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Medial Tibial Stress Syndrome

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Medial tibial stress syndrome (MTSS) is a disorder where discomfort arises across the tibia while jogging or other sports-related activities.

Medically reviewed by

Dr. Anuj Gupta

Published At March 9, 2023
Reviewed AtJune 10, 2024

Introduction

The tibia (shin bone) is the largest of the two lower leg bones and bears the most weight. Usually, due to repetitive exertion, a tibial stress fracture is a full or partial break that occurs over time. It can happen anywhere in the tibia, but the middle to lower part of the bone is where it usually happens. Although the discomfort brought on by medial tibial stress syndrome, sometimes referred to as shin splints, might be scattered and intermittent, it must be addressed immediately. Although "MTSS" may not be immediately clear, it is a general term for discomfort along the shin bone. As it is one of the most frequent overuse injuries, most individuals who participate in sports are familiar with the problem.

What Are the Causes of MTSS?

MTSS is an unknown specific etiology, and experts are divided on what causes them. They are frequently seen in runners and are considered to be brought on by excessive use or exertion. However, if certain factors are present, MTSS may be more prone to develop. They consist of the following:

  1. An abrupt rise in training volume or intensity.

  2. A calcium deficiency.

  3. Hardy running surfaces.

  4. Jogging up a slope.

  5. Earlier leg injury.

  6. Running shoes with a poor fit or poor foot support and ankle support.

  7. Many issues with the muscles in the lower leg and foot posture, such as excessive overpronation (the foot and ankle often roll slightly inwards because the foot slides inward more than usual in overpronation.)

  8. According to some specialists, minor tears in the structure of the membrane connecting the two bones of the leg below the knee may be the source of shin splints (the tibia and fibula).

  9. The interosseous membrane is the name of this structure. Some speculate that they could also be brought on by:

    1. Tendon overuse injury (tendinopathy).

    2. Sprained muscles.

    3. An infection of the skin that covers the tibia and fibula bones (periostitis).

    4. Microscopic fractures (microfractures) on the tibial surface have also been proposed as a cause.

  10. It is unclear how compartment syndrome and shin splints are related. While some specialists feel that compartment syndrome is a distinct disorder that can result in shin splints, others think that shin splints are a kind of compartment syndrome.

What Signs Indicate MTSS?

  • Pain in the shin region is the predominant symptom.
  • The inner (medial) half of the shin and the lower middle are likely to be the areas of discomfort.

  • Pain first manifests itself following a run or workout. However, the discomfort could start during a run or other exercise with time. If severe, it could also get worse when going up or down stairs.

  • After exercise, it hurts. Many people get soreness the day after exercising. It might also hurt to apply pressure on the shinbone.

  • If they can identify the pain, they might not have MTSS but rather a stress fracture.

What Are the Risk Factors for MTSS?

  1. Increase the amount, frequency, or intensity of physical activity and intense training with little rest.

  2. Those who engage in intense exercise (military recruits, distance runners).

  3. History of a stress fracture.

  4. Weak calf muscles and a lack of flexibility in one's physical condition.

  5. Jogging with flat feet or high arches when on a firm surface.

  6. Incorrect footwear or inadequate shock.

  7. Bone disease or bony defects (including osteoporosis, tumors, cysts).

  8. Hormonal issues, dietary issues, and metabolic disorders (anorexia, bulimia).

  9. Women's lack of or irregular menstrual cycles.

How Is Medial Tibial Stress Syndrome Identified?

  • As part of any investigative work-up, X-rays of the injured area are frequently reported in cases of shin splints to be completely normal. To rule out a stress fracture in one of the bones, the doctor may advise getting an X-ray of the leg below the knee. However, not all stress fractures are visible on X-rays.

  • The doctor might occasionally recommend getting a bone scan of the lower leg. This can assist in identifying the difference between stress fractures and shin splints. A tiny quantity of radioactive material is injected during a bone scan, often into an arm vein. The radiation released by the injected substance is then detected using a gamma camera. This may reveal a stress fracture or bone alterations accompanying shin splints.

