Medial Tibial Stress Syndrome | Physio4Life

Medial Tibial Stress Syndrome

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Sports physiotherapists are specialists in sports specific injuries.  They are able to use a wide range of preventative, rehabilitative and hands on techniques that can minimise the risk of needless symptoms, optimise your performance and help you recover from injury.


In our work we regularly come across a wide range of injuries including Medial Tibial Stress Syndrome (Shin-splints), these are a common injury in runners and sports people. Shin-splints is a non-descript pain which runners may report occurring in their leg, traditionally the pain is along the medial border and is a term used to describe shin pain in general.  Differentiating between types of shin-splint is however vital to a timely recovery, your training programme and the prevention of the symptoms recurring .


Here at Physio4life, we have sports physiotherapists who have experience of working with professional athletes and the Army.  This gives us an invaluable insight in to dealing with shin-splints, managing the individuals return to fitness and helping to prevent future occurrences of shin pain and ruling out factors within your control that may be contributing to shin-splints, overtraining, lack of rest, poor nutrition, poor footwear, poor training programmes and biomechanics.


Managing the London Marathon with shin splints

The marathon places huge demands on the body, each joint has a role to play in absorbing the pounding you give your body during training to achieve a lifetime goal, a personal best or simply raise money for your chosen charity.  The goals we set ourselves are what define us and we all strive to achieve them, more especially in the marathon as we put our body physically and psychologically under huge demands.
For every mile you run, your foot will absorb up to 4x your body weight 1600 times.  Your lower limb, knee, hips, ankle and foot are responsible for cushioning your steps, balancing and then propelling you.  If one joint is not strong, flexible or up to the job, then something somewhere else will have to compensate.  A specialist is needed to find out where the problem resides.


Here at Physio4life we have specialists in adopting a “top-down” or a “bottom-up” approach.   From our experience with sports-men and Army recruits, we are able to quickly, diagnose and treat your shin pain.  It is essential at the beginning to establish the exact nature of the injury and rule out what “flavour” of shin-splints the athlete has.


Top down or bottom up?

Our physio’s have orthotic and biomechanical experience with access to a fully equipped gymnasium with high speed and definition video analysis.  These state of the art facilities support a top-down and bottom up approach to the athlete.


Bottom up

In the Army, on the battlefield, it is simply not possible to stop, put your hand up and say sorry, can you hold on a moment, I just need to do my exercises to help prevent shin pain.  An orthotic may help align the foot and cushion the repetitive blows.  Using Quintic biomechanical analysis and our therapists experience, we are able to suggest appropriate orthotic solutions.  This helps align the foot “bottom-up” which may relieve the symptoms above.



Using our therapists expertise in sports and the Army, with Quintic biomechanical video analysis, we are able to provide solutions to strengthen hips, pelvis and facilitate core stability, by making gluteal muscles stronger at the top (the hips) we can adopt an approach which relieves the load on the muscles and joints in the lower limb.


Both a bottom-up and top down approach are essential when considering any injury. In our experience with professional athletes and the Army, we are able to quickly diagnose, put into place exercise and hands on therapy to reduce pain symptoms AND help to minimise the risk of shin-splints recurring.


What this means for the athlete

Personally and from anecdotal evidence, we have seen patients with shin-splints, who have had a need to get back into training and competition, whether for the Army or Marathon. A bottom-up approach helped to provide appropriate footwear for the individual for a problem that had plagued them for several years since taking up running. Through further analysis, we were able to put into place a progressive rehab and training programme that enabled the athlete to not only train at guided levels, but to compete and complete their marathons.


We managed this at Physio4life through our use of biomechanical experts, video analysis, hands on skills and preventative rehab (Pre-hab).


Additional Benefits

Significant evidence exists supporting the use of both a top-down and bottom-up approach and knowing when to use the appropriate course of action.  It is vital however to consider the evidence “pre-screening” has in the avoidance of shin-splints.  Most injuries are by the very nature avoidable.  Seeking the right advice on training and exercise, remembering that one size does not fit all has been shown in research to help individuals at amateur and elite status to not only reduce the risk of injury, but to also increase their optimum performance. Prevention is better than cure!  A simple screening may prevent shin splints through better guided training.


Food for thought indeed, especially for those contemplating their first marathon in 2011 or dramatically increasing their level of activity.


Russell Kesley MCSP works at Physio4life and has worked extensively with elite rugby players through the SRU, London Scottish and the Army.


Medial Tibal Stress Syndrome Summary

This article is dedicated to those individuals who have set themselves a goal of taking part in the London Marathon, either for fun, to better themselves and their time, and of who are seeking a sense of achievement. MTSS (Defn), what are the implications for the runner if not treated by a competent sports physiotherapist, with appropriate remedial reactive and pro-active approach to rehab and training.  Even if you have not had an injury, there is strong evidence suggesting that the an appropriate training routine.


Why use a sports physio at Physio4Life because you will have the confidence and trust in that you will be correctly diagnosed and we will have success in treatment. You will be fully assessed and we will help you achieve your goals.


“I am now finally on the road to recovery. I would highly recommend them to anyone.

Clare Fiore

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