Medial Tibial Stress Syndrome
The Highlights
MTSS is an overload injury to the middle to lower third of the front-inner part of the tibia (shin bone) that is commonly experience during running and easing with rest.
Our team can diagnose this problem through physical examination and will add other factors into the equation including your gait/running pattern and your medical history.
Treatment firstly needs to address any underlying problems with your bone health. If these are taken care of, we can look at methods of offloading the area through gait retaining, taping and foot orthoses (specialist insoles).
What is it and what are the symptoms?
Medial tibial stress syndrome (MTSS) is a coming overload injury that we primarily see in our sporting patients - runners most of all. It is the more accurate term for what some people mean when they say "shin splints" - a term we avoid in clinic as it's too vague and can mean pain in different places around the shin so isn't helpful.
The pain with MTSS is experienced around the middle to lower third of the anterior-medial aspect of the tibia (the front-inner part of your shin essentially). The pain usually comes on with running (or very brisk walking) and, over weeks and months, if symptoms worsen it will tend to come on faster and faster one activity begins. It is often painful enough that a runner will stop activity - at which point the symptoms will generally subside very soon afterwards.
Another condition that many (including us) believe is on the same spectrum as MTSS is a tibial stress fracture - the onset and nature of the symptoms can be quite similar but may linger for longer and the site of pain is usually easier to pinpoint - It is VERY important you see the experts (we like to think that's us!) to have this problem investigate thoroughly as it is a challenging condition to treat.
More important still - if you are experiencing an extraordinary amount of pain in the front of the shin brought on by exercise or a blow to the shin (such as a bad tackle in football that continues when you are at rest, there is the possibility we are dealing with a condition called compartment syndrome - this is a medical emergency and you should seek medical attention immediately, even if only to have this ruled out.
Why does it happen?
Honestly? No one is 100% sure. One popular theory is mechanical "bending forces" applied to the bone during high impact activity like running lead to stress and pain in the periosteum (the outer lining of the bone). Other ideas include stress from pulling on the bone from adjacent muscles and another is the potential role of connective tissue called fascia.
What we DO KNOW is that in running and other sports this injury almost always involves the oldest training error in the book - too much too soon. Looking over the history of the problem there is typically an increase in running mileage or intensity leading up to the problem.
As discussed next, there is also the possibility that changes in your bone health status will have put you at increased risk.
What are the treatment options?
Because of the potential for this to be a challenging condition to treat and the risk of it developing into a more serious injury (a stress fracture) our Podiatrists will focus first and foremost on the history of the problem and also discuss your overall health and lifestyle which will include questions about your eating habits, stress, sleep, hormonal status, menstrual cycle (for woman obviously) and family history of bone problems like osteoporosis - the reason being that we need to get a picture of your general bone health. If any flags are raised over this, there may be a need to refer you to other colleagues either for additional investigations or treatments. Rest assured we will guide you through this.
Bone health aside, our team may look to address mechanical issues through various strategies like gait retraining, foot orthoses (specialist insoles), taping techniques, strength training and a deep dive into your overall training plan which may include a "return to run" programme or incorporating lower impact activity in like cycling. All with the aim of finding the optimal amount of "stress" that does not cause further injury but instead provides the stimulation to adapt and heal.
