Medial Tibial Stress Syndrome Overview

Medial Tibial Stress Syndrome

Third most common running injury, also known as Shin Splints.

Common Population

Common in military recruits.

Patient Reports

Diffuse posteromedial tibial pain that is related to activity, recent increase in training, and prior history of MTSS.

Key Examination Findings

- Posterior Tibia palpated for tenderness

- MMT reveals pain or weakness of Tibialis posterior, soleus, or Flexor digitorum.

-Hip ABD Weakness

-Positive Navicular Drop

-Loss of Dorsiflexion Range

Positive Navicular Drop

Indicates excessive foot pronation.

Excessive/Prolonged Pronation

Observed during gait/running.

Running Analysis

Should be performed as part of the assessment.

Footwear Assessment

Should be performed to evaluate support and fit.

Risk Factors

- female gender

- history of MTSS or running-related injury

-higher BMI

- greater navicular drop

-prolonged rearfoot eversion & foot pronation

- greater hip ER

- stiffness in FDL & Tibialis posterior

-- muscle imbalance.

Running Experience

Running less than 5 years is a risk factor.

Differential Diagnosis

Includes stress fracture, tibialis posterior strain, and compartment syndrome.

Interventions

Activity modification and 7-10 days of rest; severe cases may require 3-8 weeks of partial weight bearing and aquatics.

Stretching Goals

- To increase dorsiflexion range/gastroc length

- Decrease stiffness of FDL & tibialis posterior.

Strengthening Focus

Includes inverters, tibialis anterior, plantar flexors, and hip muscles.

Footwear Modification

To control pronation and provide shock absorption.

Weight Loss Program

Recommended if needed.

Progressive Return to Activities

A structured approach to return to physical activities.

Extracorporeal Shock Wave Therapy

An intervention option for MTSS.

Fasciotomy

Considered when conservative treatment fails after a 6 month attempt.

Recovery Rates

- 30% recovered after 1 month

- 92% after 4 months

- Average of 109 days (3.5 months) to complete running program.

Theories of MTSS

Includes traction injury, response to repeated tibial bending/bowing, and continuum of shin splints to overt stress fracture.

Muscle Imbalance

-Posterior tibialis & other medial muscles must work to control muscle imbalance.

- Hip ABD weakness

% recovered with conservative care•

After 1 month:

30%•

% recovered with conservative care•

After 4 months:

92%•

% recovered with conservative care•

Average ______________to complete running program

109 days (3 1/2 months)