What is Medial Tibial Stress Syndrome (Shin Splints)?
Medial tibial stress syndrome (MTSS), often referred to as “shin splints,” is a common injury often seen in athletes and military personnel due to overusing their lower limbs. MTSS causes exercise-induced pain over the front part of the shin bone and is considered an early stage of stress fractures in the shin bone. This type of injury is usually the first step towards more serious conditions, such as stress fractures.
What Causes Medial Tibial Stress Syndrome (Shin Splints)?
Medial tibial stress syndrome is a condition that often happens when the shin bone (tibia) is used too much. It’s a type of injury where the bone and surrounding tissue become inflamed, and it’s often seen in people who do a lot of high-impact exercises like running and jumping. This condition is also common among military personnel.
Risk Factors and Frequency for Medial Tibial Stress Syndrome (Shin Splints)
Medial tibial stress syndrome (MTSS) is a condition that mainly affects runners and military recruits. Specifically, it occurs in about 13.6% to 20% of runners and as high as 35% of those in military training. MTSS and other bone stress injuries can be caused by increased loads, high-volume practices, and high-impact exercises.
Some factors that can increase the risk of MTSS include being female, having a previous history of MTSS, high body mass index, a drop in the arch height of the foot (navicular drop), range of motion in ankle plantar flexion and hip external rotation. Remarkably, studies involving military recruits in basic training have shown a link between lack of vitamin D and a heightened risk of stress injuries.
Signs and Symptoms of Medial Tibial Stress Syndrome (Shin Splints)
If you’re experiencing pain in your lower leg, medical professionals can diagnose a condition known as ‘Medial Tibial Stress Syndrome’ (MTSS) by asking about your symptoms and examining your leg. During the examination, a few key symptoms and signs can indicate that you’re talking about MTSS:
- Pain that’s brought on by exercise and focused on the medial (inner) part of your shin, covering the lower two-thirds of it
- The pain gets worse during or after physical activity, but improves with rest
- You’re not experiencing cramp-like or burning sensations in the back of your leg, or numbness or tingling in your foot
The doctor will also carefully examine and feel your lower leg. The signs that point toward MTSS include:
- Pain that can be reproduced by gently pressing on the posteromedial (backward and middle) part of the tibia (shin bone) over an area greater than 5 cm
- Your leg is not showing signs not typically associated with MTSS such as severe swelling, redness, or loss of pulse in the lower part of the leg.
If all these points match your situation, it’s likely that you’re dealing with MTSS. However, if these aren’t the symptoms and signs you’re seeing, then the root cause of your leg pain might be something else, and other possible causes should be investigated.
Testing for Medial Tibial Stress Syndrome (Shin Splints)
The diagnosis of medial tibial stress syndrome (or shin splints) is typically done through understanding your medical history and a physical examination. However, sometimes, imaging tests might be required – especially if the cause of your symptoms is unclear, or to rule out other common sports injuries that affect the lower body. This is particularly true if there is worry about a more serious injury to your shin bone.
X-ray images of patients with shin splints are typically normal. X-rays might also show no abnormality even in the early stages of a stress fracture, which is a tiny crack in your shin bone stemming from overuse. When an X-ray image does reveal a “dreaded black line”, it is an indication of a stress fracture.
If shin splints or a more severe bone stress injury like a stress fracture needs to be identified, an MRI (Magnetic Resonance Imaging) scan is the preferred imaging test. A nuclear bone scan, which uses radioactive material and detects areas in your bone that might be injured, is also acceptable. However, it’s less accurate and detailed as compared to an MRI.
An MRI scan can show swelling around the outer layer of the bone (periosteal edema) and within the bone marrow (bone marrow edema). Nuclear bone scan might show increased uptake of the radioactive material (radionuclide) in the hard, outer part of the bone (cortical bone), which results in a characteristic “double stripe” pattern on the scanned image.
High-resolution CT (Computed Tomography) scans can also be an option for advanced imaging. However, they are less sensitive than MRI or nuclear bone scans, which means they might not detect all injuries.
In persistent or stubborn cases, the doctor may also want to check if there is a deficiency of vitamin D. Vitamin D helps the body absorb calcium, which is critical for bone health.
