What is Medial Tibial Stress Syndrome (Shin Splints)?

At a glance:

  • Shin splints are a painful condition related to exercise.
  • Shin splints may cause pain, a persistent ache, slight swelling or weakness in the ankle/foot.
  • The pain is typically focussed along the tibia (shinbone).
  • Medial tibial stress syndrome (MTSS), the inflammation of the muscles, tendons and ligament in the lower leg is the medical term for shin splints.
  • If left untreated, shin splints may progress to form hairline fractures of the tibia (stress fractures), tendinopathy or compartment syndrome, a condition that affects the pressure inside the fascia surrounding the muscles.

What is MTSS?

Also referred to as shin splints, MTSS is a painful condition commonly related to exercise. The colloquial term for the condition, “shin splints” refers to the most common symptom associated with them - aches or pain along the tibia (shinbone), between the knee and ankle, most commonly at the lower one third of the bone. 

Shin splints are typically caused by inflammation of the muscles, ligaments and tendons in the lower leg, as well as stress to the bone tissue of your lower tibia. The pain typically radiates from where the muscles, tendon and ligaments attach to the bone.

Any repetitive or high impact activity may lead to the development of shin splints but they are  more common in people who participate in high mobility sports like tennis, basketball or soccer as well as dancers.  A rapid increase in running volume at the start of a sporting season is another common cause of shin splints. 

Women, athletes, military recruits and dancers all have an increased risk of developing shin splints compared with the general public.

Symptoms of MTSS

Pain is the major symptom of shin splints, but this discomfort can manifest in a number of ways depending on severity, cause or other factors.

  • Dull aches in the front part of the shinbone
  • Lower leg muscle pain
  • Mild swelling of the lower leg
  • Pain in the shins that develops or intensifies during exercise
  • Pain on either side of the shin bone
  • Pain or tenderness along the inner part of the lower leg
  • Weakness in the feet, sometimes accompanied by numbness or tingling

In some cases, if left untreated, the shin splints may worsen and the pain can then be the result of hairline tibial (stress) fractures. More severe symptoms may be present in such a case, including:

  • Severe, ongoing shin pain (this may occur after a fall or accident)
  • Your shins feel hot to the touch
  • Your shins are visibly swollen
  • The pain in your shins doesn’t subside after you’ve ceased physical exercise

If you are experiencing severe symptoms, booking an appointment to see a doctor , physiotherapist or podiatrist is highly recommended.

What Are The Main Causes of Shin Pain?

Shin pain may be caused by a number of factors, including:

  • MTSS - The most common cause of shin pain is medial tibial stress syndrome (MTSS), commonly known as shin splints.  This is an inflammation of the muscles, ligaments and tendons that connect to the tibia, most commonly the tibialis posterior and flexor hallicus longus muscles.  The pain from this type of shin pain is typically felt around the inside edge of the tibia at the lower one third. 

The inflammation is due to stresses caused by high impact activities like sports, running, exercising or dancing and typically subsides after the activity ceases.

  • Stress Fractures - if the pain from shin splints doesn’t subside after the aggravating activity is ceased, or does not respond to treatment the pain may be due to stress fractures in the tibia. These hairline cracks may be caused by repetitive, high impact activities or be the result of an accident.

The pain from stress fractures may be more severe than that associated with MTSS, or may be a constant, dull ache.

  • Tendinopathy - tendons are pieces of strong tissue that anchor muscles to bones. An overloading of the tendon which produces pain is called tendinopathy.   Irritation of the tendons connecting muscles to the tibia may result in shin pain. If a partial tear of the tendon is involved, the pain may be both persistent and severe.
  • Chronic Exertional Compartment Syndrome - compartment syndrome is a relatively uncommon condition related to a buildup of pressure within the fascia surrounding muscles, which can build to dangerous levels. The condition may occur in muscle groups around the body, but in the lower legs may lead to shin pain.

Compartment syndrome is typically brought on through exertion (such as exercise), with the pain subsiding after the instigating activity has ceased. 

A number of risk factors may increase your chances of developing MTSS or the other causes of shin pain, including:

  • Abnormally formed feet, such as high arches or flat feet
  • A lack of flexibility in the ankle
  • Being a woman, athlete, military trainee or dancer
  • Being overweight or obese may also increase the load on your ankles and lower legs during activity leading to shin splints
  • Exercising when you have muscle fatigue
  • Increasing the intensity of exercise too rapidly
  • Participating in activities that require frequent stops and starts, like tennis, soccer or dancing
  • Poor or improper training techniques
  • Running downhill, or on a slanted or uneven surface
  • Running or taking part in high impact activities (sports, dancing) on hard surfaces like concrete or tiles
  • Weakness or atrophy in the thighs or buttocks
  • Wearing inappropriate, ill fitting or poorly cushioned shoes while running, playing sports or working out

Depending on the underlying cause of the pain, treatment options vary, but for the most common form of shin pain, MTSS, treatments include:

  • Ice packs - use of ice packs may help reduce the pain and any swelling associated with shin splints. Ice should never be applied directly to the skin or used for more than 20 minutes at a time.
  • Increasing flexibility - tense or inflexible lower leg and ankle muscles may be the cause of your shin splints. Stretching the muscles in your lower leg may help relieve symptoms and decrease the likelihood of a recurrence of shin splints. In some cases, a visit to a physiotherapist may be needed for an exercise plan.
  • Non Steroidal Anti Inflammatory Drugs (NSAIDS) - over the counter pain relievers like ibuprofen or naproxen may be used to manage the pain caused by shin splints. 
  • Orthoses - if the shin splints are a result of gait or foot abnormalities, prescription orthoses, or those bought off the shelf may be required to correct those issues. These shoe inserts help support the ankle and foot, relieving pressure on the lower leg.
  • Rest - shin splints are usually caused by overuse or strain, so letting your legs rest after you have experienced symptoms is one of the most important treatments. Bed rest isn’t required, but it may mean refraining from the activity that caused the shin splints for a period of a few weeks. A low impact substitute exercise may be recommended during this rest period.  During this rest period it is important to address the underlying poor mechanics that are causing the strain or inflammation, or once you return to the activity, the pain will return. 
  • Shoes - wearing well fitted, supportive and cushioned shoes helps relieve pressure on the lower legs, both relieving pain and reducing the risk of further shin splints down the line.

You can reduce your risk of developing shin pain or MTSS by following a few simple steps, including:

  • Cross train - alternating high impact exercise (like running) with low impact exercise (such as cycling or swimming) may give your muscles time to recover so they don’t become overstressed and inflamed.
  • Improve your fitness gradually - when exercising or playing sport, increase the intensity, duration and frequency gradually so your body can acclimate to increased activity without becoming overstressed/exhausted.
  • Warm up and stretch - before any strenuous activity, make sure you are warmed up and limber to reduce the chance of injury or muscle fatigue. Stretching your calves, ankles and toes may also help in avoiding shin splints.
  • Wear the right shoes - make sure your shoes are properly fitted, are supportive and appropriate for the exercise or activity you are undertaking.

If your shin pain doesn’t respond to treatment or the symptoms are severe, extra testing may be required to discover the cause. Stress fractures, tendinopathy and compartment syndrome may require more targeted treatment, such as medication, bed rest or in rare cases, surgery.

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