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Medial Tibial Stress Syndrome - "Shin Splints"

By Michael DeChello, MS, PT

The term shin splints is gradually being used less because of the generality of the term. More recently the term medial tibial stress syndrome is coming into use. This term is appropriate to use in the absence of stress fracture or compartment syndrome. Medial tibial stress syndrome includes periostitis, traction peristalgia, tendonopathy and fatigue failure of the connective tissue connecting muscle to bone. Medial tibial stress syndrome occurs at the posteriomedial aspect of the tibia. There is usually no pain at rest and a palpable tenderness. Pain is usually brought on by exercise and can be sharp or dull in nature. Pronation or the lack of control at the midstance phase of running is usually associated with MTSS. Treatment approach includes rest as the most important. Training alterations needs to be considered. Biomechanical evaluation should be performed, and shoe and custom orthotics may be indicated to control pronation. Calf stretching and core strengthening should be included in a comprehensive exercise program. Alternative low impact exercise should be given during the rest period to help maintain overall cardiovascular conditioning. Gradual return to activity and incrementally building up distance and intensity should facilitate a smooth return to normal exercise.

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