Book appointment
Menu
Book appointmentMy appointments / cancel (in Norwegian)Clinics
Oslo SentrumOsloLørenOsloFornebuBærumSkiFolloKolbotnFolloLysakerBærumFredrikstad StadionØstfoldKlinikk Pluss SandvikaBærumAll clinics
TreatmentsPractitionersPricesContact
More
About BehandlerverketRehabilitationConditionsFranchiseWork with usArticlesHealth insurance
Norsk Call 53 75 55 55

Article

What exactly are shin splints?

Medial tibial stress syndrome (MTSS) was previously called shin splints and is a common injury among runners and athletes. The symptoms of MTSS are pain on the inner side of the lower leg, along the shin and often in connection with exercise.

What exactly are shin splints?

The pain often improves with rest, but for some it can persist for several days after a hard training session. MTSS can be difficult to get rid of, and many people will experience recurring pain over several years.

As mentioned, MTSS is common among athletes, particularly those who take part in running and jumping sports. Military personnel are another group that is often affected.

What is MTSS/shin splints?

MTSS was previously called shin splints because it was thought to be an inflammatory condition in the periosteum and/or in the tendon attachments of the calf muscles. This was supposedly caused by repetitive pulling from the muscles of the lower leg.

However, research has not found any inflammatory changes in the periosteum, or any other changes in the periosteum or muscles, that can explain the pain experienced with MTSS.

So what causes the pain?

The shin bone, the tibia, is exposed to considerable forces during activities such as walking, running and jumping. When there are large changes in training load, or prolonged high load, this can result in a stress reaction in the shin bone. This stress reaction is greatest in the area where the stress syndrome (MTSS) develops, on the inner/back side of the lower two thirds of the shin bone.

The reason why it is precisely this area that is vulnerable seems to be related to the bending forces that arise when the bone is loaded. The shin bone is better able to withstand compressive forces than bending forces.

When the training load becomes too high and recovery too low, the activity of the cells that break down bone tissue becomes greater than that of the cells that build up bone tissue. This can lead to reduced bone density, which weakens the bone's ability to tolerate load and makes it easier for a stress reaction to develop further.

How are shin splints/MTSS treated?

If you think you may have shin splints, it is therefore important to see a practitioner or doctor so that you can get a correct diagnosis and start treatment.

Treatment always involves reducing load to prevent further overload. MTSS is an overuse injury, so some load must be reduced so that the stress reaction does not develop further. This can be done in several ways: you can have fewer or shorter sessions, reduce the intensity of the session, or train in a different way. An example of alternative training could be less running and more cycling for a period. Even though you have to reduce load, it is not recommended to stop all loading, because even though the pain most often disappears with rest, it will most likely return with activity, as nothing has been done about the bone's ability to tolerate load.

Another important factor in treatment is gradually increasing the tolerance for load. Treatment to increase load tolerance should include graded running training and strength training, as both of these forms of activity are associated with increased bone density and cross-sectional area of the bone.

Both the running programme and the strength programme should be tailored individually based on symptoms. The running programme must involve a significant reduction in load compared with the normal training load you have had previously. Recovery is also very important!

Strength training should include strengthening of the calves as well as other tailored exercises. The load in strength training must be high enough to create a change in bone and muscle, which is why training with heavy weights is recommended.

It can also be wise to look at other factors that may be a risk factor for the development of MTSS, such as diet. It is uncertain whether shoes and insoles have an effect on, or in the treatment of, shin splints.

Pain in your lower leg when you exercise?

MTSS can be a long-lasting and frustrating injury both to have and to treat, but correct diagnosis and treatment are important in order to become pain-free and to resume “normal” activity or training. Our practitioners can help you with the treatment of shin splints/MTSS.

The article draws inspiration from Ken Fredin's fantastic website mtss.no, and if you would like more information about MTSS, it is recommended to read more there.

Sources:

