Pre-season injuries: medial shin pain/ MTSS / MTP / ‘Shin Splints’

 
Most people have heard the term shin splints which is a generalised term covering a number of different injuries in the shin area. This term is slowly being phased out by medical professionals as it doesn’t accurately describe the precise pathology of what is happening at a cellular level in the shin.   Most importantly however, there are multiple unique causes of shin pain; tibialis anterior tightness, stress fractures, tibialis posterior tendinosis and referred pain from the lower back.  Therefore, each injury needs to be diagnosed specifically so that the treatment can match the problem!

This blog focuses on medial shin pain (through the inside of the tibia bone) which is known as Medial Tibial Periostitis (MTP). Basically what happens is inflammation develops at the insertion of the muscles (tibialis posterior & soleus).  This creates a traction force where the muscle inserts to the inside of the tibia bone.  Commonly people with MTP will complain of a general pain along the inside of the tibia bone.  If the pain is more focal, you should be suspicious of a stress fracture. It is not uncommon for MTP to develop into a stress reaction or stress fracture if left untreated! The best way to diagnose a stress fracture is a bone scan, and your physio can speak to you about whether or not this is necessary in your particular case.

There are a number of reasons why MTP can develop –

  • Athletes with flat feet: (excessive pronation) where the soleus & tibialis-posterior muscles are placed in a lengthened position and are required to contract harder & longer while running, leading to chronic traction on the bone.
  • A high-arched foot has limited shock absorbtion therefore increases the impact pressure on the tibia bone. Tight calf muscles are often involved, as well as weakness of the calf and tibialis-post muscles.
  • Training error, or a recent increase in training load will be bring on MTP. Similarly the surface that the athlete is training on (concrete/grass/track) can also play a part.

Treatment for Medial Tibial Periostitis needs to be specific to the individual patient & will be dependent on the cause. Initially treatment begins with symptomatic relief; including rest from running (or the aggravating activity). The athlete can usually continue with cross-training such as swimming or cycling provided its pain-free. I generally encourage firm ice-massage down the inside of the tibia 1-2 times per day, and anti-inflammatories (either prescribed from sports physician, or from pharmacy).

The correct footwear is essential! This may require visiting a podiatrist, or specialist shoe store where they look at you running on a treadmill. Regular calf stretches are important (see pics above!), as well as addressing any strength issues through the calf, tibialis-posterior muscle, or any other biomechanical weakness in the core, lower back and hip.

Balance is very important – you can see a video of Fiona in our Pilates studio doing a great exercise to retrain balance:

Your physio can assess you for these causative factors and guide you towards the best strengthening exercises for you. Soft-tissue massage through the calf and inner tibia your physiotherapist is also recommended, though may be painful!

Lastly looking at your training schedule and loads is important, this may involve speaking to your coach or trainers. When you are ready to return to running/sport, a graduated return should be prescribed.