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Paulson, Chase » Medial Tibial Stress Syndrome

Medial Tibial Stress Syndrome

MTSS: Shin Splints

What is MTSS?

MTSS stands for Medial Tibial Stress Syndrome, although you might know it better as shin splints. It appears as a sharp pain over the inside of the tibia (shin) that occurs during motions that require you to be on your toes—such as sprinting and jumping. Overuse  & poor biomechanics are the main factors that lead to MTSS. MTSS is an injury that is caused by a number of anatomical factors like: tight calves, poor endurance of the lower leg muscles, low arches and flat feet, and a condition we call “calcaneal inversion,” or tilted heel. MTSS can happen to anyone, although sprinters, distance runners, and soccer players are at the highest risk due to the amount of time spent moving. You don’t have to be one of these athletes to get MTSS, however. It doesn’t matter if you are the best or worst athlete, anyone can suffer from MTSS.

What causes MTSS, exactly?

MTSS is caused by a few different factors, including overuse, improper warm-up and training, and poor biomechanics. When athletes fail to prepare their bodies correctly for exercise—through dynamic warm-ups and stretching, they are more likely to suffer injury. Although, some athletes are more prone to MTSS simply due to the way their body—specifically their feet—are formed.

When an athlete suffers from MTSS it is usually due to tight calf muscles. The calf actually consists of two separate muscles, the gastrocnemius and the soleus. These muscles are attached to the tibia (shin) on the medial, or inside, part of the lower leg. When  the soleus becomes tight it starts to pull on the tibia, causing the symptoms of MTSS. When the calves lack enough endurance for the work they must perform, they fatigue easier and become weakened quickly, leading to other muscles having to accommodate and pick up the slack.

Having low arches, or flat feet, is another indicator that lead to MTSS. This condition is known as pes planus. A person with pes planus will typically have to work harder to propel the body forward, as the arch acts like a spring when running. This condition, combined with what we call “calcaneal inversion” can put an athlete at a higher risk of developing MTSS.

How do I know if I have MTSS?

MTSS can appear suddenly after only a few minutes of training; however it takes anywhere from 4 days to 3 weeks to develop. Most commonly athletes will complain of a sharp or burning pain that appears over the inner portion of the lower leg, right next to the tibia (shin). Almost all cases of MTSS occur in the lowest third of the lower leg, just above the ankle. MTSS worsens with activity, and will typically subside when activity is stopped, or when at rest.

Preventing MTSS

Preventing MTSS is as easy as this:

  • Warm up your muscles by doing dynamic movements (lunges, skips, hops, mummy walks, etc.)
  • Stretch the muscles of the calf before and after all activity
  • Perform the following exercises daily to build strength in the lower legs:
  • Walk on your toes for 20 yards there and back.
  • Repeat 3 times.
  • Walk on your heels for 20 yards there and back.
  • Repeat 3 times.
  • Perform 3 sets of 25 calf raises.
  • Squeeze and curl your toes as hard as possible.
  • Perform 3 sets of 25 reps.
  • Consider taking a day of training to do “cross-training” exercises. Any activity besides normal training is considered cross-training.
  • (ex: swimming for runners, basketball for soccer players)
Treating MTSS

If you are suffering from MTSS here is what you can do to decrease your pain and symptoms:

  • Perform the prevention exercises after practice to alleviate the symptoms and prevent another occurrence.
  • Ice the affected area after all activity (practice, prevention exercises, and stretching) for 15-20 minutes.
  • OR
  • Use a paper cup to create a large ice cube. Massage the tibia for 7-10 minutes applying gentle but firm pressure.
  • Over the counter NSAIDs (Ibuprofen, Motrin®, Advil®, or Aleve®) can be used to decrease pain symptoms.
  • Follow all recommended dosage and instructions provided by the manufacturer.
  • Compression sleeves keep the muscles warm, preventing them from tightening up.