  • https://www.mtss.no/
  • Lopes, A. D., Hespanhol, L. C., Yeung, S. S., & Costa, L. O. P. (2012). What are the main running-related musculoskeletal injuries? Sports medicine, 42(10), 891-905.
  • Rauh, M. J., Macera, C. A., Trone, D. W., Reis, J. P., & Shaffer, R. A. (2010). Selected static anatomic measures predict overuse injuries in female recruits. Military medicine, 175(5), 329-335.
  • Sharma, J., Golby, J., Greeves, J., & Spears, I. R. (2011). Biomechanical and lifestyle risk factors for medial tibia stress syndrome in army recruits: a prospective study. Gait & posture, 33(3), 361-365.
  • Yates, B., & White, S. (2004). The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. The American journal of sports medicine, 32(3), 772-780.
  • Kortebein, P. M., Kaufman, K. R., Basford, J. R., & Stuart, M. J. (2000). Medial tibial stress syndrome. Medicine & Science in Sports & Exercise, 32, S27-S33.
  • Winters, M. (2017). Medial Tibial Stress Syndrome: Diagnosis, Treatment and Outcome Assessment. Utrecht University,
  • Johnell, O., Rausing, A., Wendeberg, B., & Westlin, N. (1982). Morphological bone changes in shin splints. Clinical Orthopaedics and Related Research (1976-2007), 167, 180-184.
  • Bhatt, R., Lauder, I., Finlay, D., Allen, M., & Belton, I. (2000). Correlation of bone scintigraphy and histological findings in medial tibial syndrome. British journal of sports medicine, 34(1), 49-53.
  • Moen, M., Schmikli, S., Weir, A., Steeneken, V., Stapper, G., De Slegte, R.,... Backx, F. (2014). A prospective study on MRI findings and prognostic factors in athletes with MTSS. Scandinavian journal of medicine & science in sports, 24(1), 204-210.
  • Winters, M., Bon, P., Bijvoet, S., Bakker, E. W., & Moen, M. H. (2017). Are ultrasonographic findings like periosteal and tendinous edema associated with medial tibial stress syndrome? A case-control study. Journal of Science and Medicine in Sport, 20(2), 128-133.
  • Edama, M., Onishi, H., Kubo, M., Takabayashi, T., Yokoyama, E., Inai, T.,... Kageyama, I. (2017). Gender differences of muscle and crural fascia origins in relation to the occurrence of medial tibial stress syndrome. Scandinavian journal of medicine & science in sports, 27(2), 203-208.
  • Judex, S., Gross, T. S., & Zernicke, R. F. (1997). Strain gradients correlate with sites of exercise‐induced bone‐forming surfaces in the adult skeleton. Journal of Bone and Mineral Research, 12(10), 1737-1745.
  • Magnusson, H. I., Westlin, N. E., Nyqvist, F., Gärdsell, P., Seeman, E., & Karlsson, M. K. (2001). Abnormally decreased regional bone density in athletes with medial tibial stress syndrome. The American journal of sports medicine, 29(6), 712-715.
  • Gross, T. S., Edwards, J. L., Mcleod, K. J., & Rubin, C. T. (1997). Strain gradients correlate with sites of periosteal bone formation. Journal of Bone and Mineral Research, 12(6), 982-988.
  • Gemmell, L. M. (2002). Injuries among female army recruits: a conflict of legislation. Journal of the Royal Society of Medicine, 95(1), 23-27.
  • Hart, N. H., Nimphius, S., Rantalainen, T., Ireland, A., Siafarikas, A., & Newton, R. (2017). Mechanical basis of bone strength: influence of bone material, bone structure and muscle action. Journal of musculoskeletal & neuronal interactions, 17(3), 114.
  • Frost, H. M. (1997). Strain and other mechanical influences on bone strength and maintenance. Current Opinion in Orthopaedics, 8(5), 60-70.
  • Magnusson, H. I., Ahlborg, H. G., Karlsson, C., Nyquist, F., & Karlsson, M. K. (2003). Low regional tibial bone density in athletes with medial tibial stress syndrome normalizes after recovery from symptoms. The American journal of sports medicine, 31(4), 596-600.
  • Özgürbüz, C., Yüksel, O., Ergün, M., İşlegen, Ç., Taskiran, E., Denerel, N., & Karamizrak, O. (2011). Tibial bone density in athletes with medial tibial stress syndrome: a controlled study. Journal of sports science & medicine, 10(4), 743.
  • Fredericson, M., Bergman, A. G., Hoffman, K. L., & Dillingham, M. S. (1995). Tibial stress reaction in runners: correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. The American journal of sports medicine, 23(4), 472-481.
  • Newman, P., Witchalls, J., Waddington, G., & Adams, R. (2013). Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open access journal of sports medicine, 4, 229.
  • Kaspar, D., Seidl, W., Neidlinger-Wilke, C., & Claes, L. (2000). In vitro effects of dynamic strain on the proliferative and metabolic activity of human osteoblasts. J Musculoskelet Neuronal Interact, 1(2), 161-164.
  • Lozupone, E., Palumbo, C., Favia, A., Ferretti, M., Palazzini, S., & Cantatore, F. P. (1996). Intermittent compressive load stimulates osteogenesis and improves osteocyte viability in bones cultured “in vitro”. Clinical rheumatology, 15(6), 563-572.
  • Waldorff, E. I., Christenson, K. B., Cooney, L. A., & Goldstein, S. A. (2010). Microdamage repair and remodeling requires mechanical loading. Journal of Bone and Mineral Research, 25(4), 734-745.
  • Moen, M. H., Holtslag, L., Bakker, E., Barten, C., Weir, A., Tol, J. L., & Backx, F. (2012). The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology, 4(1), 12.
  • Paul, I., Munro, M. B., Abernethy, P., Simon, S., Radin, E., & Rose, R. (1978). Musculo-skeletal shock absorption: relative contribution of bone and soft tissues at various frequencies. Journal of biomechanics, 11(5), 237-239.
  • Radin, E. L. (1986). Role of muscles in protecting athletes from injury. Acta Medica Scandinavica, 220(S711), 143-147.
  • Winter, D. A. (1983). Moments of force and mechanical power in jogging. Journal of biomechanics, 16(1), 91-97.
  • Milgrom, C., Radeva-Petrova, D. R., Finestone, A., Nyska, M., Mendelson, S., Benjuya, N.,... Burr, D. (2007). The effect of muscle fatigue on in vivo tibial strains. Journal of biomechanics, 40(4), 845-850.
  • Popp, K. L., Hughes, J. M., Smock, A. J., Novotny, S. A., Stovitz, S. D., Koehler, S. M., & Petit, M. A. (2009). Bone geometry, strength, and muscle size in runners with a history of stress fracture. Med Sci Sports Exerc, 41(12), 2145-2150.
  • Popp, K. L., McDermott, W., Hughes, J. M., Baxter, S. A., Stovitz, S. D., & Petit, M. A. (2017). Bone strength estimates relative to vertical ground reaction force discriminates women runners with stress fracture history. Bone, 94, 22-28.
  • Fischer, V., Haffner-Luntzer, M., Amling, M., & Ignatius, A. (2018). Calcium and vitamin D in bone fracture healing and post-traumatic bone turnover. Eur Cell Mater, 35, 365-385.
  • Moen, M. H., Tol, J. L., Weir, A., Steunebrink, M., & De Winter, T. C. (2009). Medial tibial stress syndrome: a critical review. Sports medicine, 39(7), 523-546.
  • Korakakis, V., Whiteley, R., Tzavara, A., & Malliaropoulos, N. (2018). The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction. Br J Sports Med, 52(6), 387-407.