Medial Tibial Stress Syndrome!

 (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
  • Redness
  • 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!!

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Dr. John Michie

About Dr. John Michie

John L. Michie, D.C., C.C.S.P., founder of Whole Health Chiropractic, embraces Edison's wisdom and incorporates a balance of nutrition, exercise, physiotherapy and chiropractic care to positively impact his patients’ health. Whole Health Chiropractic is a holistic, patient-centered practice. "It's our goal to uncover the causes of debilitating symptoms and follow with an action plan that addresses necessary steps for sustained healing."

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