Shin Splints medial tibial stress syndrome
Shin splints, also known as medial tibial stress syndrome, is the catch-all term for lower leg pain that occurs below the knee either on the front outside part of the leg (anterior shin splints) or the inside of the leg (medial shin splints).
The condition typically involves only one leg, and almost always the athlete’s dominant one. If the athlete is right-handed, he or she is usually right-footed as well. Thus, the right leg of this individual would be more susceptible to shin splints.
Shin splints often plague beginning runners who do not build their mileage gradually enough, as well as seasoned runners who abruptly change their workout regimen by suddenly adding too much mileage or switching from running on flat surfaces to hills, to cite just two examples below we list other risk factors.
Risk factors for medial tibial stress syndrome
What factors put physically active individuals at risk to develop medial tibial stress syndrome (MTSS)? Doctors at Indiana State University wrote in the Journal of athletic training:
- body mass index (BMI), navicular bone drop (the navicular bone, one of the small bones located at the instep or arch of the middle of the foot, drops out of place as the foot-arch complex becomes unstable due to excessive pronation (tilt).
- ankle instability causing hyper plantar-flexion range of motion
- quadriceps angle,
- hip instability causing hyper plantar-flexion range of motion. 1
Doctors from Regis University and St. Louis University also wrote in the medical journal Sports health that not only was hip external rotation factors involved in greater risk for developing medial tibial stress syndrome but risk factors also included:
- Being female
- previous running injury.2
Doctors at Tokyo Medical and Dental University examined runners for Medial tibial stress syndrome (shin splints) to determine risk factors for High School age athletes.
Here are their findings:
- In females, higher Body Mass Index significantly increased the risk of Medial tibial stress syndrome
- Increased internal rotation of the hip significantly increased the risk of Medial tibial stress syndrome
Instability and excessive joint movement, besides being a risk factor for shin splints are risk factors for osteoarthritis and degenerative joint disease. In the ankle and hip, stabilizing ligaments may be worn or damaged; Ligament laxity (looseness) is a primary cause of joint instability.
The issue of does hip instability cause lower leg issues such as shin splints and ankle instability or whether lower leg injuries such as shin splints and ankle instability cause hip instability is still much debated, as pointed out by a team lead by Israeli researchers publishing in the journal The Physician and sports medicine. 5 One thing for sure, is that in Prolotherapy treatment all areas can be examined and treated to prevent a constant cycle of hip/foot/ankle pain problems.
Since shin splints are felt as intense pain in the leg, traditional treatment usually involves rest. This is after other measures, such as taping the arches, using heal cups in the athletic shoes and applying topical creams to the sore muscles have failed to give relief. The problem with this approach is that resting the muscles and the periosteum, or the bone covering, will further weaken the already weak structures. It does not repair the weakened ligaments of the hip and ankle.
Dutch doctors also warn against the use of corticosteroids, in the conclusion to their research, the investigators found “no positive effect of injections with corticosteroids. . . Furthermore, considerable tissue atrophy and hypopigmentation of the skin was observed.” Corticosteroids made the condition worse.3
As discussed in the videos, we have found that shin splints respond very well to Prolotherapy. As the ligament and tendon attachments strengthen, the athlete can continue to get back to working out.
Are you a candidate for our non-surgical treatments? Ask our specialists:
- Ross Hauser, MD | Danielle Steilen-Matias, PA-C | Katie Worsnick, PA-C | David Woznica, MD
1 Winkelmann ZK, Anderson D, Games KE, Eberman LE. Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. J Athl Train. 2016 Nov 1. Indiana State University. [Pubmed] [Google Scholar]
2 Reinking MF, Austin TM, Richter RR, Krieger MM. Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors. Sports Health. 2016 Oct 11. pii: 1941738116673299. [Pubmed] [Google Scholar]
3 Loopik MF, Winters M, Moen MH. Atrophy and Depigmentation After Pretibial Corticosteroid Injection for Medial Tibial Stress Syndrome: Two Case Reports. J Sport Rehabil. 2016 Aug 24:1-9. [Pubmed] [Google Scholar]
4. Yagi S, Muneta T, Sekiya I. Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners. Knee Surg Sports Traumatol Arthrosc. 2013 Mar;21(3):556-63. doi: 10.1007/s00167-012-2160-x. Epub 2012 Aug 9. [Pubmed] [Google Scholar]
5 Steinberg N, Dar G, Dunlop M, Gaida JE. The relationship of hip muscle performance to leg, ankle and foot injuries: a systematic review. The Physician and sportsmedicine. 2017 Jan 2;45(1):49-63. [Pubmed] [Google Scholar]