Pain in the Leg

Do you ever wonder what the term shin splints means? The term shin splints has been widely used as a catch-all term referring to a collection of different conditions that cause lower leg pain. The term Medial Tibial Stress Syndrome (MTSS) better defines the injury and separates it from injuries such as stress fractures or compartment syndrome. MTSS is caused by chronic strain, overuse, and microtrauma of the soleus (calf) muscle at its origin on the inside of the shinbone (posteromedial tibia), or deep inflammation of the periosteum, which is the connective tissue that covers the bone, of the tibia beneath the posterior tibialis muscle. MTSS usually occurs in unconditioned people who begin a new running or jumping activity or conditioned runners who change or increase their speed or distance or change their type of shoe or running terrain. MTSS also affects individuals who have flat feet because the mechanics of the foot increase stress on the soleus muscle.

MTSS is the most common presentation of lower leg pain, with pain localized to the inner portion of the tibia in the middle/lower thirds of the lower leg and in the surrounding soft tissue. With MTSS, pain usually disappears once the activity that causes the pain is reduced or stopped. An X-Ray sometimes shows chronic cases of MTSS, where there is a mild thickening of the tissue surrounding the tibia (periostium) or an uneven edge at the end of the tibia in the back. Despite being the most common of lower leg complaints, MTSS is often a common misdiagnosis for similar conditions such as stress fractures and compartment syndrome.

It is important not to forget that stress fractures can also give you pain in the leg. It often follows as a result of shin-splints that have not been managed correctly or when patient tries to “run-through” the problem which is why it is important to manage MTSS correctly.

Major causes are;
Flat feet
Calf tightness
Poor shoes or old shoes
Rapid increase in training workload; either speed or distance

Things to look out for;

Aching along the front of the shin with activity. The pain may begin as a dull aching sensation after running. The aching may become more intense, even during walking, if ignored.
Pain along the inside (medial) part of the lower leg

Generally, develops gradually over weeks/months

May have swelling in lower leg

Tender areas are often felt as one or more small bumps along either side of the shin bone.

Things to do to manage it;

Initially you can manage it with rest, ice and anti-inflammatories (ie nurofen, voltaren). Physiotherapy at this stage will involve ultrasound, light massage, and education with guidelines into exercise intensity and frequency. This aims to settle and relieve the inflammatory process thereby relieving symptoms. More intense physiotherapy can then be commenced. It usually involves, deep tissue massage, Myofascial releases, muscle frictions, structure rehab programs to increase flexibility, strength and endurance and gradual recommencement to normal activities. Throughout rehabilitation your physiotherapist will advise you on continuing aerobic fitness activity, however it will likely be modified to reduce lower limb impact (ie swimming, orbital training, beach walking/running)

Conclusion; MTSS can be painful but is usually easily resolved. If you experience pain in your shin, thoroughly stretch before exercising, reduce your activity level, and check your footwear. If you run on a hard surface, find some softer ground to train on. Avoid training errors (‘start low and go slow’). Introduce gradual changes in intensity, activity, and terrain. Maintain adequate calf and anterior tibial flexibility, strength, and endurance.

Happy Running!

1 reply
  1. Kim OLeary
    Kim OLeary says:

    I had a patient in the Como Physio Pro / Biotech Physiotherapy clinic this week who reminded me of this blog. He had been treated previously for shin splints / MTSS but upon clear history taking of the onset of pain he was provisionally diagnosed in the clinic as compartment syndrome which was confirmed by the sports doctor with follow up testing. Although the predisposing factors such as fallen arches, tight muscles, poor biomechanics were all there the management required and long term prognosis was vastly different.

    Reply

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