Treatment Options for Medial Tibial Stress Syndrome (Shin Splints)
Medial tibial stress syndrome, which is a fancy term for a condition commonly known as “shin splints”, is typically managed with non-surgical methods. The focus is primarily on rest and adjusting your activities to involve less repetitive, weight-bearing exercises. The exact amount of rest needed can vary from person to person and there’s no set guideline, it really depends on how an individual’s body responds.
There are many additional treatments available that have shown to be somewhat beneficial, although the evidence is not the strongest. These treatments include iontophoresis (a method of delivering drugs through the skin), phonophoresis (using ultrasound to deliver medication), applying ice to the area, using ultrasound for therapy, periosteal pecking (which invovles small and repeated tapping of the shinbone), and extracorporeal shockwave therapy (non-invasive treatment using pressure waves).
On the other hand, certain treatments have been found to be ineffective for managing shin splints. These include low-energy laser therapy, stretching, strength exercises, lower leg braces, and compression stockings.
In terms of avoiding this condition, one recent study has indicated that using prefabricated orthotics (customizable shoe inserts) can decrease the risk of getting shin splints in naval recruits.
In those stubborn cases where shin splints don’t respond well or respond slowly to rest and modifications in activity, it may help to make sure you’re getting enough calcium and vitamin D, and reconsidering your walking or running style (known as “gait retraining”). These changes may improve recovery and help to avoid further harm.
What else can Medial Tibial Stress Syndrome (Shin Splints) be?
If you’re experiencing lower limb discomfort, various medical conditions could be the cause, such as:
- Tibial stress fracture (a type of bone stress injury)
- Chronic exertional compartment syndrome (CECS, a muscle disorder that causes exercise-induced leg pain)
- Vascular issues such as functional popliteal artery entrapment syndrome (FPAES, compression of a specific artery during increased activity) and peripheral arterial disease (PAD, often due to clogged arteries)
Tibial stress fractures may be challenging to differentiate from medial tibial stress syndrome (MTSS), another bone stress injury. These fractures often present as pain concentrated in a small area on the shinbone. X-rays might show a worrisome black line, and an MRI can provide more information about the extent of the injury.
CECS causes widespread exercise-induced pain in the lower limbs, often affecting both legs. The pain usually eases with rest. More symptoms might include numbness, pale skin, chilly skin temperature, and a diminished pulse in the lower extremities. CECS diagnosis involves measuring the pressure within the muscles.
Both FPAES and PAD result in intermittent leg pain or discomfort when walking or exercising, easing with rest. FPAES occurs due to structural variations or thickening of the leg muscles leading to compression of the popliteal artery (a main artery in the leg) during physical exercise. The diagnosis of FPAES involves looking at how the arteries react during stress. PAD is frequently due to atherosclerosis (plaque buildup in the arteries) and is diagnosed via arterial imaging or a Doppler ultrasound of the blood flow.
What to expect with Medial Tibial Stress Syndrome (Shin Splints)
With proper rest and changes to your daily activities, you should expect to make a full recovery.
Possible Complications When Diagnosed with Medial Tibial Stress Syndrome (Shin Splints)
Athletes and military personnel with acute conditions often face quick-onset complications, including pain. This can lead to reduced performance and time missed from training or activities. It’s thought that a condition known as “medial tibial stress syndrome” (MTSS) might turn into a stress fracture in the tibia. That’s because small-scale bone damage (or “cortical microtrauma”) may develop into a full-on fracture, although this doesn’t happen for everyone with MTSS. In some severe cases, a tibia stress fracture may need surgery.
Quick-onset complications:
- Pain which can reduce performance
- Missed time from training or activities
- Potential transition of MTSS to a stress fracture in the tibia
- Possibility of requiring surgery for serious tibia stress fractures
Preventing Medial Tibial Stress Syndrome (Shin Splints)
Medial tibial stress syndrome, simply put, is a type of injury to the shin bone (tibia) that occurs from overuse. To prevent this, the focus is on educating people about the correct way to move and exercise without straining the body, and the importance of not overdoing it. It’s similar to how athletes prepare – gradually increasing the intensity of their training rather than jumping in with high intensity from the beginning.
Making sure you have enough of vitamin D and calcium can also help lower the chances of such injuries; it’s been proven to be particularly effective among soldiers in training. This could be something to consider for those who are frequently engaged in physical activities.
Athletes and soldiers can particularly benefit if their trainers or instructors are aware of this condition and understand the need for a properly planned training program. This includes ensuring there is enough time for rest and recovery between intense training sessions.
