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Medial tibial stress syndrome (MTSS), commonly known as "shin splints," is a frequent injury of the lower extremity and one of the most common causes of exertional leg pain in athletes (Willems T, Med Sci Sports Exerc 39(2):330-339, 2007; Korkola M, Amendola A, Phys Sportsmed 29(6):35-50, 2001; Hreljac A, Med Sci Sports Exerc 36(5):845-849, 2004)....
Citations
... For treatment options, our study revealed a variety of strategies employed by participants to alleviate the symptoms of MTSS. Among the reported treatments, rest and ice application emerged as commonly utilized approaches, aligning with established recommendations for the initial management of MTSS symptoms [30]. Furthermore, participants frequently engaged in physiotherapy involving regular stretching and strengthening exercises, which have shown efficacy in improving lower limb biomechanics and reducing pain associated with MTSS [13]. ...
Background/aims
Medial tibial stress syndrome (MTSS), also known as “shin splint”, is most often described as exertional leg pain along the shinbone (tibia), which occurs due to the inflammation of the muscles, tendons, and bone tissue in this area. This study aims to assess the prevalence, risk factors, and their association with the development of MTSS, as well as the effective treatments that reduce pain and improve functions among the Saudi general population.
Materials and method
The present cross-sectional study was conducted on the general population of Saudi Arabia through an electronic survey over a period of three months. The study sample of 443 patients was deemed and considered. The study included participants from the general population in Saudi Arabia above the age of 18. A structured self-response questionnaire was given to the participants after institutional research ethical approval was obtained for the study.
Results
Among the 443 participants, the majority were male (n = 228, 51.5%), aged 18-29 (n = 227, 51.2%), and residing in the central region of Saudi Arabia (n = 398, 89.8%). Most participants reported engaging in sporting activities (n = 211, 47.6%), with high-intensity training being the most common (n = 93, 44.1%). Only a small proportion (n = 8, 1.8%) reported a previous diagnosis of MTSS. Analysis revealed associations between MTSS prevalence and certain demographic factors, including walking surface preferences and engagement in specific sports. Treatment strategies for MTSS included rest, ice application, physiotherapy, and pain-relieving medication, with varying degrees of satisfaction and recurrence rates among participants.
Conclusion
The study provides valuable insights into the prevalence, risk factors, management, and preventive measures related to MTSS among the Saudi general population. While certain demographic factors and exercise practices were associated with MTSS prevalence, effective treatment options such as rest, physiotherapy, and appropriate footwear were reported. Moreover, adherence to preventive measures such as stretching, proper footwear selection, and gradual training progression may help mitigate the risk of MTSS development.
... 20 Activity alteration, amendment of modifiable risk factors, custom foot orthosis, shoe modifications, motion control foot wear, therapeutic adhesive taping, splinting or gait training are some of the other available options 1 Alternate treatment in the case of no response to the available options, Injections (cortisones), acupuncture or posterior fasciotomy can also be done. 1 Physical therapy methods and treatments are employed for assistance. Various techniques such as iontophoresis, phonophoresis, ice massage, ultrasound, low-energy laser treatment, periosteal pecking, stretching and strengthening exercises, sports compression stockings, lower leg braces, extracorporeal shockwave therapy, TENS 22,23 and pulsed electromagnetic field have been extensively researched 17,21 along with augmented soft tissue mobilization, whirlpool baths and non-weighted ambulation in the acute stages. 1 Recently, a technique introduced by Dr. Kenzo Kase in the 70's, which is Kinesiology Taping has attracted interest among sports medicine clinicians for the treatment of many musculoskeletal conditions. ...
... Various techniques such as iontophoresis, phonophoresis, ice massage, ultrasound, low-energy laser treatment, periosteal pecking, stretching and strengthening exercises, sports compression stockings, lower leg braces, extracorporeal shockwave therapy, TENS 22,23 and pulsed electromagnetic field have been extensively researched 17,21 along with augmented soft tissue mobilization, whirlpool baths and non-weighted ambulation in the acute stages. 1 Recently, a technique introduced by Dr. Kenzo Kase in the 70's, which is Kinesiology Taping has attracted interest among sports medicine clinicians for the treatment of many musculoskeletal conditions. 24,25 This technique is expected to have four effects; to adjust muscle function 26 to amplify lymphatic 27 and vascular flow, to lessen pain, to help in the correction of possible articular malalignment 28,29 and it also reduces the irritation and pressure of the neurosensory receptors which produce painful sensations. ...
