Medial Tibial Stress Syndrome

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Original Editors - Karsten De Koster

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Search Strategy 

Search on Pubmed and Pedro with keywords: “Shin-splints”, “Medial tibial stress-syndrome” , “shin pain”and “tibial periostitis”. Search in libraries books about sport injuries, sports medicine, sport anatomy.

Definition/Description

The American Medical Association defines shin-splint syndrome as “pain and discomfort in the leg from repetitive activity on hard surfaces, or due to forceable, excessive use of the foot flexors(1). The diagnosis should be limited to musculoskeletal inflammation, excluding stress fractures or ischemic disorders” ((1) Citation).

Shin-splints is a general term for overuse injuries of the lower leg, except stress fractures and compartmental syndrome. (2) Hutchins C.P. says that shin-splints is a controversial term, because authors disagree about the in- and exclusion criteria’s. (3)

A synonym for shin-splints is: medial tibial stress syndrome. But Bruckner and Kahn say: “A more descriptive term that accounts for the inflammatory, traction event on the tibial aspect of the leg common in runners is medial tibial traction periostitis or just medial tibial periostitis “.

There are five possibilities which can describe the experienced shin pain: bone stress, inflammation, vascular insufficiency, nerve entrapment and a raised intracompartmental pressure.(4)

Clinically Relevant Anatomy

The most important clinical region is the lower leg. A dysfunction of tibialis anterior and posterior, of soleus muscles are commonly implicated, also the area of attachment of these muscles can be the location of pain. (5 )

Figure1:
Chasan N., shin-splints, http://srcpt.blogspot.com/2009/02/shin-splints.html, 2 February 2009

Epidemiology /Etiology 

Shin-splints is most common with athletes who made training errors, especially when they overload or when they run too fast for his potential. As we can see this injury can also be related to changes in the training program like an increase in distance, intensity and duration.(6 ) Running on a hard or uneven surface and bad running shoes (like a poor shock absorbing capacity) could also be one of the factors related to the casualty. Biomechanical abnormalities as foot arch abnormalities, hyperpronation of the foot, unequal leg length,..( 7) are the most frequently mentioned intrinsic factors.
Women have an increased risk to incur stress fractures, especially this syndrome. This is due to nutrional, hormonal and biomechanical abnormalities. Individuals who suffer of overweight are more susceptible for this syndrome. Therefore it’s important that people with overweight combine their exercises with a diet or try to lose weight before starting a therapy or a training program. These people, along with poor conditioned people, should always slowly increase their training level. Cold weather contributes to this symptom, therefore it’s important (even more than usual) to warm up properly. (1)
“Internally a chronic inflammation of the muscular attachment along the posterior medial tibia and bony changes are considered to be the most likely cause of the medial tibial stress syndrome. “(8)

Characteristics/Clinical Presentation

 The most common complication of shin-splints is a stress fracture which shows itself by tenderness of the anterior tibia(6). Sensor and motor loss in association with exertional lower leg pain are another possible clinical symptom. Also pheripheral vascular disease could be a cause of the pain(6). So the main symptom is pain on the medial side, in the second third of the leg. The pain is caused by repeated landing and take-off from the surface (8) . This pain worsens at each moment of contact(7). The symptoms are often bilateral(1).
At first the patient only felt pain when starting the training but further on the pain could remain even when in rest. In some cases we can also see a certain degree of swelling. (8)

Differential Diagnosis

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Diagnostic Procedures

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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