  • A magnetic resonance imaging (MRI) scan can also be utilized to assist in distinguishing between stress fractures and shin splints.

What Is the Treatment of MTSS?

  1. Rest - Shin splints are mostly treated with this. This entails refraining from any exercise that could have triggered the shin splints, such as running.

  2. Ice - Shin splint discomfort may also be reduced by lifting the leg and applying ice to the shin. Ice cubes can create an ice pack by being wrapped in a towel or plastic bag. (Ice burns can occur if it is placed too close to the skin.) As an alternative, use a bag of frozen peas. Apply the ice pack gently to the damaged area. The ice's coolness is believed to lessen the blood flow to the injured ligament.This might reduce inflammation and discomfort. Some medical professionals advise repeating the treatment for ten minutes every two hours (during the day) for the first 48 hours after the initial application.

  3. Elevation - Any swelling is intended to be limited and reduced by elevating the leg. When the patient is sitting, raise the foot of the chair to at least hip level. (Lying on a sofa and placing the foot on some cushions may make it simpler.) Place the foot on a pillow while in bed.

  4. Medication - To reduce discomfort, pain relievers like paracetamol are helpful. It is preferable to start taking them routinely. One alternative is painkillers that reduce inflammation. Ibuprofen is only one of many brands and varieties available. They reduce discomfort and could also reduce swelling and inflammation. In certain cases, anti-inflammatory medicines have side effects. The most significant symptoms include stomach discomfort and bleeding from the stomach. Some people may be unable to use anti-inflammatory medicines if they have asthma, high blood pressure, renal disease, or heart failure.

  5. Surgery - If everything else fails, surgery could be an option. The procedure is known as a fasciotomy. It entails cutting a hole in the tissue that covers the muscles in the lower leg (the posterior compartment).

What Are the Ways to Avoid MTSS?

  1. Before a game or practice, warm up properly and stretch.

  2. Keep adequate cardiovascular fitness, leg and ankle flexibility, strength, and endurance.

  3. During exercise and training, use the appropriate technique. First, increase the training and activity levels gradually. Then, reduce activities to ensure adequate rest.

  4. Wear appropriate shoes (for example, change shoes after 300 to 500 miles of running).

  5. Address nutritional, metabolic, and hormonal imbalances.

Conclusion

Medial tibial stress syndrome, also known as shin splints, is common in athletes who have recently increased or modified their exercise regimens. As a result, the muscles, tendons, and bone tissue are being overworked by increased activity. Training mistakes, shoe wear, and training intensity, duration, and surface modifications may influence the development of medial tibial stress syndrome. Shin splints are treatable with rest, ice, and other self-care techniques. In addition, shin splints can be avoided by changing the workout program and using the appropriate footwear.

Frequently Asked Questions

1.

What Are the Methods to Get Rid of Medial Tibial Stress Syndrome?

- Employing proper rest and reducing high-impact activities to allow the affected area to heal.
- Implementing gradual return-to-activity programs, along with stretching and strengthening exercises for the lower limbs, to prevent recurrence and promote recovery.

2.

How Would You Describe the Symptoms of Medial Tibial Stress Syndrome?

- Pain and tenderness along the inner (medial) side of the shin bone (tibia).
- Discomfort that worsens during or after physical activities, especially running or jumping.
- The possibility of mild swelling or inflammation in the affected area.

3.

Can Medial Tibial Stress Syndrome Be Considered a Severe Condition?

- Medial tibial stress syndrome is generally not considered a severe condition, but it can lead to complications if not addressed promptly.
- It is a common overuse injury, and early intervention can lead to successful recovery in most cases.
- If left untreated, it may progress to more severe injuries like stress fractures, making timely management crucial to prevent further complications.

4.

Can Medial Tibial Stress Syndrome Result in a Permanent Condition?

