Shin splints is a one of the more complicated pathologies that Physiotherapists treat in their clinics. Here are 10 simplified points to make things easier for you to understand

1) In the medical world, Shin splints is now better known as Medial Tibial Stress Syndrome (MTSS) and has been reported to account for 12-18% of all running injuries.

2) Athletes presenting with MTSS will typically complain of an aching pain at the middle to bottom of the medial (or inside) border of the tibia (see picture 1- red). Some people may complain of pain more towards the outside of the shin (see picture 1 blue) Like most overuse injuries MTSS starts as a mild pain experienced at the beginning of activity (ie running) diminishing during activity and returning hours later. Symptoms can however progress and pain may reach the point of impairing performance and eventually be felt even during rest.

3) Researchers used to think that MTSS was a problem that occurred in the fascial attachment of the muscle to the bone and was caused by the repetitive pull of the muscle on the bone. However, there is now growing evidence that MTSS is caused by abnormal bending forces to the actual tibial bone itself. These forces set up an inflammatory process in the bone. The continued repetitive force of running prevents the area from healing and can result in a chronic inflammatory state in the bone.

4) Some authors believe that MTSS if continued untreated can develop into a tibial stress fracture. Others believe that MTSS and stress fractures although induced by similar activities are 2 different pathologies all together. One way to differentiate between MTSS and a tibial stress fracture is that the area of tenderness in MTSS is over a 4-6cm region whereas a stress fracture has tenderness in one specific point.

5) MTSS like most repetitive strain injuries are caused by abrupt changes in training techniques- doing too much too fast too soon. In addition the type of surface one runs on can also influence the stresses placed on bone. Running on hard surfaces such as asphalt can elicit pain. However, grass, sand and road shoulders are not universally preferable to road running due to their irregular surfaces. A level uniform surface of moderate firmness is optimal for minimizing injury risk.

6) Improper footwear has also been shown to be a risk factor for MTSS. Some research shows that shoes may lose up to 60% of their shock absorbing capabilities after as little as 250 miles.

7) Some studies show that excessive pronation is a risk factor for shin splints. Other studies show there is no link at all. Other factors like muscle imbalances, poor running technique and poor movement control can also contribute to the increased risk of developing MTSS.

8) Treatment of MTSS will involve a period of rest and a cessation of running. How much time all depends on the severity of the injury. Cross training and activities that do not hurt are recommended to keep fitness levels in check.

9) If you are worried that you may have MTSS or a Tibial Stress fracture, it is advisable to see a professional. Investigations such as MRI, bone scans and X-rays are often used to help diagnose and differentiate between these conditions.

10) Physiotherapy can be useful in the treatment and diagnosis of MTSS. In addition to manual therapy techniques and acupuncture that Physiotherapists use to improve pain and decrease inflammation, a thorough assessment needs to be done to identify any intrinsic factors that may be contributing to the pathology (see point 7)

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