Objective: to evaluate the effectiveness of Kinesiology Taping with conventional physical therapy in patients with Medial Tibial Stress Syndrome. Material and Methods: Athletes with ages between 18-35 years, of both gender, having MTSS score between 4-10 were recruited in the study. A total of 30 patients were split into two groups randomly, with 15 in each. Group 1 received Kinesiology Taping alongside conventional physical therapy (Cryotherapy+ TENS+ Calf muscle stretch), while Group 2 only received conventional physical therapy. Treatments were administered every other day for three weeks. Results: Within the group analysis utilized repetitive measure ANOVA. The average NPRS percentages for both groups were similar at the start. However, for the experimental group NPRS percentages as well as average MTSS percentage, there was a significant decrease till the end (0.90 &1.00 respectively) of the sessions. Between-group analysis was carried out using an independent t-test. Both the NPRS and MTSS results were statistically significant in both groups (p<0.01), but the mean values indicated that the experimental group exhibited a greater reduction in pain and an enhanced functional level compared to the control group. Conclusion: Kinesiology taping combined with standard physical therapy proved effective in lessening pain and enhancing the functional status of athletes with medial tibial stress syndrome.
... resources, highlighting the difficulty in diagnosing and managing injuries in this anatomical region given the high number of imaging and referrals, respectively [22,23]. Shin injuries were diagnosed using the largest proportion of imaging services to differentiate subtle differences between medial tibial stress syndrome and bone stress injuries, allowing providers to discern the appropriate management path based on injury. ...
Purpose:
Over a 10-year time frame, this study aimed to evaluate diagnosis, treatment, and referral trends for adolescent runners seeking care for running-related injuries (RRIs) at a clinic that specializes in running medicine.
Methods:
This study was a retrospective chart review of 392 adolescent runners (2,326 encounters) who sought care for RRIs between the years 2011 and 2021. Descriptive statistics were used to summarize clinical assessments, referrals, assistive devices, and medications prescribed or administered overall and by injury type. Chi-square analyses were used to compare proportions of services rendered across the 10-year time frame.
Results:
Patients most frequently received manual evaluations or special tests during clinic visits. Most visits resulted in at least one referral (91%), primarily for physical therapy or gait-training. Assistive devices and medications/supplements were offered at only 18% of patient visits. The majority of assessments (X2 = 69.7, p = 0.002), treatments (X2: 23.6-43.8, p: < 0.001-0.003), and referrals (X2 = 132, p < 0.001) were for shin injuries. Larger proportions of nutrition assessments (X2 = 40.7, p < 0.001), interventions (X2 = 26.8, p = 0.003), and referrals (X2 = 27.5, p = 0.002) were performed in or after the year 2015.
Conclusion:
Clinic visits for shin injuries required the most clinical resources per episode of care. There were observed shifts in clinical assessment and treatment approaches to include more expanded nutritional and physiologic considerations.
... 5 6 Examination often reveals tenderness of the distal one-third of the posteromedial border of the tibia while the anterior tibia remains non-tender. 7 Patients with mild MTSS experience the worst pain when exercising that can reduce with rest and in more WHAT ARE THE NEW FINDINGS ⇒ The use of an investigational lower limb orthosis significantly reduced Medial Tibial Stress Syndrome (MTSS) pain, assisted with an earlier return to sport and was associated with reduced recurrence of disease compared with a placebo in those with established disease. ...
... severe cases pain symptoms may persist for a number of hours or days later despite adequate rest. 7 The pathophysiology is believed to be a combination of tendinopathy, periostitis, periosteal remodelling and tibial stress reaction. 4 5 8 Dysfunction of the tibialis posterior, tibialis anterior and soleus muscles are commonly implicated 4 5 8 and these appear to be associated with alterations in tibial loading and bending. ...