- In the majority of cases, medial tibial stress syndrome is not permanent and can be resolved with appropriate treatment and rest.
- However, if not managed properly or if there are underlying risk factors, it may lead to chronic or recurring issues.
- Early diagnosis and appropriate care can significantly enhance the probability of complete recuperation and minimize the chances of enduring repercussions.

5.

What Is the Typical Healing Duration for Medial Tibial Stress Syndrome?

- The healing duration for the presentation of medial tibial stress syndrome can differ based on the extent of the injury's severity and individual factors.
- In most cases, with proper rest and treatment, the condition may take several weeks to a few months to heal completely.

6.

Can Massage Be Beneficial in Managing Medial Tibial Stress Syndrome?

- Massage can relieve muscle tension and improve blood flow to the affected area, promoting healing in medial tibial stress syndrome.
- It may help alleviate pain and discomfort associated with the condition, contributing to enhanced recovery and overall well-being.

7.

Which Muscle Is Frequently Impacted in Medial Tibial Stress Syndrome Cases?

- The tibialis posterior muscle is commonly affected in medial tibial stress syndrome cases.
- The involvement of this muscle notably influences the arch of the foot's stability and can become overworked during repetitive activities, leading to the development of the syndrome.

8.

How Does Medial Tibial Stress Syndrome Differ From a Stress Fracture?

- Medial tibial stress syndrome occurs along the inner (medial) side of the shinbone (tibia) in the lower leg.
- The discomfort is typically felt in this specific region due to the overuse and stress placed on the muscles and tissues in that area during physical activities.

9.

How Does Medial Tibial Stress Syndrome Differ From a Stress Fracture?

- Medial Tibial Stress Syndrome (MTSS) is an overuse injury caused by repetitive stress and strain on the muscles and tissues along the inner side of the shinbone (tibia). It typically presents diffuse pain and tenderness in that area.
- On the other hand, a stress fracture is a small bone crack or break resulting from repeated impact and stress, often due to excessive physical activity. Unlike MTSS, stress fractures involve a specific localized point of tenderness along the bone.

10.

What Are the Clinical Practice Guidelines for Managing Medial Tibial Stress Syndrome?

- Rest and Gradual Return to Activity: The initial management of medial tibial stress syndrome involves rest from the activities that exacerbate the pain, followed by a gradual return to weight-bearing exercises and physical activities once symptoms subside. This approach helps reduce the stress on the affected tibia and promotes tissue healing.
 
- Addressing Contributing Factors: Clinical practice guidelines emphasize identifying and addressing contributing factors that may predispose individuals to medial tibial stress syndrome. These factors include improper footwear, training errors, muscle imbalances, and biomechanical abnormalities. Implementing appropriate footwear, modifying training routines, and prescribing corrective exercises can help prevent future occurrences and aid recovery.

11.

How is Medial Tibial Stress Syndrome Classified?

- Severity: The classification includes different grades or stages, ranging from mild discomfort after physical activity to severe pain that affects daily activities and requires immediate attention.
- Anatomical Location: The syndrome is categorized based on the specific area along the tibia where the pain is most prominent, such as the anterior, posterior, or middle portion of the medial border.
- Underlying Causes: The classification considers contributing factors, such as biomechanical abnormalities, training errors, footwear issues, and muscle imbalances, which may play a role in the development of medial tibial stress syndrome. Identifying these causes helps in tailoring appropriate treatment strategies.

12.

What Diagnostic Methods are Used to Identify Medial Tibial Stress Syndrome?

- Patient History: Obtaining a detailed account of the patient's medical history, physical activities, and any previous lower limb injuries or relevant factors.
- Physical Examination: Conduct a thorough assessment of the affected leg, checking for tenderness, pain along the tibia, and possible swelling.
- Imaging Studies: Utilizing X-rays or Magnetic Resonance Imaging (MRI) to visualize the tibia and surrounding structures, ruling out other potential causes and confirming stress-related changes in the bone.
Dr. Anuj Gupta
Dr. Anuj Gupta

Spine Surgery

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