Medial Tibial Shin Pain

what is the MTSS

inflammation along the medial tibial border of the leg

what is the injury classification for MTSS

overuse chronic injury

• pain progressively worsens over time

what is the mechanism of injury for MTSS

repeated stress to the shin and leg muscles causes irritation and small tears in the surrounding muscles and their attachment

how does running work

• each foot-strike delivers a shockwave that travels up the leg

• this energy must be absorbed by the foot, ankle, and lower leg

• when the stress becomes greater than what the body can absorb, injury occurs

signs and symptoms

• diffuse pain

• point tenderness

• inflammation along the medial anterior side of the tibia

• an area of discomfort measuring 4-6 inches in length is frequently present

• pain is often noted at the early portion of the workout, then lessens, only to reappear near the end of the training session

• shin splint discomfort is often described as dull at first

  • pain becomes more extreme with continuing trauma

what are the intrinsic factors that can cause MTSS

• foot conditions (high / low arches)

• inflexible posterior leg muscles

• toe running

what are the extrinsic factors

• running surface does not absorb shock

• poor shoe cushioning

what are the immediate first aid steps

• apply ice and have the athlete rest

• ice massage 8-10 minutes

• compress with tensor

what treatments can be used to alleviate pain

• anti-inflammatory medications

• 4-inch wide ace bandage wrapped around the region helps reduce discomfort

• calf and anterior leg stretching and strengthening

• pay careful attention to selecting the correct running shoe based on foot type

• stretching / strengthening exercises should be done twice a day

• run only when symptoms have generally resolved

towel stretch

• sit on a hard surface with your injured leg stretched out in front of you

• loop a towel around your toes and the ball of your foot

• pull the towel toward your body keeping your leg straight

• hold this position for 15 to 30 seconds then relax

• repeat 3 times

standing calf stretch

• stand facing a wazll with your hands on the wall at about eye level

• keep yoru injured leg back with your heel on the flloor

• keep the other leg forward with the knee bent

• turn your back fopot slightly inward

• slowly lean into the wall unbtil you feel a stretch in the back of your calf

• hold the stretch for 15 to 30 seconds

• return to the startting poisition

• repeat 3 times

anterior compartment stretch

• stand sideways next to a wall or chair with yoru injured leg further from the wall or chair

• put one hand on the wall or chair for balance

• bend the knee of your injured leg and grab the front of your foot

• bend the front of your foot toward your heel

• hold for 15-30 second and repeat 3 times

resisted ankle dorsiflexsion

• anchor one end of the tubing to somethign that wont move

• tie a loop in the end of the tubing and put the foot on your inmured side through the loop so that the tubing goes around the top of the foot

• sit wit hyour injured leg straight out in front of yopu

• keeping your leg straight, pull the top of your foot toward your body, stretching the tubing

• 2 sets of 15 for each exercise

ankle range of motion

• sit with yoru legs straight and your knees potining toward the celing

• point your toes on your injured side toward your nose then away from your body

• point your ties in toward your other foot and then out away from your other foot

• move the top of your foot in circles

• move only your foot and ankle

• repeat 10 times in each direction

heel raise

• using something as support to keep your balance, raise your body onto your toes and hold for 5 seconds

• slowly lower yourself down without holding ont othe support

• repeat 15 times for 2 sets, rest 30 seconds betwene each set

resisted ankle inversion

• sit with your legs stretched out in fornt of you

• cross the ankle of your uninjurd legf over your other ankle

• wrap elastic tubing around the ball of your foot of your injured leg then loop it around the other foot so that the tubing ios anchored at one end

• hold ther other end of tubing in yuour hand

• turn the foot of our injurd leg inward and upward

stadning toe raise

• stand with your feet flat on the floor

• rock back onto your heels and lift your toes off the floor

• hold for 5 seconds and then put your toes back on the floor

• 2 sets of 15

resisted hip abduction

• stand sidewatys near a door with your injured side further from the door

• tie elastif tubing around the ankle on your injured side

• knot the other end of the tubing and close the knot in the door near the floor

• pull the tubing out to the side, keeping your leg stragith

• return to the starting poisition

• 2 sets of 15

walking exercises

• walk on toes

• walk on heels

• walk with feet turned in

• walk with feet turned out