How to treat medial tibial stress syndrome in runners?

While running is a great way to get fit and help with a healthy lifestyle, it is not without it risks and a number of runners can get an overuse injury each year that can be enough to stop them running. One of the more common injuries that runners get is medial tibial stress syndrome which used to be called shin splints, but is now not a good term to use. This is an injury to the structures just behind the lower medial side of the tibia bone in the lower half of the leg. Typically, this starts of as a minor ache in the area. If you palpate along and behind the tibial bone on the medial side of the leg it can be quite painful. If the athlete keeps running, then this will get progressively worse. The most common cause of this problem is simply a too rapid increase in the running distances and frequency. If this done too quickly and there is not enough time to recover from hard runs, then an injury is often the likely outcome. Poor foot biomechanics, a faulty running gait and maybe using the wrong running shoes may also play a role in the cause of medial tibial stress syndrome.

The treatment of medial tibial stress syndrome is to initially manage the running training loads down to a level that can be tolerated and find alternative activities such as cycling to help maintain the aerobic fitness. On occasions this may need a period of total rest from running. Modalities such as ice after a run can always be used to help manage the symptoms. If the are problems with the foot biomechanics, then foot orthotics and changes to the running shoes may be needed to help with the alignment of the foot posture. The running biomechanics probably should be assessed to see if there is anything in the running technique that may be a factor in the cause of the medial tibial stress syndrome. If an issue is found with the running technique, then that needs to be addressed. Typically, the gait changes that are needed for medial tibial stress syndrome are to run with a wider base of gait, so that the legs hit the ground more vertical rather than angled in. The most important part of the recovery is the return to full running as the symptoms start to improve. When the symptoms do start to improve, the amount of running that is done needs to be very slowly increased. This slow and gradual increase is crucial. After each time there is an increase in the distance and frequency of running there needs to be a period of recovery to allow the tissues to adapt to that increased load. If this is done too quickly, then there is a high chance that the injury might happen again. Long term the prevention is based on using foot orthotics to alter the biomechanics, make the changes to the gait long term and carefully manage the running loads with adequate recovery following hard runs.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.