When addressing a lower leg injury between the knee and ankle (shin), Medial Tibial Stress Syndrome (MTSS), or more commonly known as shin splints, is an injury that affects athletes who primarily engage in running sports or any other prolonged plyometric activities. This condition is characterized by pain along the inside edge of the tibia (shin bone), which is the large bone in the lower part of the leg (below the knee). Shin splints and other tibial injuries can be caused by repeated trauma to the tibia and the connective muscle tissue surrounding the tibia through repetitive running activities or heavy plyometric (jumping) activities (running is also plyometric in nature).
What causes shin splints
Shin splints can usually be linked to overloading the muscles of the lower extremities with high mileage running programs, hard running surfaces, high impact activities (sprinting, jumping) or they can also be attributed to biomechanical and/or anatomical irregularities. If an athlete begins a running sport such as track and field or cross country and they end up running a lot of miles, jump too much, or at train at high intensities without progressing in their running or jumping program over a designated period of time, the overload of physical activity will put excess stress on the muscles, causing shin splints. Even if you have a progressive training program, muscle imbalances such as weak core muscles could cause shin splints injuries and inflexibility and tightness of the gastrocnemius and soleus may also contribute to shin splints as well.
If an athlete such as a track runner increases their activity, intensity, and duration too quickly, there is a good chance they will develop shin splints because the tendons and muscles are unable to absorb the impact of the shock force as they become fatigued. The pain associated with shin splints is caused from a disruption of Sharpey’s fibres that connect the medial soleus muscle’s fascia through the periosteum (membrane that lines the outer surface of all bones) of the tibia where it inserts into the bone. With repetitive stress from repetitive running and jumping activities (primarily in track and field), the impact forces eccentrically fatigue the soleus muscle and the repeated trauma to the tibia may even cause some micro-flexing, thus contributing to decreased performance and increased discomfort.
Common causes of shin splints:
- Excessive pronation while running.
- Engaging in excessive amounts of running, sprinting, and jumping activities.
- Running, sprinting, and jumping on hard surfaces.
- Excessive outward rotation of foot while running.
- Tight calf muscles.
Worst case scenario…
Ignoring a shin splints injury may result in a more serious condition such as a stress fracture or even worse, a broken leg (remember that basketball player from Louisville?). Females have to be extremely careful because they are more likely to develop stress fractures from shin splints due to poor nutrition habits. The unfortunate part about these poor nutrition habits is that they are found in young girls who are trying to maintain a low calorie diet because of the added pressures of body image.
Make sure you have an accurate diagnosis of shin splints in order to choose the most appropriate treatment. If you have a stress fracture, you will be required to rest until the bone has healed (2-5 months). If addressing shin splints, the inflammation of soft tissue can be initially treated with rest, ice (reduce inflammation), NSAIDS (ibuprofen), physiotherapy, or even chiropractic care. For ignored and severe shin splints, rest may be required for a couple of weeks. For athletes who notice the first signs of shin splints, they may be advised to decrease the duration or intensity of their training and then build it up slowly while minimize training at high volumes and at high impact (jumping) on hard surfaces.
- Try running shoes with a medial arch post (dark grey on medial part of shoe).
- Reduce high volume or intense impacts on hard surfaces.
- Decrease activity and build it back up slowly.
- Ice (10-20min).
- Increase calcium and vitamin D intake.
- Chiropractic care (nerves along the hips/spine may be entrapped).
- Stretch calf/soleus muscles.