Medial Tibial Stress Syndrome (Shin Splints) in Pre-Season
As athletes gear up for the season, many focus on building strength, endurance, and skill. However, one common injury that often sidelines athletes during pre-season training is Medial Tibial Stress Syndrome (MTSS), commonly known as shin splints. MTSS is an overuse injury that causes pain along the inner part of the shinbone (tibia). It typically occurs when the muscles and tendons around the shin excessively pull on the tibia which becomes irritated or inflamed due to repetitive stress. The pain is often localised along the inner edge of the tibia and can range from a dull ache to a sharp, burning sensation. While MTSS is common among runners and athletes who perform high-impact activities, it can affect anyone who suddenly increases the intensity or volume of physical activity. Symptoms of MTSS The most noticeable symptom of MTSS is pain along the inner part of the shinbone, often after exercise. The pain can initially be mild and can persist for hours or days following activity. However, as MTSS progresses, the pain may become more intense and persistent during training as well. Other symptoms include: Tenderness when pressing along the inside of the shin. Swelling or warmth in the shin area. Pain that worsens with activity but may subside with rest. If left untreated, MTSS can worsen and lead to more serious stress fractures, which require more time off for healing.Why Does MTSS Happen During Pre-Season?
Pre-season training is all about building fitness after a period of rest. Athletes often ramp up their exercise intensity and volume quickly to prepare for the upcoming competition. This sudden increase in training load can put excessive stress on the muscles and bones of the lower leg, leading to MTSS. Here are some factors that contribute to the development of shin splints during pre-season: Increased Training Intensity: Jumping back into intense training after a break puts significant stress on the muscles and tendons of the lower leg. Hard Surfaces: Running or training on hard surfaces like concrete or asphalt increases the risk of MTSS due to the repetitive impact on the legs. Improper Footwear: Worn-out shoes or shoes that don’t provide adequate support can contribute to biomechanical imbalances, putting more strain on the lower leg muscles. Muscle Imbalances or Weakness: Weakness in the calf muscles or a lack of flexibility in the Achilles tendon can place additional strain on the tibia. Poor Running Mechanics: Overstriding or improper foot placement while running can exacerbate stress on the shin area. Training on Hills: Running on uneven terrain or inclines can alter an athlete’s gait and increase stress on the shins.How to Manage MTSS If It Occurs
If you start to feel the early signs of MTSS during pre-season training, don’t ignore the pain. Here are steps to manage the injury and prevent it from getting worse: Rest: Give your shins time to heal. Rest is essential, especially in the early stages of MTSS. Consider reducing training intensity or switching to low-impact activities like swimming or cycling. Ice Therapy: Apply ice to the affected area for 15-20 minutes after exercise to help alleviate pain. Strengthening: Focus on strengthening the lower legs as part of your rehabilitation plan. Gradual Return to Activity: Once the pain subsides, gradually return to training. Avoid jumping back into high-intensity or high-volume activities too quickly. Consult a Physiotherapist: A physiotherapist can assess your condition, suggest corrective exercises, and guide you on managing MTSS through manual therapy and tailored rehabilitation programs. At Complete Balance, your physiotherapist will guide you through your individualised rehabilitation to address your goals and return to sport/activity. Physiotherapy management includes: Hands on treatment for pain relief Address work ons Prescription of an initial de-load period to allow for symptom relief Progressive reload to allow for return to full function – this will include an exercise program (home or gym based) and a run/walk program if applicable to your goals Assist in the management of risk factors Discuss pain relieving strategies Assist with ongoing load managementFranklyn, M., & Oakes, B. (2015). Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments. World journal of orthopedics, 6(8), 577–589. https://doi.org/10.5312/wjo.v6.i8.577
Hamstra-Wright, K. L., Bliven, K. C., & Bay, C. (2015). Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. British journal of sports medicine, 49(6), 362–369. https://doi.org/10.1136/bjsports-2014-093462
Moen, M. H., Tol, J. L., Weir, A., Steunebrink, M., & De Winter, T. C. (2009). Medial tibial stress syndrome: a critical review. Sports medicine (Auckland, N.Z.), 39(7), 523–546. https://doi.org/10.2165/00007256-200939070-00002