MEDIA TIBIAL STRESS SYNDROME OR SHIN SPLINT

Runner’s painful tibia is a condition associated with intense exercise and sport activities. It refers to the inner part of the tibia bone, in its entire length.

It usually occurs after intense activity and especially after running. Any intense activity can cause pain especially, during the first days of a specific exercise program. There are some simple pain relief measures and instructions. Resting in combination with ice therapy often helps. In addition, it should be understood that the patient should not exaggerate with exercises and sports activities.

 

DESCRIPTION

Medial tibial stress syndrome is an inflammation of the muscle groups, tendons around the tibia and the tibial bone. The pain is located along the inner rim of the tibia, a point where the muscles are inserted in the bone.

MEDIAL TIBIAL STRESS SYNDROME

ETIOLOGY

Medial tibial stress syndrome generally occurs when the muscles and periosteum of the tibia are strained after intense and repetitive activity.

In particular, it is developed after sudden changes in physical activity. These changes may relate to the frequency, duration or intensity of training.

 

Other factors that contribute to the medial tibial stress syndrome include:

  • Flatfeet
  • Exercise with inappropriate footwear
  • Long distance runners (at higher risk)
  • Professional dancers and recruits (two high risk groups)

MEDIAL TIBIAL STRESS SYNDROME

CLINICAL EXAMINATION

The most common symptom of the medial tibial stress syndrome is pain along the tibia rim, while local edema may also be present.

The characteristics of pain may be:

  • Acute pain with a sharp onset or mildness
  • Onset during exercise or even after exercise
  • Worsening with pressure, locally

 

CLINICAL EXAMINATION

After receiving a detailed medical history, the Orthopedist will examine the patient’s tibia. Sometimes, there may be other problems that may affect the course of the disease.

Your doctor may recommend imaging tests to rule out other problems. There are enough conditions that can cause tibial pain, including fatigue fractures, tendonitis, or chronic compartment syndrome.

 

Fatigue Fracture: If the medial tibial stress syndrome does not respond to treatment, the physician may need to rule out the possibility of a fatigue fracture after intense activity.

Imaging tests are useful to confirm the diagnosis. Bone scintigraphy and magnetic resonance imaging (MRI) are able to demonstrate a possible fatigue fracture in the tibia.

 

Tendonitis: By “tendonitis” we mean inflammation of the tendon. These are painful conditions that can resemble the medial tibial stress syndrome. Magnetic resonance imaging can help in the diagnosis.

 

Chronic compartment syndrome: Chronic compartment syndrome, although rare, it can mimic the symptomatology of the medial tibial stress syndrome. The chronic compartment syndrome is a painful pathological condition that occurs when the pressure inside the muscles rises up to dangerous levels. The chronic compartment syndrome is caused by fatigue and strenuous exercise. The pain usually subsides immediately when the activity is stopped. Diagnosis is usually confirmed by measuring the pressure inside the tibia compartments before and after exercise.

 

TREATMENT

CONSERVATIVE THERAPY

Rest: Given that the medial tibial stress syndrome is caused by excessive and intense activity, the initial treatment involves several weeks of rest. Later on, the typical exercises that caused the problem can be replaced by activities such as swimming and cycling.

Non-steroidal anti-inflammatory drugs: Drugs such as ibuprofen, aspirin and naproxen reduce pain and edema.

Ice therapy: Application of ice pads 3 to 4 times a day for 20 minutes each.

Compression: Elastic bandages or use of elastic knee pads.

Stretching Exercises: They can reduce the severity of the symptoms.

Suitable footwear: Using well-supported athletic shoes can help relieve symptoms.

Orthopedic footwear: Footwear with inserts that support the foot arch by distributing loads on the lower legs.

Return to Exercise: Before returning to exercise, it is advisable to have at least 2 weeks without symptoms, while the intensity of training should be gradually increased.

The program of warm-up with stretching exercises should always be performed before training. If symptoms reappear, the patient should immediately stop exercising and use all of the above-mentioned means by gradually starting again with sports activities.

 

SURGICAL TREATMENT

Few patients with the medial tibial stress syndrome eventually end up having surgery, but to date it is unclear how effective it can be.

 

PREVENTION

Suitable footwear: Following some simple guidelines can help prevent medial tibial stress syndrome. The use of appropriate sports footwear helps to distribute loads properly to the feet and generally to the lower limbs. In addition, the footwear must be designed for specific sports.

Gradual increase in activity: The intensity and duration of training should be gradually increased. Shoe-free training: In recent years, shoe-free running has gained popularity. Patients report that it has contributed to their recovery from the medial tibial stress syndrome. However, there is no clear evidence that training-without-shoes reduces the risk of developing symptoms.

If all of the above measures do not help relieve the symptoms of the medial tibial stress syndrome, the patient should visit the Orthopedist.