... 5 12 Treatment of MTSS is predominantly conservative with few recent advances and limited well-conducted randomised controlled trials (RCTs). 7 13 14 Rest has been shown to be the most effective treatment. 4 5 12 15 For many athletes, however, prolonged rest is not ideal. ...
Objective
Medial tibial stress syndrome (MTSS) is common and often difficult to treat. The purpose of this study was to examine the effect of a lower leg brace on MTSS symptoms compared to a placebo.
Methods
A pilot of a prospective double-blinded randomised placebo-controlled trial conducted in two private sports medicine practices. Included were those with symptomatic MTSS lasting 6 weeks or more. Excluded were those with other lower limb pathologies. Fourteen participants formed the study cohort who wore the brace or placebo. The brace applied counterforce pressure to the musculotendinous junctions of the soleus, compressed periosteum at the distal third of the posteromedial tibia and applied inferomedial torsion to the soleus muscle. Additional treatment modalities were recorded. Participants completed a standardised MTSS Severity Score at 0–6, 8, 12 and 24 weeks and recorded return to full activity.
Results
The brace group demonstrated a significantly reduced MTSS severity score from 5 to 24 weeks (p<0.03) and had returned to full activity within 5 weeks. MTSS score in the placebo group remained unchanged (p >0.05), all participants experienced MTSS recurrence and none returned to full activity over 24 weeks.
Conclusion
The lower leg brace demonstrated a reduction in MTSS symptoms from 5 weeks that was sustained over 6 months with a lower rate of MTSS recurrence compared with the placebo. If similar results are seen in a larger cohort, it has potential to benefit patients with MTSS as an adjunct to current treatment modalities. Further investigation regarding efficacy is needed.
Trial registration number
ACTRN12620000906954.
... Diagnosis will be made by history alone in a very majority of cases, but if the diagnosis is unclear, an X-ray and resonance imaging should be considered. [5] Most literature supports "rest" at the acute phase of shin splints. For several athletes, however, prolonged rest from activity is n't ideal, and other therapies are necessary to assist the athlete return to activity quickly and safely. ...
... Medial tibial stress syndrome (MTSS), or shin splints is an overuse injury or repetitive-99 stress injury of the shin area. Various stress reactions of the tibia and surrounding mus-100 culature occur when the body is unable to heal properly in response to repetitive muscle 101 contractions and tibial strain (13). ...
... A study involving 146 college athletes showed that 87% had a history of MTSS [7]. A history of MTSS is a risk factor for MTSS recurrence [2,8,9]. ...
Background
Medial tibial stress syndrome (MTSS) is a running-related injury of the lower extremities. After returning to competition, there are often recurring episodes of MTSS. Therefore, it is important to prevent the onset and recurrence of MTSS among long-distance runners. This case–control study aimed to compare the kinematics and kinetics of runners with and without previous MTSS during running to clarify the biomechanical characteristics of the lower extremity of runners with previous MTSS.
Methods
Thirteen male long-distance runners aged over 18 years and asymptomatic at the time of measurement were divided into an MTSS group and a non-MTSS group based on their history of MTSS as reported in a questionnaire. The kinetics and kinematics of running were analyzed when participants ran at a speed of 2.0 ± 0.2 m/s by a three-dimensional motion analysis system and two force plates. Data regarding the joint angles, moments, and powers of the ankle, knee, and hip during the stance phase while running were extracted and compared between the two groups using the Mann–Whitney U test.
Results
Of the 13 participants, 5 and 8 were included in the MTSS (10 legs) and non-MTSS (16 legs) groups, respectively. The ankle maximum eversion moment was significantly larger in the MTSS group than in the non-MTSS group (p = 0.04). There were no significant differences in other parameters.
Conclusions
This study found that the ankle maximum eversion moment during the stance phase of running was larger in the MTSS group than in the non-MTSS group. Even after the disappearance of the symptoms of MTSS, the running biomechanics of participants with previous MTSS differed from those of participants without previous MTSS.
