Medial Tibial Stress Syndrome (Shin splints)
What is it?
Medial Tibial Stress Syndrome (MTSS) is a common overuse injury in runners and is described as exercise-induced pain down the inside border of the shin bone.
Symptomatic of this is pain provoked by physical activity and reduced by relative rest. Pain may also be felt by pressing the inner aspect of the shin bone and is caused by inflammation of the periosteum* along this bone.
*The periosteum is a fibrous tissue that covers the outer surface of the bone, it plays an important role in bone growth and repair
What causes it?
Although ‘training error’ may be the most likely cause of the pain, biomechanical issues may also be part of the picture.
There is evidence pointing to the potential for a range of muscular imbalances:
- calf weakness or tightness
- excessive foot pronation
- foot arch issues
- imbalance in strength and/or flexibility between the hamstrings and the quads.
All of which your therapist should examine and assess.
In addition, hip and core strength are implicated in lower limb injuries more generally, meaning these will also benefit the rehabilitation process.
Rehab
As with all overuse injuries, the immediate treatment is to manage load through a reduction in aggravating activities.
This should encompass a reduction in running distance, frequency, and intensity, but can also include the introduction of a low impact activity, like cycling.
If this is not the first time of experiencing MTSS or it is a persistent problem, it may be worth assessing your walking and/or running gait, which again will be suggested by the therapist. So, in all the spare time created by cutting down on the running, there are plenty of exercises that can still be done to help you get strong, and plenty of time to do it in!
Summary
- Common overuse injury, often seen in runners.
- Exercised induced pain, often on the inside border of the shin bone.
- Immediate reduction in the amount of load placed upon the lower limb is recommended, being replaced by non-weight bearing activities such as swimming, cycling etc.
- Assessment of muscular imbalances should be made by a therapist.
- Hip and core stability and strength exercises should begin.
- Full assessment of walking or running gait is recommended.
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Here's a great beginner workout for anyone looking to improve their strength and mobility with a few simple circuits. All from the comfort of your own home! There are four circuits in the programme: Upper body Lower body Core Balance Simply click on the workouts below to download or print them.
What should a programme be? A good exercise programme should be first and foremost FUN. This can mean numerous things; exercising with a friend, time to yourself, challenging exercise, not so challenging, being outside, etc, etc. The most important thing is knowing what you enjoy then you’ll continue with it. The best exercise is the exercise that gets done! The second most important ingredient is variety. Ideally your exercise programme should contain elements of cardiovascular exercise (anything that gets the heart and lungs working a little harder) and strength work. Cardio? As far as cardiovascular exercise is concerned, I’m a big advocate of doing it outside. Also as stated above make it enjoyable; walking or cycling with friends, swimming, etc. Ideally you get outside once a day and if you have a fancy watch that measures your steps, set yourself and your friends a target and encourage each other to achieve it. If you need the promise of a cup of coffee in the local cafe that is fine too. Strength? As we get older the amount of muscle we have slowly decreases, so it’s important for us to maintain it. A good strength programme will... assist in preserving a good range of movement of all your joints challenge your balance so as to maintain your confidence in your physical ability as well as maintaining and possibly increasing your strength And who doesn’t like the feeling of being strong?! So when planning a strength programme think of big movements like the sit to stand and the squat and press, the balance work and core stability. A Final thought Please stay away from the latest gadget or diet that’s promising quick results! Keep it simple and have lots of fun.
What is it? This is a common condition, often described as the most prevalent overuse injury of the knee. Symptomatic pain arises behind or around the kneecap, also known as the patella, and is likely to have a gradual onset rather than result from a single incident of injury. Pain is likely to be associated with activities like squatting, running, using stairs, and potentially any movement where the knee is loaded in a flexed position, though it can also occur with prolonged sitting with the knees bent. Patellofemoral pain is a clinical diagnosis reached by excluding alternative and more specific conditions (e.g. patellar tendinopathy, bursitis, osteoarthritis). What causes it? There are likely to be signs of reduced muscular control and strength that are believed to contribute to biomechanical impairment of the patellofemoral joint. However, given the slow onset of pain and its potential to then become persistent, like other overuse injuries, symptoms can be complicated with a growing belief that the condition is worse than it is (‘catastrophisation’) and fear avoidance (‘kinesiophobia’). This introduces the need to consider and resolve aspects of pain sensitisation and wider psychological factors to successfully treat the condition. Rehab There is a body of high-quality evidence showing the effectiveness of combining knee and hip exercises in the treatment of patellofemoral pain syndrome. In the short-term, patellar taping, foot orthoses (to counter biomechanical issues, for example, relating to excessive rear-foot eversion and mid-foot pronation), stretching, and some hands-on therapy may be useful for reducing pain. These are not, however, believed to help beyond the short-term and exercise is currently seen as the critical element in a treatment programme. Similar to other conditions described as overuse injuries, the complete avoidance of pain-provoking movement and a ‘wait and see’ approach are not seen to be effective at improving pain and function. Summary Often referred to as an overuse injury, rather than the result of a single incident. Pain can be felt behind or around the kneecap. Pain can be associated with running, squatting, using stairs and/or prolonged periods of sitting. It is important to speak with a therapist about strengthening the muscles around the hips and knees. The therapist will also assure you that complete rest is not the answer and movement is both ok and vital.
What is it? A painful overuse condition presenting as lateral knee pain, often brought on by running or cycling. The iliotibial band (ITB), is a thick area of fascia (connective tissue) which runs from the lateral aspect of the pelvis and inserts into the lateral aspect of the tibia. There is some debate as to which tissues are affected, however it is thought that the tightening of the muscles around the hips, results in the ITB becoming taught, which in turn creates pressure upon the lateral tissues around the knee. Typically the pain will feel sharp, and may appear at the same point or duration of the run, walk or cycle ride, it may feel like the tightness is building and forcing the individual to stop. The pain may also come on during a squat or walking down stairs. What causes it? It is very important to understand that there isn’t an issue with the tissues of the knee. The pain is being caused by the pressure being placed upon the tissues below the ITB, not the tissues themselves, rather like pressing down upon a bruise. Rehab Your therapist will need to know what activities you have been undergoing and how this may have increased, or changed since you began experiencing the pain. With this information it will be a case of load management or bringing any changes, such as hill running back in slowly. Filming your running gait is a useful tool, this may show you and the therapist that there are some movement patterns which are leading to the pressure build up. Running drills and/or strengthening exercises will then be offered as a treatment. Most importantly though, don’t stop running! ITB syndrome can be painful, however pain doesn’t always equate to damage and speak with us at ParnellHarper about your running programme and how much the knees are being loaded.