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Medial Tibial Stress Syndrome


Also caused by the muscle imbalance of anterior and posterior lower leg muscles. ... Stretching of Achilles tendon several times daily, as well as other leg muscles ... – PowerPoint PPT presentation

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Title: Medial Tibial Stress Syndrome

Medial Tibial Stress Syndrome
  • By Fafa Tsikata

What is Medial Tibial Stress syndrome?
  • Commonly called shin splints
  • Can be anterior or posterior
  • MTSS is periostitis- inflammation of the
    periostium of the deep posterior Tibial muscles.
  • Also caused by the muscle imbalance of anterior
    and posterior lower leg muscles.

Where does MTSS occur?
  • The posteriom-edial Tibial border
  • Along the distal 1/3 of the Tibia

  • Believed to be caused by periostitis of the
    insertion of the soleus along the posterior
    medial border of the tibia.
  • Biomechanical abnormalities
  • Pes planus
  • Arch does not support or absorb shock from the
    ground which causes stresses to travel up the
  • Pes Cavus
  • Causes more stress to the tibia due to the foots
    inflexibility during gait which does not allow
    for shock to be absorbed
  • Excessive pronation and supination of the foot
  • Causes an eccentric contraction of the soleus.
    The stess from the contraction inflames the
    periostium therefore causing pain.

History Cont.
  • Changes in running form
  • Usually trained individuals
  • Increase in training
  • Speed or distance
  • Usually untrained individuals
  • Footwear
  • Old or new shoes
  • Improper shoes for arches
  • Changes in running surface
  • Hard/ soft

Signs and symptoms
  • Typically occurs in runners or jumpers
  • Athlete will be point tender on the medal aspect
    of anterior Tibial crest.
  • Athlete will complain of dull ache
  • Pain occurs at any time during activity
  • Pain diminishes with activity
  • Pain will reappear within hours after activity
  • Athlete will also have pain ascending and
    descending stairs

Signs and Symptoms
  • Pt. will be tender along the length of the
  • If Pt. is point tender in one specific spot is
    and indication of stress fx.

Special Test
  • One Leg Hop Test
  • Pt. stork standing on affected leg
  • Pt. hops 10x
  • Pt. with MTSS should be able to complete test
    without severe pain
  • If severe pain occurs indication of Stress Fx

  • RICE
  • Approximately 5-7 days rest
  • Cryotherapy
  • Ice Massage
  • Stretching of Achilles tendon several times
    daily, as well as other leg muscles
  • Muscle strengthening
  • Of muscles involved in Pt.s activity
  • Proper periodization of Training
  • Biomechanical assessment

Management Cont.
  • Compression taping
  • Arch Taping
  • X taping
  • Tear Drop taping
  • Arch support
  • Orthotics
  • Proper shoes with sufficient heel support and
    shock absorption

  • As pain subsides Pt. can work gradually towards
  • Low impact training such as biking or swimming to
    keep cardiovascular levels
  • Progress to around 1/2 of full intensity
  • Keep in mind that if pain returns progression is
    to fast.

  • 1. shin splints. 27 March, 2008.
  • 2. shin splints. 28 March, 2008.
  • 3. Anderson M., Hall S., Martin M., Foundations
    of Athletic Training. 3rd ed. Philadelphia, Pa
    Lippincott Williams Wilkins 2005 578,579
  • 4. Shin splints. 08 April,2008.
  • Lecture Notes