(AKA Shin Splints)
This is one frustrating Repetitive Stress Injury (RSI) that can and should be prevented from ruining a competitive season!!
What is it??
Medial Tibial Stress Syndrome is a periostitis of the inside of the tibia (long bone in the lower leg) and is described as a “tearing away” of muscle fibers at the muscle-bone interface that results in sub-periosteal hemorrhage and inflammation! MTSS can progress to tibial stress fractures if not managed accordingly!!
Symptoms of Medial Tibial Stress Syndrome:
- Pain @ inside/back of Tibia
- Dull ache progressing to sharp pain
- Pain starts with activity and reduces then increases again at or near end of activity
- Swollen lower leg
- Lump and/or bump @ lower leg
- Pain with ankle/foot/toe plantar flexion (pointing down)
- Pain is relieved by rest
- Generally normal x-rays!
Causes of Medial Tibial Stress Syndrome:
- Increased training intensity and/or mileage
- Running down-hill
- Uneven running surfaces and road pitch
- Weak dorsi-flexors (toes pointing up) and strong plantar flexor (toes pointing down) muscles
- Over-pronation!! (major cause)
- Inadequate calcium intake!
- Shoe Fatigue (change shoes about the 400 mile range)
- Body compensation/imbalances – leg length discrepancy, mal-aligned body mechanics, etc.
Management of Medial Tibial Stress Syndrome:
- Ice (30 minutes 3X/day)
- Activity modification: swimming, Rowing Erg, Recumbent bike, etc. (Relative Rest!!)
- Kinesio-taping and compression socks
- Orthotics to correct pronation and foot faults and/or motion control shoes
- Adjustments to create alignment of foot, ankle, knee, hip and Sacroiliac Joints
- Clear out muscular imbalances @ hip (External rotators), hip flexors (Psoas), and Adductors
- Iontophoresis (2-3X/week for three weeks)
- Strengthen Tibialis Posterior, Soleus, Gastrocnemius and FDL muscles (muscles that control pronation)
Nutritional Anti-Inflammatory Protocol: avoid sugar, trans-fats, grains and dairy!, increase hydration, add proteolytic enzymes 3-5 tid, Omega 3 fatty acids (fish oil 3-9 grams/day, Collagen forming amino acids, horsetail herb, and Calcium as MCHC.
MTSS and all RSIs are the result of a combination of contributing factors – so with this in mind, embrace a comprehensive approach to diagnosis and management by a sports- minded practitioner to shorten the healing window and prevent re-occurrence!!