Shin Splints or Medial Tibial Stress Syndrome (MTSS)

Presentation

MTSS or “shin splints” often time present as generalized pain on the inside of the lower leg bone during exercise.

Many associate this injury with runners, but it can occur in many activities, including but not limited to tennis, soccer and dancers. The underlying cause of MTSS is often multifactorial. Athletes often develop pain after a change in running or playing surface, changes in footwear, or sudden increase in how much or how hard they are exercising. It can stem from changes in these external factors but may also be an indicator of flat feet, lack of flexibility, weak lower leg muscles or a weak core. Athletes will notice the pain when first starting their workout. Sometimes the pain will improve with continued activity but sometimes it is strong enough that they have to stop their exercise.

Treatment

Most of the time shin splints will heal with simple treatments that can be done at home. Rest is important to reduce the stress on the muscles and bones. Low impact cross training, such as an elliptical or swimming, can allow athletes to continue to condition while decreasing the stress on the shins. Athletes should adjust their workouts based on pain; if pain is worsening, they are likely doing too much. They can also use ice after activity and over the counter pain medications as needed to reduce pain. They should also make sure that their shoe has enough support for their foot type. Adding an over the counter arch support may help to improve symptoms.

There are also simple stretching and strengthening exercises that improve symptoms and can help them return to activity. Stretching the calf muscles by dropping the heel off the edge of a step is one good stretch that can be held for 10 seconds and repeated 2-3 times. Stretching the front of the ankle may also improve symptoms. This can be done by kneeling on a soft surface with your legs/feet together and toes pointing back and slowly sitting back onto your calves until you feel a stretch on the front of the ankle. By simply sitting in a chair and writing the alphabet in the air with your big toe, one can improve range of motion and strength in the ankle, which can improve MTSS as well as prevent it from happening again.

Prevention

To prevent shin splints athletes should focus on maintaining good flexibility along with ankle and core strength. They should also take caution when increasing their activity. For example, runners should never increase their mileage more than 10% a week to allow the muscles to adjust to an increase in training. All athletes who are recovering from shin splints should be careful to ease back into their activities to prevent them from happening again. Being mindful of shoe wear during activity as well as training surfaces can also help athletes avoid developing shin splints.

When to seek medical help

Several other conditions can cause pain in the lower leg with activity, including compartment syndrome and stress fractures. If you continue to have pain even after rest, stretching and a slow progression back to activity, you should seek the advice of a sports medicine physician to see if you need further diagnostic testing to rule out other conditions.

AMSSM Member Authors
Donella Herman, MD