In my last blog, I wrote about why treatment for shin splints, or medial tibial stress syndrome (MTSS), has been held back by a lack of understanding of what causes this painful condition. But thanks to new research, we have a better understanding about how to deal with this common sports injury.

While there isn’t yet enough research for there to be a proven treatment for MTSS, there is new evidence that it’s a bony overload injury and treating it as such has yielded positive responses in clinical practice.

Rehabilitating bone is a slow process of building its strength through very gradual overloading, and is a technique well established for preventing and treating osteoporosis.

As I covered in my last blog, bones constantly shed old or damaged tissue and replace it with fresh tissue through a process known as bone remodelling . This can be exploited in the same way that we train our muscles, by causing microtrauma to the tissue that damages it just enough to promote new growth, but not so much that the rate of repair can’t keep up.

If we treat MTSS as a bony overload injury, this means that the rate at which the bone can repair has already been overwhelmed, so the first thing we must do is dramatically reduce the load on the tibia.

The next step is to very, very gradually load the tibia with simple walking exercises before moving to jogging and eventually interval running. This slow pace can be very frustrating for athletes or dedicated runners, but the bone needs to be given time to catch up if there’s to be any improvement.

There’s no way around it: bone repairs very slowly, and rushing this process is why so many people never recover from MTSS.

It’s only when pain subsides that you can return to longer distances but the increases must remain gradual. If you finally work your way up to being able to run 5k pain-free, that doesn’t mean you’re ready for 10k. Our general rule for physical activity is not to increase load by more than 10% per week, but if you’re susceptible to bony overload, you may choose an even more gradual approach.

Whether you’re suffering from MTSS or not, I recommend tracking the amount of exercise you do (there are many dedicated apps for this) and making sure there isn’t too much variation from one week to the next – up or down. A change of 50% in one week increases injury risk by four times.

One of the challenges of treating MTSS is the impact that it can have on your lifestyle. If you’re active enough to have developed MTSS in the first place, then whatever activity that caused it is likely to be a big part of your life. Having that taken away can be upsetting and detrimental to your fitness, but our priority is always to get you back to doing what you love.

To stay fit while minimising load on your tibia, you should try exercises that will keep your muscles, ligaments and tendons active while being easy on your bones. Using a cross trainer or cycling are the ideal candidates, but swimming will also allow you to remain fit while you recover. It’s essential that you maintain or increase your muscle strength during rehabilitation, especially in your calf, so that your muscles can help to absorb the loads onto your tibia.

There’s also the possibility that it wasn’t the amount of force put through your tibia that was the issue, but how it was distributed. For example, if your feet are overpronated (dipping inwards as your foot hits the ground) there may be uneven load put through your tibia, requiring specific foot exercises to rebalance your foot strike.

Most importantly, successful treatment of MTSS depends upon a holistic, patient-tailored approach. While there are broad similarities between cases, the exact causes of MTSS vary significantly from person to person depending upon their lifestyle and physiology.

Early intervention is also important, as pain that’s been nagging you for a few weeks is much easier and quicker to treat than pain you’ve been suffering from for months or even years. If you’re concerned about pain in your shin or any other part of your body, don’t hesitate to get in touch with us by emailing enquiries@physiolondon.co.uk or by calling us on 020 7093 3499.

 

Marinus Winters

Sports and Spinal Physiotherapist