Medial Tibial Stress Syndrome (MTSS)

Contributing Factors associated with MTSS

INTRINSIC FACTORS

– Gender

– Body weight

– Biomechanics

– Calf strength and endurance

– Foot posture

– Bone density

– Running technique 

EXTRINSIC FACTORS

– Training errors

– Footwear 

– Work load (i.e., time on feet)

Considerations in the management of MTSS

SHORT TERM

• Assess to determine possible tissue source

As there are a number of tissues that may be implicated in shin pain, it is important to assess for the most likely tissue contributions to each presentation. The management of presentations will vary dependent on the likely tissue source (i.e., bone versus muscle)

• Activity modification

Load often needs to be modified to reduce symptoms and allow contributing factors to be assessed and addressed. This doesn’t mean no running, but running load should be reduced to a volume that provides an opportunity for tissues involved to rest and recover. 

• Dry Needling & Soft Tissue Techniques

These techniques can help to improve the health of affected tissues.

LONG TERM 

• Strengthening (if indicated)

Calf strength and endurance is often a contributing factor in the presentation of MTSS, and if a deficit exists, it needs to be addressed. In addition, a lack of hip strength can contribute to adverse biomechanics that are associated with the development of lower leg pain in runners. 

• Running Technique 

There are variances in running technique that can result in an increased load through your lower leg. Some individuals may benefit from technique modifications to reduce impact loads.

• Footwear

Footwear can have an impact on medial shin pain as they have an effect on both lower limb biomechanics, and muscle activation.