... For an athlete, this kind of injury can disturb their performance and all their activities [1]. A stress fracture of the tibia, which is represented by focused discomfort in the front tibia, is the most frequent complication of medial tibial stress syndrome [2]. The discomfort gradually lasts longer into the run as a patient's injury gets worse; eventually, it lasts through the cooldown and into daily activities and can localize to become point soreness [3]. ...
Medial tibial stress syndrome (MTSS), usually referred to as "shin splints," is a common overuse injury of the lower extremities affecting a large percentage of athletes. A variety of factors can lead to shin splints, including overtraining, poor footwear, muscular imbalances at the ankle, overtight or weak triceps surae muscles, imbalances at the thoracolumbar complex, and a body mass index (BMI) above 30. Injuries present with diffuse palpable pain that is often described as a dull ache following exercise. The pain is often alleviated by resting. Often, athletes complain of tenderness along the posteromedial edge of the tibia and pain along the middle to distal third of the posteromedial border of the tibia following an exercise session. The pain caused by a shin splint should be categorized according to its location and cause, such as lower medial tibial pain caused by periostitis or upper lateral tibial pain caused by raised compartment pressure. In order to prevent MTSS or shin splints, it is important to avoid excessive stress. The main objectives of shin splint treatment are to relieve pain and to enable the patient to return to normal activities without pain. To prevent shin splints, repetitive stress should be avoided. In this paper, we review what is known about the pathophysiology of shin splint syndrome, present evidence regarding risk factors associated with shin splints, assess the effectiveness of prevention strategies, and make recommendations for prevention. The purpose of this study is to assess the effectiveness of interventions to prevent shin splints.
... Mezi anatomické rizikové faktory lze zařadit zvýšený navicular drop (ND), zvýšenou hodnotu body mass indexu, zvýšený rozsah pohybu do zevní rotace v kyčelním kloubu a zvýšený rozsah pohybu do plantární flexe v hlezenním kloubu. Mezi anamnestické rizikové faktory patří dle studií zranění jména u aktivních jedinců, a přestože se často nejedná o vážné zranění, může je výrazně omezovat a způsobit závažnější komplikace [7]. Proto je důležitá znalost patofyziologie, rizikových faktorů, diagnostiky a vhodné léčby tohoto poranění mezi fyzioterapeuty, lékaři i trenéry. ...
... V terapii zranění je důležité ovlivnit individuální rizikové faktory pro vznik MTSS [41]. Podstatné je edukovat sportovce o režimových opatřeních a vytvořit vhodný individuální rehabilitační program [7]. V rámci terapie je důležité zaměřit se na prevenci opětovného vzniku zranění, k němuž jsou jedinci s MTSS náchylní [7]. ...
... Podstatné je edukovat sportovce o režimových opatřeních a vytvořit vhodný individuální rehabilitační program [7]. V rámci terapie je důležité zaměřit se na prevenci opětovného vzniku zranění, k němuž jsou jedinci s MTSS náchylní [7]. Cílem léčby je, aby byl pacient bez bolesti při každodenních aktivitách a sportu a neobjevovala se u něj ani palpační citlivost v postižené oblasti tibie [41]. ...
Summary: The medial tibial stress syndrome (MTSS) is an overuse injury caused by repetitive stress applied to the tibia. The MTSS presents as exercise-induced pain over the distal two-thirds of lower leg, more specifically, over the posteromedial aspect of the tibia. The MTSS is one of the most common injuries among runners, however, it occurs also in other running and jumping sports. The high prevalence of the MTSS is also in soldiers. If not treated properly, the MTSS may limit individuals not only in sport but also in everyday life activities. Moreover, in the case of soldiers and professional athletes, the MTSS may limit their capability to work. For that reason, knowledge of the MTSS and its treatment is required especially in healthcare and sport environment. However, the scientific literature written in the Czech language is lacking on this topic. Therefore, the aim of this article is to summarize the current scientific literature concerning the MTSS. This article focuses on the MTSS pathophysiology, which is still not fully understood, the MTSS diagnosis and differentiation from other pathologies in this area such as tibial stress fractures, and the MTSS injury risk factors. Knowledge of the risk factors is necessary not just for a proper therapy but also for a prevention of this overuse injury. The main focus of the article is on the therapy of MTSS, which is often conservative with physiotherapy playing a crucial role. Usually, it includes a specific individual rehabilitation plan which consists of lifestyle and activity modification, gradual loading of tibia and change of movement biomechanics.
