (the structure that covers the bone like glad wrap to which muscles attach)
• Improper footwear
• Biomechanical irregularities.
• Inflexible fascia leading to compartment syndrome
• Excessive pronation at subtalar joint or poor dynamic foot control
• Excessively tight calf muscles& leg (FDL) (which can cause excessive pronation)
• Engaging the medial shin muscle in excessive amounts of eccentric muscle activity
• Undertaking high-impact exercises on hard, noncompliant surfaces (i.e: running on concrete)
• Poor knee, hip and ankle alignment (dynamic or static)
• Poor buttock, knee control at in the stance phase (poor eccentric control)
• Poor core stability
• Training Intensity

Epidemiology

It is a common injury that affects athletes who engage in running sports or basic activities such as cross country, football, or hiking.

Females are 1.5 to 3.5 times more likely to progress to stress fractures from shin splints.

It affects mostly runners and accounts for approximately 13% to 17% of all running-related injuries.

A typical clinical presentation of this condition involves pain, palpable tenderness, and possibly swelling. In early diagnosis, individuals may experience pain at the beginning of a workout, which may go away by continued activity and then occur again at the end of the activity. Radiographies and three-phase bone scans are recommended to differentiate between MTSS and other causes of chronic leg pain.

Treatment

• rest, ice to reduce inflammation, NSAIDS, and physiotherapy.
• rest may be required for a couple of weeks or up to three months for severe cases.
• Crutches may be necessary for temporary non-weight bearing,
• Footwear or an orthotic may be used to prevent a reoccurrence of shin splints.
• Ultrasound, whirlpool baths, phonophoresis, augmented soft tissue mobilization, electrical stimulation, and unweighted ambulation.
• Stretching and strengthening exercises. Exercises should focus on strengthening the tibialis anterior and other muscles controlling both inversion and eversion of the foot. Strengthening of the core hip muscles may also be beneficial.
• Extracorporeal shock wave therapy, which is used to treat various tendinopathies of the lower extremity, injection methods, which have been used to treat injuries of the lower extremity, including cortisone.
• “Posterior fasciotomy” is the procedure performed. This may include cauterization of the posteromedial ridge of the tibia, and results may not cause complete resolution but can improve the pain and function.