MEDIAL TIBIAL STRESS SYNDROME

 The Injury

Medial tibial stress syndrome is an irritation of the tibia (shin bone) at points where the soleus and tibialis posterior muscles attach to it.

• It is caused by over-use in runners, with those who run on hard surfaces being particularly affected.
• However, there are a number of factors, such as altered foot, knee and hip posture, that can predispose a person to the syndrome.

 Signs and Symptoms

• People suffering from medial tibial stress syndrome will feel pain on the inner border of the tibia (medial tibial border) during exercise and also at rest.
• It is important to distinguish medial tibial stress syndrome from other causes of shin pain ("shin splints") such as compartment syndrome and stress fracture. A bone scan is the best way investigate this.

 Treatment

• This involves rest, electrotherapy and strengthening and stretching exercises, followed by a gradual return to running after symptoms subside.
• In order to help prevent recurrence of the condition, a bio-mechanical analysis (an analysis of posture at rest and during walking and running) is very useful. This will pick up any factors that may be predisposing a person to medial tibial stress syndrome, so that they can be corrected before a return to activity. For example, a common cause of the condition is pes planus (flat feet). This would be identified during bio-mechanical analysis and corrected with orthotics (special insoles).
• In some cases of medial tibial stress syndrome that are resistant to conservative treatment, surgery may be necessary.

• When beginning or changing an exercise program, any increases in activity must be gradual. For example, an increase from running 2 miles per day one week to running 10 miles per day the next week cannot be undertaken without putting the body at risk of a number of problems.
• The amount of stress being placed on the shins can be minimized by running on soft surfaces and wearing good quality, supportive running shoes.
• It is possible that some cases of medial tibial stress syndrome could be prevented before they even happen by correcting such problems as flat feet with orthotics. However, many people have flat feet and run without any problems, and in such cases changing the foot posture with insoles might actually cause a problem. Therefore, the sensible rule is to only correct things if there is a problem, and the old adage "If it ain't broke, don't fix it" applies.