Medial tibial stress syndrome (MTSS) is also known as shin splints. This is due to overuse or stress in the shin area (the front of the lower leg between the knee and ankle). According to the American Medical Association (AMA), MTSS is defined as “pain and discomfort in the shins of the legs due to repeated running on hard surfaces and forced overuse of the flexors of the foot.”
MTSS is common among athletes who have recently strengthened their exercise and training routines. These increased activities overuse tendons, bone tissue, and muscles. The majority of MTSS cases can be treated with self-care measures such as ice packs, rest, and proper shoe wear. Also, changing the exercise routine can help prevent the recurrence of MTSS.
MTSS is a common sports injury. The incidence is about 4% to 20% in the athletic population and about 4% to 35% in the military population. MTSS is most common among runners and jumping athletes when their training program changes. Changes include increased intensity, duration, and distance of physical activity.
What is the cause of MTSS?
The continuous stress of the tissue that connects the tibia and muscle to the bone leads to MTSS.
What are the common symptoms of MTSS?
If you have pain, pain, or tenderness on the inside of the tibia and a slight swelling on the lower leg, you may be suffering from MTSS. Initially, the pain in the shin splints may stop after you stop exercising.
What are the risk factors for MTSS?
MTSS usually occurs due to repeated stress on the connective tissue that attaches the tibia and muscles to the bone. You run the risk of suffering from MTSS if:
● Starting a running program to become a runner
● The frequency, intensity, or duration of exercise suddenly increased
● Run on uneven surfaces such as hills, mountains, concrete areas and other hard surfaces
● You are undergoing military training
● I have flat feet
● The arch is high
● You are a woman suffering from osteoporosis (a condition in which your body has too little or no bones).
● My legs are out of balance
● Calf muscles are tight
MTSS is common among people who are actively involved in the following influential sporting activities:
● Military training
How is MTSS diagnosed?
MTSS is usually diagnosed by physical examination, taking into account the medical history. In some cases, healthcare professionals can request an x-ray or image scan to help identify possible causes of MTSS, such as stress fractures.
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How to handle MTSS?
In most cases, MTSS can be treated with simple self-care procedures. Some of the self-care treatment options for the treatment of MTSS are:
● Acute phase: This treatment phase includes the remaining approximately 2-6 weeks of medication to resume activity as soon as possible. Treatment options are as follows:
○ Ice – Apply an ice pack to the injured shin for approximately 15-20 minutes. Run the same routine 4-8 times a day for several days. This helps relieve pain. To protect your skin, you can wrap the ice pack in a cloth or a thin towel.
○ Rest – If you feel pain, take a break for a while. However, you should not give up physical activity altogether. Rest can heal the pain caused in the tibia in a few weeks.
○ Over-the-counter medications – If the pain is severe, you can choose over-the-counter medications such as ibuprofen, naproxen sodium, and acetaminophen to relieve the pain.
● Subacute phase: During this treatment phase, training routines need to be modified to address the problem. Treatment options are as follows:
○ Changes in training routines – After basic treatment, you need to change your training regimen. It also addresses the problem by reducing the duration and intensity of the activity.
○ Stretching and Strengthening Exercises – Focus on calf stretching and eccentric calf exercises to prevent muscle fatigue.
○ Footwear – Choose footwear that includes the appropriate shock absorbing sole and insoles to prevent MTSS outbreaks.
○ Brace – Pneumatic brace is recommended for severe MTSS cases and stress fractures
● Other treatment options
○ Extracorporeal shock wave therapy – This therapy is used to treat a variety of tendon disorders in the lower extremities.
○ Injections – Various injections, such as cortisone, are used to treat MTSS.
○ Acupuncture – Acupuncture is also recognized as one of the treatment options for MTSS.
However, the effectiveness of these other treatment options is unclear due to conflicting results.
Therefore, if treatment options such as ice packs, over-the-counter medications, and rest do not help relieve pain, you should consult your healthcare professional.
How to prevent MTSS?
If the pain is severe, the individual can seek professional help. However, self-analysis and observation of changes in exercise routines can help prevent MTSS. To avoid MTSS, do the following:
· Choose the right shoes – shoes can help speed up your activity. For runners, it is recommended to change shoes every 600-800km.
• Avoid overdoing – Running too much or doing other high-impact activities for long periods of time can increase your shin load.
· Motion Analysis – Video analysis of running techniques can help identify movement patterns that lead to shin splints. You can reduce MTSS events by slightly changing your running behavior.
· Choose a shock-absorbing insole – a shock-absorbing insole reduces the symptoms of MTSS and prevents the recurrence of pain
· Consider arch support – arch support helps prevent MTSS, especially for flat feet
• Low-impact activities – Sport training often begins with low-impact activities such as walking, swimming, and cycling. Always start new activities slowly and gradually increase the time and intensity of the activities.
• Strengthen your workout routine – Strengthen your workouts to stabilize your ankles, hips, and legs and prepare you for high-impact sports.
People suffering from MTSS are very likely to be re-injured, especially due to training errors, poor skill, and misalignment. Therefore, doctors, therapists, coaches, etc. need to educate athletes on injury prevention and work on ways to prevent the occurrence of MTSS.
The growing popularity of physical and sporting activities leads to an increase in the number of people suffering from sports injuries such as MTSS. This usually results from regular physical activity and exercise skills and changes in duration. MTSS can be treated with self-care, including ice packs, rest, and application of painkillers. If the pain persists and increases over time, you should immediately consult a healthcare professional.