Souhrn: Mediální tibiální stresový syndrom (MTSS) patří mezi poranění z přetížení, vzniká jako důsledek opakované traumatizace tibie. Projevuje se bolestí vyvolanou pohybovou aktivitou v distálních 2/3 bérce, přesněji v oblasti posteromediální hrany tibie. MTSS je jedním z nejčastějších běžeckých zranění, ale často se s ním setkáváme i u jiných sportů, jejichž součástí je běh či skoky. MTSS má vysokou prevalenci také u vojáků. Jedinci s MTSS mohou být bez správné léčby limitováni nejen ve sportovních aktivitách, ale i v aktivitách běžného života a v případě vojáků a profesionálních sportovců také ve výkonu povolání. Z tohoto důvodu je znalost MTSS a jeho léčby mezi zdravotníky, ale i trenéry důležitá, přesto se však problematice MTSS věnuje jen minimum odborné české literatury. Cílem článku je tedy shrnout současné poznatky o MTSS. Pozornost je věnována patofyziologii, která dosud není zcela objasněna, a diagnostice tohoto poranění-především odlišení MTSS a stresové zlomeniny tibie. Dále se článek zaměřuje na rizikové faktory vzniku MTSS, jejichž znalost je nezbytná pro správnou prevenci a léčbu. Hlavní část článku se věnuje terapii, která je v případě MTSS obvykle konzervativní a v níž podstatnou roli hraje fyzioterapie. Fyzioterapeut tvoří jedinci individuální rehabilitační plán, který se skládá především z režimových opatření, postupné adaptace tibie na zátěž a z úpravy biomechaniky pohybu.
... Although these patients have a benign prognosis, possibility of chronicity and the development of a debilitating form over time is possible. 18 There is limited evidence to support the superiority of any particular intervention in the treatment or prevention of MTSS. 2,5,11,12 Extracorporeal shock wave therapy (ESWT) is defined as a sequence of sound waves with a high peak pressure (100 MPa), fast pressure increase (less than 10 ns), short duration (10 μs), and an energy density of 0.03 to 0.89 mJ/mm 2 . ...
... MTSS tends to become chronic and may lead to tibial stress fractures 18 and hinder the exercise or functional capacity because of prolonged recovery time. The most prolonged duration of MTSS symptoms was reported in a study by Newman et al., 32 and because ESWT had no significant effect on symptom improvement in this study, it appeared that the therapeutic advantage of shockwave could be diminished in more chronic cases of MTSS. ...
Background
This systematic review evaluates the available evidence for extracorporeal shockwave therapy (ESWT) use in the treatment of medial tibial stress syndrome (MTSS).
Method
PubMed, EMBASE, Scopus, ISI Web of Science, and Cochrane Central Register of Controlled Trials (Cochrane CENTRAL) database searches were performed without a time limit in August 2021. Two independent researchers performed the search, screening, and final eligibility of the articles. Data were extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions, and outcomes. The methodological quality of the included studies was independently assessed by two reviewers using the Physiotherapy Evidence Database scale (PEDro).
Results
Three studies were identified that compared 23, 12, and 22 participants in the intervention group with 19, 12, and 20 participants in the control group, respectively. The mean age of participants in these studies was 26.51 yr, and the mean duration of symptoms in the two studies that reported this was 16.36 mo. All studies used focus shockwave therapy.
Conclusions
Extracorporeal shockwaves reduced pain and time to recovery and increased patient satisfaction. No study reported adverse effects. Based on the limited studies, ESWT may reduce pain and shorten recovery duration in MTSS. Further randomized clinical trials with sham control may substantiate these findings in other patient populations.
Level of Evidence
Level II.
