Medial Tibial Stress Syndrome (MTSS)

Medial Tibial Stress Syndrome (MTSS) is also known as shin splints. It happens because of the overuse of or stress in the shin area (front of the lower leg between the knee and ankle). MTSS is pain and discomfort in the shin area of the leg from repetitive running on hard surfaces or forcible, excessive use of the foot flexors.

MTSS often occurs in athletes who have increased their exercise and training routines. These increased activities overwork the tendons, bone tissues, and muscles. Most of the MTSS cases can be treated with ice packs, rest, self-care and modification of the exercise routine.

Is MTSS common? 

MTSS is a common sports injury with an incidence rate of around 4% to 20% in the athletic population and around 4% to 35% among the military population. It is common among runners and jumping athletes when there is a change in their training regime. Changes include increases in intensity, duration, and distance of physical activities.

What are the causes of MTSS?

Continuous stress in the shinbone and the tissues that connect the muscles to the bone, leads to MTSS.

What are the common symptoms of MTSS?

Soreness, pain, or tenderness on the inner side of the shinbone and mild swelling in the lower leg are some common symptoms of MTSS.

What are the risks involved with MTSS?

MTSS is usually caused due to repetitive stress on the shinbone and the connective tissues that attach the muscles to the bone. You are at risk of suffering from MTSS if:

•  You are beginning running training to become a runner
•  You have suddenly increased the frequency, intensity, or duration of exercise/workouts
•  You run on uneven surfaces such as hills, mountains, concrete area, or any other hard surfaces
• You are in military training
• You have flat feet or high arches
• There is an imbalance in your leg
• There is tightness in your calf muscles

MTSS is diagnosed in people who are active in high impact sports activities such as:

• Basketball
• Running
• Gymnastics
• Military training
• Dancing

How is MTSS diagnosed?

MTSS is diagnosed with a physical examination while considering medical history. In some cases, healthcare professionals can ask for an X-ray or imaging scans to help identify the possible causes of MTSS such as stress fracture.

MTSS treatments?

In the majority of cases, MTSS can be treated with simple self-care steps. Some of the self-care treatment options for the treatment of MTSS are:

• Acute phase: This treatment phase includes  rest of around 2 – 6 weeks with medications in order to resume your activities at the earliest. Here are some of the treatment options
  – Ice – Apply ice packs to your injured shin for around 15 to 20 minutes. Follow the same routine four to eight times a day for a few days. This will help with relief from the pain. To protect the skin, you can wrap the ice pack in a cloth or thin towel.
• Rest – When you feel pain, rest for some time. However, you should not give up physical activities completely. Rest can heal the pain caused to the shin bone in a few weeks.
• Over-the-Counter Medicines – If the pain is severe, you can opt for over-the-counter medicines such as ibuprofen, naproxen sodium, and acetaminophen to reduce the pain.
• Sub-acute phase: This treatment phase requires modification in the training routine to address the ISSUE . The treatment options include:  
• Modify your training routine – After the basic treatment,  you should modify your training regimens. Also, address the problem  by reducing the duration and intensity of the activities.
• Stretching and strengthening exercises – Focus on calf stretching and eccentric calf exercises to prevent muscle fatigue.
• Footwear – Opt for  footwear that include appropriate shock-absorbing soles and insoles to prevent the occurrence of MTSS.
• Bracing – A pneumatic brace is recommended for severe MTSS cases and stress fractures
• Other treatment options
• Extracorporeal Shock Wave Therapy – This therapy is used for the treatment of various tendon disorders of the lower extremity.
• Injections – Various injections, such as cortisone, are used for the treatment of MTSS.
• Acupuncture – Acupuncture is also identified as one of the treatment options for MTSS.

However, the efficacy of these other treatment options is unclear due to conflicting results.

Thus, you should consult a healthcare professional if the treatment options such as ice packs, over-the-counter medications, and rest do not help to relieve the pain.

How to Prevent MTSS?

An individual can seek professional help if the pain is severe. However, self-analysis and observation of the variations in your physical exercise routine can help you to prevent MTSS. You can follow the following steps to avoid MTSS:

• Opt for the right pair of shoes – The shoes help to increase your activity speed. If you are a runner, it is advised to change your shoes after every 600 to 800 kilometers.
• Avoid overdoing  – Running too much or any other high-impact activity performed for a long time can increase the load on shin.
• Analyze movement – A video analysis of your  running technique can help you to identify the movement pattern that leads to shin splint. A slight change in the running movement can help to decrease the event of MTSS.
• Opt for shock-absorbing insoles – Shock-absorbing insoles reduce the symptoms of MTSS and also prevents recurrence of the pain
• Consider arch supports – Arch supports can help to prevent MTSS, especially if you have flat feet
• Lower  impact activities – To get trained for a sport, often start with lower impact activities such as walking, swimming, or cycling. Always start new activities slowly and gradually increase the time and intensity of the activities.
• Add strength to the workout routine – Strengthening exercises will help to stabilise ankles, hips, and legs, it will also help to get you prepared for high-impact sports

The people suffering from MTSS are highly susceptible to re-injury especially due to training errors, poor technique, and alignment abnormalities. Thus, physicians, therapists, coaches, and others should educate athletes and patients about injury prevention and work on ways to prevent the re-occurrence of MTSS.

Conclusion

The rising popularity and need for physical and sports activities leads to an increase in the number of people suffering from sports injuries such as MTSS. It usually occurs due to a change in the technique and duration of regular physical activities and exercises. MTSS can be treated with self-care that includes the application of ice packs, rest, and pain killers. If the pain persists and increases with the time one should immediately consult the healthcare professionals.