WHAT IS MEDIAL TIBIAL STRESS SYNDROME (MTSS)/SHIN SPLINTS?
- Medial tibial stress syndrome (MTSS), more commonly known as shin splints, is a common overuse injury of the anterior lower leg, which occurs when the shin bone becomes inflamed resulting in pain. Shin splints are typically seen in repetitive, high-impact sports such as running, dancing and basketball, as well as in the military recruit population. Certain factors may increase your risk of developing shin splints such as flat feet, rigid arches or wearing worn out or unsupportive shoes while being physically active. If left untreated, shin splints may develop into stress fractures of the tibia.
WHAT ARE THE SYMPTOMS OF SHIN SPLINTS?
- Symptoms of shin splints include dull or sharp pain along the lower two-thirds of the shin, and pain that worsens during or immediately following physical activity that improves with rest. Pain may be felt along one or both shins.
- There is no severe swelling, burning or cramping associated with shin splints. Presence of these injuries likely indicate a different diagnosis.
HOW ARE SHIN SPLINS DIAGNOSED?
- Diagnosis is based on detailed history, physical examination, and imaging. While a patient’s history and findings on physical exam often provides adequate information for the clinical diagnosis of shin splints, imaging may be utilized to rule out other similar lower extremity injuries and determine whether a more severe stress injury is present.
HOW DO YOU TREAT SHIN SPLINTS?
- Initial treatment of shin splints consists of rest, ice, NSAIDs, and physical therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain relief and physical therapy may be utilized to improve strength and flexibility of the surrounding musculature. Orthotics and supportive, appropriate footwear may help address contributing mechanical issues.
- Shockwave therapy may be used as an adjunctive therapy for shin splints. Shockwave therapy initiates the body’s natural healing process by improving circulation and speeding up healing and tissue regeneration with the aim of reduction in pain and increase in function.
- One case-controlled study by Rompe et al., measured pain severity and ability to return to sport in populations diagnosed with shin splints for greater than 6 months. The two groups received either a home training program and 3 shockwave therapy treatments, or just a home training program. Those who received shockwave therapy in addition to the home program had lower pain severity ratings at 1, 4 and 15 months and more participants able to fully return to their sport. Additional high level evidence is necessary to determine treatment parameters and protocols for shockwave therapy for shin splints moving forward.
- In instances where conservative management is unsuccessful and the injury persists or worsens, surgery for more severe cases may be necessary.
REFERENCES
Rompe JD, Cacchio A, Furia JP, Maffulli N. Low-Energy Extracorporeal Shock Wave Therapy as a Treatment for Medial Tibial Stress Syndrome. The American Journal of Sports Medicine. 2010;38(1):125-132. doi:10.1177/0363546509343804
