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Medial Tibial Stress Syndrome

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Medial tibial stress syndrome (MTSS)

Medial Tibial Stress Syndrome (MTSS) is a common overuse injury that affects athletes, particularly runners and jumpers. It manifests as pain along the inner edge of the shinbone (tibia) and is caused by repetitive stress placed on the lower leg muscles and bone. While MTSS can be debilitating, with proper care and rehabilitation, you can overcome this condition and regain your athletic prowess.




Symptoms of MTSS include pain and tenderness along the inner aspect of the shin bone, usually starting as a dull ache and progressing to a more intense sensation. Pain worsens with physical activity, especially during running or jumping. Other signs may include swelling and inflammation in the affected area, tenderness to the touch, and pain that diminishes with rest but returns upon resuming activity.



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MTSS primarily affects the tibia (shinbone) and the surrounding muscles and connective tissues.


The tibia, the larger of the two bones in the lower leg, is subjected to significant stress during weight-bearing activities like running and jumping. The muscles responsible for foot and ankle movement, such as the posterior tibialis, soleus, and flexor digitorum longus, attach to the inner aspect of the tibia. These muscles play a crucial role in maintaining foot arch stability and controlling pronation (inward rolling) of the foot.


In individuals with MTSS, repetitive stress and overuse lead to microtrauma in the muscles and periosteum (the outer layer of the bone) of the tibia. The exact mechanism of injury is still not fully understood, but it is believed to involve a combination of factors.


One contributing factor is excessive pronation of the foot, which places increased stress on the muscles and connective tissues that attach to the inner aspect of the tibia. This excessive stress can lead to inflammation, irritation, and pain. Additionally, muscle imbalances and weaknesses in the lower leg, hip, or core can contribute to abnormal movement patterns and increased stress on the tibia.


Structural abnormalities, such as flat feet or high arches, can also play a role in MTSS. Flat feet (overpronation) result in increased strain on the muscles and bones of the lower leg, while high arches (supination) can lead to reduced shock absorption and increased impact forces on the tibia.



MTSS can be attributed to various factors, such as overtraining or sudden increase in training intensity, poor footwear or worn-out shoes lacking proper support, training on hard or uneven surfaces. Muscle imbalances and weaknesses in the lower leg, hip, or core, poor running or jumping technique, and structural abnormalities like flat feet or high arches.


Rehab Strategies:


The key to overcoming MTSS lies in implementing effective rehabilitation strategies. Start with rest and initial pain management, avoiding activities that exacerbate the pain and applying cryotherapy to reduce inflammation. Gentle stretching and strengthening exercises targeting the calf muscles can help improve flexibility and relieve tightness. Gradually progress to more challenging exercises as pain subsides.


It's crucial to undergo a biomechanical assessment conducted by a qualified physical therapist who can analyze your movement patterns and identify any biomechanical issues. Correcting faulty running or jumping techniques reduces stress on the shins. Addressing muscle imbalances through targeted exercises and stretching routines is equally important.


Additionally, seek a professional evaluation of your footwear and consider temporary use of orthotic inserts while you are recovering. A gradual return to activity is essential, following a structured program that gradually increases intensity and duration while listening to your body to avoid relapses.


At Latitude Physiotherapy, we can design a personalized treatment plan based on a thorough evaluation of your condition. Through a combination of manual therapy techniques, targeted exercises, biomechanical analysis, and education, we can guide you through each step of your recovery. Our goal is to not only alleviate your pain, but also equip you with the knowledge and tools necessary to prevent future injuries and enhance your athletic performance.


Medial Tibial Stress Syndrome (MTSS) can present challenges for athletes, but it doesn't have to hinder your progress. By recognizing the symptoms, understanding the causes, and implementing effective rehabilitation strategies, you can overcome shin splints and return to your sport stronger than ever. At Latitude Physiotherapy, we are here to support you on your path to recovery, providing expert care and guidance every step of the way. Don't let shin splints hold you back—take the first step toward your comeback by scheduling an appointment today!

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