Medial tibial stress syndrome (MTSS) is an overuse injury or repetitive stress injury that affects the shin area. Athletes often subject their tibia and the surrounding connective tissue with too much force and their physical acidity levels also raise the risk of MTSS. This type of injury is more often seen in athletes that participate in sports that are require sudden starts and stops, such as basketball, soccer, and tennis (Mayo Clinic, 2010). Many athletes refer to MTSS as “shin splints”, but there exist a variety of injuries that can be sustained in the lower leg area and therefore a professional healthcare provider will need to accurately diagnose the athlete.
Signs and symptoms that are associated with MTSS are tenderness, soreness, and pain around the tibia area. There may be swelling in the lower leg area, as well. The prevalence of these signs and symptoms vary for each individual, but are usually more likely to be seen and/or felt during the exercise and may stop when the activity is discontinued. There may be complications in the diagnosis of MTSS, so the healthcare provider we need to do an in-depth history and physical exam to eliminate other causes that could be misconstrued as MTSS. Other measures that may be taken to ensure the correct diagnosis is provided include imaging, vascular and nerve conduction studies, and compartment pressure measurements (Galbraith, 2009).
The cause for MTSS is the excessive force, the overloading, of the tibia bone and the connective tissues of the muscle of the tibia area (Mayo Clinic, 2010). The athlete engaging in a running program or exercise program that has implemented running too hard, too fast or for too long may cause the injury. Specific athletic activities that can cause and overload on the tibia area include running on a decline, running on an uneven surface, participating in sports with constant stops and starts, and running inadequate footwear (Mayo Clinic, 2010). The injury is often a combination of both training errors and biomechanical abnormalities.
Although MTSS is usually not that severe injury, it can be somewhat debilitating and may even progress into more complicated injury if not treated properly. Rehabilitation includes ice, rest, and analgesic in the first 48-72 hours (Galbraith, 2009). The healthcare professional may also suggest discontinuing the activity that is suspected of being the culprit of the injury. Usually, decreasing by the weekly running distance, frequency, and intensity by 50% will likely improve the symptoms, so completely stopping activity may not be warranted (Galbraith, 2009). The healthcare professional may suggest or recommend someone more knowledgeable that can prescribe a specific training program for stretching and strengthening the lower extremities. Other recommendations may include modifying the athlete’s previous training routine, implementing the use of orthotics, wearing the appropriate footwear, and the use of manual therapy to correct biomechanical abnormalities (Galbraith, 2009).
The key to treatment for MTSS is the prevention of the injury. Athletes are more susceptible to incurring the same injury if the errors in their previous training program are not corrected and the alignment of the abnormalities are not corrected by a competent healthcare professional. An athlete that partakes in an extracorporeal shockwave therapy (ESWT) compared to a graded running program will recover significantly faster, respectively 59.7±25.8 and 91.6±43.0 days (Moen, 2011). The length of recovery is dependent upon the severity of the injury, the adherence to the prescribed rehabilitation program set forth by the healthcare provider, and the individual person’s biomechanical abnormalities.