What is MTSS?
Medial Tibial Stress Syndrome (MTSS), commonly referred to as shin splints, presents as pain along the inner edge of the tibia (shin bone), typically in the lower two-thirds. It’s caused by repetitive strain on the tibia and the surrounding connective tissues that attach muscles to the bone. Over time, this stress can lead to inflammation, microtears, or even stress reactions in severe cases. MTSS is an overuse injury, common among runners, dancers, military recruits, and anyone who engages in high-impact activities.
Physiotherapists play a crucial role in both the prevention and treatment of MTSS. We employ a thorough assessment and tailored rehabilitation plan to ensure proper healing and reduce the risk of recurrence.
What are the Symptoms?
Pain: Dull, aching discomfort along the shin, typically worsened by activity and improving with rest. In the early stages, pain typically only occurs during exercise, but in more chronic cases, it can persist at rest.
Tenderness: Pressing along the shin bone will often elicit tenderness, especially on the medial (inner) side.
Progression: If untreated, pain may escalate and become more constant, affecting performance and overall function.
What are the Causes & Risk Factors?
As physiotherapists, we assess several key factors to identify the underlying causes of MTSS:
Overuse/Training Errors: A sudden increase in training volume or intensity is a key contributor, especially when activities involve repetitive impact (e.g., running or jumping on hard surfaces).
Poor Biomechanics: Abnormal biomechanics—such as overpronation (flat feet) or improper footwear—can increase the stress on the tibia. Weak hip muscles, especially the glutes, also play a role in poor lower-limb alignment, contributing to shin stress.
Muscle Imbalance: Tight calf muscles (gastrocnemius and soleus) and weak tibialis posterior muscles can cause uneven force distribution, which places additional stress on the tibia.
Previous Injury: A history of MTSS, stress fractures, or other overuse injuries can make an individual more susceptible to future episodes.
How we can help!
As physiotherapists, the key to successful treatment is a comprehensive assessment, including:
Postural Analysis: Assessing for overpronation or abnormal knee/hip alignment.
Movement Analysis: Looking for any deviations during running or jumping and identifying weaknesses or imbalances in the lower limb muscles.
Range of Motion (ROM) Testing: To determine any restrictions, particularly in ankle or hip mobility, that could be contributing to MTSS.
Education on training loads
Assessment of foot wear.
Once we’ve completed the assessment, we can implement the PEACE & LOVE protocol for effective management.
PEACE (Immediate Care):
Protect: Initially, reducing load is paramount to allow for healing. This may involve modifications in training intensity or temporary cessation of high-impact activities (e.g., running).
Elevate: While MTSS typically doesn’t result in significant swelling, elevating the legs can help with fluid circulation in the lower extremities.
Avoid Anti-Inflammatories: Anti-inflammatory medication can interfere with the body’s natural healing processes, so we prefer to focus on gradual rehabilitation and natural recovery.
Compress: For individuals with excessive pronation, physiotherapists often recommend supportive footwear or custom orthotics to reduce stress on the tibia and improve alignment.
Educate: A key role of physiotherapy is patient education. We ensure patients understand the importance of a slow and gradual return to activity, focusing on the long-term recovery rather than quick fixes. Educating patients about biomechanical factors such as foot posture and hip stability is crucial.
LOVE (Ongoing Care):
Load: Gradually reintroducing load through controlled activities like walking, cycling, or swimming helps rebuild strength and stamina without overloading the shin.
Optimism: We work to reassure patients that MTSS, while frustrating, is treatable with a structured and patient-centred rehabilitation programme.
Vascularisation: Encouraging low-impact cardio exercises, such as swimming or cycling, not only helps maintain cardiovascular fitness but also enhances blood flow to the muscles, aiding recovery.
Exercise: A key element of recovery is addressing any muscle imbalances. This may involve strengthening exercises for the calf muscles (e.g., calf raises), the tibialis posterior, and the hips (e.g., glute bridges or clamshells). Stretching tight areas such as the calves and hamstrings is also critical to restore flexibility and reduce strain on the tibia.
Prevention:
Preventing MTSS involves a combination of training adjustments, biomechanical interventions, and strengthening:
Gradual Progression: We work with athletes to ensure they increase their training load gradually to prevent overload on the shin.
Proper Footwear: Assessing footwear and recommending orthotics, if necessary, can help align the foot and reduce excess strain.
Cross-Training: Encouraging athletes to incorporate a variety of training modalities can help reduce repetitive strain on the shins. This might include cycling, swimming, or strength training.
Strengthening and Stretching: A physiotherapy-led programme that targets the lower leg, foot, and hip muscles can significantly reduce the risk of MTSS. Focus on building strength in the tibialis posterior, calves, and glutes, as well as improving flexibility in the calf muscles and hips.
By tailoring the treatment and rehabilitation plan to each individual, physiotherapists can provide the best chance of full recovery and minimise the risk of recurrent shin splints.
Comments