MEDIAL TIBIAL STRESS SYNDROME OR SHIN SPLINTS

ANATOMY

The tibia is a long, triangular-shaped bone located in the anterior part of the leg, articulating with the femur, fibula, and talus. At the top, it forms the tibial plateau where the menisci are housed and the forces that go to or come from the femur are transmitted. At the bottom, it forms the internal malleolus that articulates with the talus. The tibia is medial to the fibula with which it articulates at its proximal and distal ends. Also, between both bones there is a fibrous membrane called "interosseous membrane" that provides stability to both joints.
 

Tibia Anatomy

WHAT IS IT?

Medial tibial stress syndrome is one of the most common injuries to athletes' legs. It produces localized pain along the distal two thirds of the posterior medial tibia during exercise, with pain on palpation of the tibia. It is caused by overloading of the bony cortex of the tibia, leading to inflammation of the membrane that lines the bone.

This tension normally causes micro bone damage, leading to bone adaptation processes to strengthen the bone to resist tibial flexion. When this bone zone exceeds a certain threshold and becomes overloaded, osteoclast activity can exceed osteoblast activity, leading to local tibial osteopenia.

Very common in runners who have performed excessive exercise, trained on hard surfaces or with incorrect running biomechanics. Common training mistakes include a recent onset of increased activity, intensity, or duration. Running on hard or uneven surfaces is also a common risk factor. People with previous injuries to the lower extremities and who run more than 20 miles a week are especially predisposed to injuries from overuse of the lower extremities, including shin splints. It is found more frequently in runners and also in other ballistic sports, such as soccer, basketball, soccer, and dance.

The most common complaint of patients with shin splints is diffuse pain in the lower limb, along the mid-distal tibia associated with exertion. In the early course of medial tibial stress syndrome, pain is worse at the beginning of exercise and gradually decreases during training and within a few minutes of cessation of exercise. However, as the injury progresses, the pain becomes less active and may occur at rest.
  

 

RISK FACTOR'S

• Increase in body mass: being overweight increases the load on our legs, which increases the possibility of suffering this type of injury
• Non-progressive training increase: excess training load on a body not adapted for it can trigger tibial pain.
• Flat foot: a bad biomechanical footprint produces adaptations of other areas of the body that can affect the tibia.
• Lack of range of motion in the ankle: Muscular shortening of the triceps surae (calves and soleus) or lack of ankle travel produces, once again, adaptations in the footprint.
• Lack of hip range of motion: Lack of gluteus medius triggers a valgus knee and, as a consequence, a wrong footfall.
• Running on hard surfaces: the harder the terrain, the more impact our body will suffer.
 

TREATMENT

In the acute phase: it is recommended to apply cold and interrupt activities that have an impact. The application of cold has an analgesic effect and reduces inflammation on the area. The most effective are 20 minutes of cold 2/3 times a day with an interval between both applications of at least 2 hours.

In subacute phase: introduce low impact exercises such as swimming or elliptical training and low intensity training. Continue with the application of cold.

Finally, a progressive return to training incorporating exercises to gain ankle joint travel and strengthen the gluteus medius. Plantar flexion, dorsal flexion, eversion and inversion must have a correct range of movement, and stretching of the triceps sura can also be beneficial. Having a strong gluteus medius will make our hips more stable during running or running. One of the least worked areas and that sometimes causes the alignment of the hip-knee-ankle to be lost.

 

GENERAL RECOMMENDATIONS

·    Lower training load: As symptoms subside, progressively increase it. Sandblast exits to dirt or grass tracks.
·    Caution with massages: the area is very sensitive and can increase pain.
·     Ice application.
·    Search for suitable footwear.
·    Solving biomechanical problems: such as flat feet or excessive pronation of the ankle.
 

 

HOW IS MEDIAL TIBIAL STRESS SYNDROME TREATED WITH PHYSIOTHERAPY?

The first thing is to analyze the biomechanics of the footprint to recommend strengthening or relaxing specific muscles to prevent, for example, the knee from having an excessive movement towards the inside.

Relaxing the leg muscles can help rest the traction periosteum because a tight muscle pulls more on its insertion.

Also diathermy technology, based on the use of high frequency electric currents that are not noticeable by the patient. Increasing metabolism and helping an earlier recovery.

Shin Splints Physiotherapy