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. However, some athletes will complain of bilateral shin splints that have the same severity on each side.
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. They can also occur if someone runs in poor footwear or changes to a new type of running shoe. These are just several examples; we have laid out more risk factors below:
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). Increased BMI means increased pressure on your legs and joints as you run, which could lead to shin splints
- navicular bone drop. 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 Ankle instability can cause hyper plantar-flexion range of motion (increased ability to point your toes down). Simultaneously, it can cause increased difficulty dorsiflexing the foot (pointing toes up), which causes the muscles that dorsiflex the foot (anterior shin muscles) to be overactive and increase stress on the shin.
- quadriceps angle. Commonly called the “Q angle”, this is the measurement of the angle between your quadriceps muscles and patellar tendon. This angle helps us determine the alignment of your knee. Increased Q angles, more common in women, can contribute to the development of shin splints.
- hip instability This can cause hyper plantar-flexion range of motion, similar to that which can be found with ankle instability. In addition, instability of the hip can increase forces on the tibia during activity or alter the Q angle, both of which increase torque on the lower leg and lead to shin splints. 1
- Simply putting too much pressure on the tibia from reasons listed above (change in running habits, change in shoes, etc). Changes such as these can simply cause increased pressure on the tibia in the absence of joint instability and cause the development of shin splints.
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 joint instability causing shin splints 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 that may be contributing, nor does it repair or undo the stress done on the tibia and surrounding soft tissue.
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 splint pain responds very well to Prolotherapy. Whether the pain is from the actual shins themselves or instability of surrounding joints, Prolotherapy works to strengthen weakened or damaged tissue and get rid of pain. As the soft tissue attachments strengthen, the athlete can continue working out with a personalized rehabilitation schedule that can help them meet their exercise and training goals.
29 y/o male with history of shin splints presented to the office as a new patient. For the past 4 years, he has been suffering from shin splints when running, which he attributed to running in worn out shoes for several years. He reported that his shins were in intense pain and “clicked” when running. He had tried rest, ice, ultrasound, stim, and chiropractic care for several years without any long term benefit.
On exam, no instability in his hips, knees, or ankles was noted. His shins were diffusely severely tender to touch along the tibia and surrounding musculature attachments. He underwent several dextrose Prolotherapy and neural Prolotherapy treatments, all the meanwhile doing cross training and walk/jog intervals as the tissue healed. After three treatments, he reported significant pain when running and his shins were no longer clicking. At that time, he started training for a half marathon. As his training increased, he came back for two more treatments to his shin and ended up running his half marathon in just over two hours.
Are you a candidate for our non-surgical treatments? Ask our specialists:
- Ross Hauser, MD | Danielle Steilen-Matias, PA-C | Katherine 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]