From NCAA Players to Middle Age Runners, who is at risk for Shin Splints?

By Amanda DiGangi for Athletico Physical Therapy

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 theyshin splints 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 it? 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!

*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 on 1 Basketball Players ShootingWho 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?

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”