There are stretches for shin splints. I know. I had to do them for my own. I have been a regular runner for the past 14 years. When I first started running in 2009, I was already a physical therapist. My main form of physical activity at that time was yoga. I have had a very strenuous yoga practice for years but wanted to add in more cardiovascular activity. I had run on and off during high school and college so I figured it wouldn’t be a big deal to pick it back up.
As a PT, I knew that I should ease into running and slowly build up distance. However, that is not what I did. I wanted to run about 4 miles, 3 times a week. Instead of working up to this over a few months, I did it in a few weeks. After several weeks of running, I ended up having really sore shins. They were extremely tender to the touch. I remember yelping at one point when my husband accidentally tapped my shin with his hand. At this point, I knew that I had medial tibial stress syndrome or, as it is more commonly known, shin splints. It did eventually go away, and I am still running. Read on to learn more about medial tibial stress syndrome and how to treat it.
What is medial tibial stress syndrome (MTSS)?
Medial tibial stress syndrome (aka shin splints) is an overuse injury of the lower legs. It is the result of the lower leg muscles pulling on their attachment sites at the tibia (shin bone) during activity. This causes micro-damage to the underlying bone. If this damage is not allowed to heal, it begins to accumulate and get irritated. The muscles that are most likely involved in MTSS are the soleus, posterior tibialis, and flexor digitorum longus. Because of the location of these muscle attachments, the pain will most likely be on the inside of the shin bone.
What does MTSS feel like?
There are several symptoms associated with MTSS. These include:
- Pain in the middle or bottom third of the inside of your shin
- Sharp pain when the tender area is touched
- Ache during or after exercise
Symptoms usually develop gradually. They will initially present with the start of the activity and then decrease. They will then progress to constant pain during the activity that decreases with rest. Without treatment or significant rest, they will progress to pain during activity and at rest.
Who gets MTSS?
Anyone can get MTSS. It is a very common musculoskeletal injury. It usually occurs with recurrent impact activity such as running and jumping. It can affect any active individual but can often be seen in:
- Military personnel
- Dancers
- Distance runners
- Sprinters
- Basketball players
- Tennis players
- Gymnasts
What are the risk factors for MTSS?
There are several risk factors for MTSS. These include:
- Female
- Previous history of MTSS
- High BMI (body mass index)
- Weak calf muscles
- Tight calf muscles
- Participating in sport that requires recurrent running and/or jumping
- Running on hard or uneven surfaces
- Bad running shoes
- Foot overpronation – Flattening of the arch while standing, walking, or running
- Increasing training intensity and duration too quickly
Can MTSS lead to a stress fracture?
Yes, MTSS can lead to a stress fracture in the tibia. Not all MTSS will lead to a fracture. However, if left untreated a fracture in the bone could occur. The symptoms of a tibial stress fracture are very similar to MTSS. However, fractures tend to have more pinpoint pain when touched while the MTSS pain is more diffuse.
What should I do?
- Physical therapy – This would be my first stop. Physical therapy can help decrease the pain and swelling with techniques including manual therapy and dry needling. PT can evaluate and address abnormal joint mobility, muscle weakness, and flexibility. Your PT will also assess your shoe wear, training schedule, and technique to prevent the problem from happening again.
- Orthopedic physician – An orthopedist might be necessary if a stress fracture is suspected, or the injury is not responding to physical therapy. Your orthopedist can order imagining to help determine the extent of the condition.
What can I do at home?
- Relative rest – Resting the area to decrease further pain and damage from occurring is one of the best ways to treat MTSS. Basically, stay away from the activities that are causing pain. This gives the bone time to rest and heal. Swimming, walking, and biking would be good alternative activities that do not put much stress through the shin. Stay away from the irritating activity until the pain subsides. When returning to your sport, begin at about 50% running distance, frequency, and intensity. Also avoid running on hills or uneven surfaces. Very slowly increase your distance, frequency, and intensity over the period of several months.
- Ice – Ice can help decrease the pain and swelling at the tendon. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or preventing you from participating in an activity. Ice immediately after activity.
- Compression socks – Wearing compression socks while performing your activity can help decrease swelling and pain by improving circulation.
- Stretching – Stretching the calf muscles and hips can help improve running technique. See the videos below.
- Strengthening – It is important to strengthen the calf muscles along with the muscles of the knee, hip, and core. All of these muscles work together while running, cutting, and jumping. Using loop resistance bands can help increase strength and difficulty. See the videos below.
- Shoe wear and orthotics – Having flat feet or overpronating is a risk factor for MTSS. Changing shoe wear or using orthotics to place the foot in a neutral position will help decrease the stress on the shin. An overpronation shoe might help or you might need orthotics. Most running stores will evaluate your foot type and suggest appropriate shoe wear and/or orthotics. Your PT can also evaluate your foot and help determine appropriate shoe wear.
In review
- Medial tibial stress syndrome (aka shin splints) is an overuse injury of the lower legs.
- It is the result of the lower leg muscles pulling on their attachment sites at the tibia (shin bone) during activity.
- Pain or ache is felt on the inside of the shin bone.
- At first pain is felt at the beginning of activity but can progress to the entirety of the activity and afterwards if the condition is allowed to worsen.
- It usually occurs with recurrent impact activity such as running and jumping.
- There are many risk factors for medial tibial stress syndrome.
- MTSS can lead to tibial stress fracture.
- Physical therapy is very successful in aiding recovery and returning to activity.
- Contact an orthopedist if you suspect a stress fracture.
- There are many things that you can do:
- Relative rest
- Once returning to activity, start at 50% intensity, distance, and frequency.
- Ice
- Compression socks
- Stretching
- Strengthening
- Shoe wear and orthotics
- Relative rest
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Medial_Tibial_Stress_Syndrome
https://www.ncbi.nlm.nih.gov/books/NBK538479/