MTSS: Don’t Let Shin Splints Break Your Stride

Medial Tibial Stress Syndrome (MTSS), also known as shin splints, is a common condition among athletes and active individuals. It presents as pain along the inner edge of the shinbone (tibia) and is often associated with physical activity. Today, we will delve into the causes, symptoms, and differential diagnoses of MTSS, helping you understand how to identify this condition and differentiate it from other potential issues that present similarly.

What is Medial Tibial Stress Syndrome?

MTSS is characterised by pain and discomfort along the lower two-thirds of the tibia. It is often linked to overuse, particularly in runners, dancers, and other high-impact sports & activities. The condition results from repeated stress on the bone and surrounding soft tissues, leading to inflammation and micro-tears.

Common Symptoms

1. Pain: typically, the pain is localised along the inner tibia in the middle to lower thirds, and may vary in intensity from a dull ache to sharp pain.
2. Mild swelling: in some cases, a small amount of swelling may be present in the area. It is important to note, however, that swelling can be a sign of other more serious conditions listed below.
3. Tenderness: the affected region is generally tender to touch, especially along the bone for at least 5cm.
4. Pain with activity: symptoms often worsen during physical activity and generally improve with rest, though sometimes can take a few hours to settle after cessation of activity.
5. Reduced performance: athletes may notice a decline in their performance due to pain and discomfort.

Causes of MTSS

Several factors can contribute to the development of MTSS, including:

• Overuse: increased training intensity or frequency without adequate rest.
• Biomechanical issues: flat feet, high arches, or poor running form can increase stress on the tibia.
• Surface: running on hard surfaces (e.g., concrete) can exacerbate the condition.
• Improper footwear: worn-out shoes or those lacking proper support can lead to MTSS.
• Muscle imbalances: weakness in the hip and core muscles can alter gait mechanics, increasing strain on the lower legs.

Differential Diagnoses

There are a number of other conditions that can present similarly to MTSS, which are important to consider in order to manage symptoms correctly:

1. Stress fracture of the tibia

• A stress fracture is a small crack in the bone, often caused by repetitive stress. If MTSS is left unmanaged, it can progress into a stress fracture.
• Symptoms: sharp, localized pain that worsens with weight-bearing activity. Unlike MTSS, pain from a stress fracture typically persists even at rest and at night.

2. Compartment syndrome

• This condition occurs when swelling within a muscle compartment leads to increased pressure, compromising blood flow.
• Symptoms: severe pain, swelling, and sometimes a sensation of tightness in the affected compartment, usually after activity. It may also involve numbness or weakness.

3. Tendinopathy

• Inflammation or degeneration of the tendons around the tibia.
• Symptoms: localised pain near the tendon insertion, often aggravated by specific movements. Unlike MTSS, pain is usually more focussed on the tendon itself.

4. Shin splints (anterior)

• Anterior shin splints involve pain along the front portion of the tibia.
• Symptoms: similar to MTSS, but the pain is focused on the front of the leg rather than the inside border.

5. Popliteal artery entrapment syndrome

• A rare condition where the popliteal artery in the knee is compressed by surrounding structures, usually during exercise.
• Symptoms: intermittent claudication (pain in the calf muscles) during exercise, often relieved by rest.

6. Venous insufficiency

• Poor blood flow in the veins of the legs can lead to pain and swelling.
• Symptoms: often worse with prolonged standing or sitting and may include swelling and visual skin changes.

Diagnosis and Treatment

A thorough clinical assessment, including a physical examination and patient history, is essential for accurate diagnosis. Imaging studies like X-rays or MRI may be necessary to rule out stress fractures or other conditions.

Treatment Options

1. Rest and load management: allows tissues time to recover. Contrary to popular belief, this doesn’t mean sitting on the couch doing nothing! Your physio will guide you in training around the injury and slowly building your load back up.
2. Ice: can be helpful for pain relief when the area is really irritated.
3. Physiotherapy: targeted exercises to address biomechanical issues contributing to symptoms, and to prevent re-injury.
4. Footwear: invest in supportive shoes or orthotics tailored to your foot type.

Conclusion

Medial Tibial Stress Syndrome is a common yet manageable condition for those who engage in physical activities. Understanding its symptoms and potential differential diagnoses is essential for effective management and recovery. If you experience persistent shin pain, book a consult with one of our physios today to get you back on track with your recovery.