Medial Tibial Stress Syndrome

June 1, 2022

Shin Splints or Exercise Induced shin pain or Medial Tibial Stress Syndrome

What is it?

Exercise Induced Shin Pain or medial tibial stress syndrome, both commonly known as shin splints is a painful condition commonly experienced by runners or running athletes. It is characterised by pain along the medial border of the tibia (shin bone) which tends to progress with exercise. Exercise induced shin pain is the early stage on the continuum of a bone stress injury, characterised by repeated microdamage with inadequate recovery. Exercise induced shin pain which can be quite vague in pain distribution, then without appropriate intervention, can lead to bone stress reactions or stress fractures where pain becomes increasingly more localised.

How does it happen?

When we load a bone, we cause microdamage which stimulates bone cells (osteoblasts, osteoclasts and osteocytes) to help strengthen and remodel the bone, thereby increasing the bones tolerance to stress. If the microdamage takes place with inadequate recovery and time between sessions for bone cells to appropriately repair, the microdamage never completely recovers and can lead to microcracks in your bone. This process is what initiates exercise induced shin pain. If this is not appropriately managed through adequate rest or significant load management, these microcracks will further escalate by expanding through the entire width of the bone, resulting in a fracture.

Risk Factors:

Rapid change in training stimulus: volume, intensity and surfaces

Weekly running distance increase > 30%

Inadequate recovery between sessions

Biomechanics resulting in increased bone loading at specific points. Some examples may in some cases include increased pelvic drop, increased hip internal rotation and high navicular drop

Female sex

RED-S (relative energy deficiency in sport)

What do we do about it?

A period of rest is essential to eliminate any further loading and stress to the bone. How much rest is needed is very individual depending on the severity of the injury. Throughout this period, your usual sport may be supplemented with low impact activities including cross training (e.g. swimming) or resistance training other areas of the body, that is not going to be stressing the injury further. 

Once we have established that you are able to return to impact, we will develop a graduated return to running program. This may look like a walk run program initially and will progress you all the way until you have reached your goals.

In some cases, we may consider referring you to a Podiatrist for further assessment and advice on how we can get you back to your sport as quickly as possible.