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Shin Splints: Who is at Risk?

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From basketball players in the NCAA tournament to middle age runners on the sidewalk, who is at risk and why? If you have lived an active lifestyle, participated in sports or even follow sports you’ve probably heard of or experienced ‘shin splints’ at some point. But what are shin splints?

In the physical therapy world, it is referred to as medial tibial stress syndrome (MTSS).

What does it feel like?

Athletes often experience this as pain along the inside portion of the shin when they exercise. If you recently increased your physical activity more than your body is used to, and you feel this pain in your shin, it is possible that you are in the acute phase of MTSS. Pain is often with early activity and decreases with continued exercise in this phase of the syndrome.

If you’ve had this syndrome for a long time, you may feel pain even after activity is ended and may also feel pain at rest.

What causes Shin Splints? There are two theories.

  • Traction to the periosteum from calf muscles stresses the tissues on the bone (posterior tibialis, flexor hallucis/digitorum longus, soleus)
  • Repeated bending of the tibia causes uneven stress on the bone which leads to pain. Concave posteriormedial border of the tibia is compressed and there is an imbalance between osteoclasts/osteoblasts with new exercise program.
  • It can very well be a combination of these two theories.

In long standing MTSS, the affected part of the bone is 15% more porous than control subjects. This means that the bone may be weaker! (1)

May be one of the reasons professional athletes end up with open tibial fractures. They play through the pain of medial tibial stress syndrome, develop stress fractures of the tibia and continue to play on these stress fractures. The bone will progressively get weaker and the risk for fracture continues to increase until it gives way (1).

Who is at risk for MTSS?

  • High BMI
  • Flat feet (navicular drop >10 mm)
  • Female gender
  • History of MTSS
  • Fewer years of running experience
  • Previous use of orthotics
  • Increased hip external rotation in males

What to look for as a physical therapist?

  • Higher score on Foot Posture Index (pronated foot)
  • Early and overpronation with walking/running
    • Leads to longer eccentric contraction of anti-pronatory muscles and earlier muscle fatigue, and more force absorbed by the tenoperiosteum/bone
  • Abductory twist
  • Early heel rise
  • Apropulsive gait
  • Differential Dx: compartment syndrome (non-tender to palpation, cramp/burn/ache) or stress fracture (pain on percussion)

How to treat Shin Splints?

There is not much research out there, however, there was a study performed using on-screen pressure mapping to assist physical therapy with increasing lateral pressure for heel strike and control eversion during loading response/stance phase of gait. 30 minutes, 18 sessions.

Added this with exercise and NMRE to decrease musculoskeletal impairments related to foot posture, gait mechanics, flexibility and balance. 30 minutes, 3x/week.

Results: intervention group had ¼ the risk of developing MTSS. “Gait retraining is a viable strategy for reducing impact of MTSS” (2)

If you are experiencing shin splints, schedule your complimentary injury screen at an Athletico physical therapy clinic near you!

Schedule a Free Injury Screen

The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

(1) Reshef et al (2012) Medial Tibial Stress Syndrome. Clin Sports Med 31, p273-290.
(2) Sharma et al (2014) Gait Retraining and incidence of medial tibial stress syndrome in army recruits. Medicine and Science in Sports and Exercise.
Moen et al (2009) Medial Tibial Stress Syndrome: A Critical Review Sports Med 39, p523-545
Newman et al (2013) Risk Factors Associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access Journal of Sports Medicine 4: 229-241.
Sharma et al (2011) Biomechanical and lifestyle risk factors for medial tibial stress syndrome in army recruits: A prospective study. Gait and Posture. 33: 361-365
Tweed et al (2008) Biomechanical risk factors in the development of medial tibial stress syndrome in distance runners. Journal of the American Podiatric Medical Association. Vol 98, No 6.
Yates and White (2004) The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. American Journal of Sports Medicine Vol 32, No 3.

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