As a sports physiotherapist, I often see runners or athletes who often jump with tibia complaints that could have been resolved much sooner and earlier in the event of an earlier intervention. What are the tibia complaints really? How does it arise? And what can you do about it yourself?

What are the tibia complaints?

The medial tibial stress syndrome (MTSS) causes pain in the shins and is one of the most common “overload injuries” in runners. The complaint is common with repeated high-impact loads and is responsible for 13 to 17% of all running injuries (1). Women have a higher risk than men to develop these complaints.

In this injury, nagging pain on the inside of the lower part of the tibia is experienced in a specific area (see illustration). Initially, the pain often occurs only during exercise, but the pain can later also continue after the load.

tibia

On the Internet and by athletes, the term ‘shin splints’ is often used as a container term for all tibia complaints, while in most cases MTSS is meant. Furthermore, there is often to read that there is bone inflammation of the tibia in shin splints. In the meantime, it is probably clear that this is not a cause of the complaints at MTSS (2) .

At the MTSS there is a change of the Tibia (shin bone) because load and load ability are not in balance. In the case of a lot of (hard) walking and jumping, the tibia acquires considerable compressive forces. Normally, the bone will only get stronger here, until a certain limit in terms of the load is overwritten. From that moment on, the opposite occurs, namely that the bone becomes more painful and weaker with less strain. Bone scans show that bone density in injured athletes is 23% lower than in non-injured athletes and at the moment that symptoms decrease, bone density recovers to normal values (2).

If pain complaints last longer than twelve weeks, one speaks of chronic pain. The nervous system becomes oversensitive as pain is longer (3). I will go back to this in a subsequent blog.

Cause?

Overload

The main causes of overload are a lot of jumping or running. Often, tibia injuries result from a too fast build-up in load. For example, if you pick up your running again after a period of being stopped, it is important to build it up again. A build-up schedule is important, even if you can handle it conditionally. Your muscles, tendons, and bones have to get used again and therefore adapt to the load again.

Walking pattern

The way you run can play a role in developing this injury. For example, if you drop through your hips while running, causing your knee to turn slightly inward (end rotation), your foot may tip inward (pronation). This is a known intrinsic risk factor for the development of MTSS. When there is pronation in the foot, an (eccentric) tightening of the calf muscle occurs (m. Soleus). As a result, an extra length of the muscle is requested from the heel, resulting in additional tensile forces on the tendon and on the tibia  (1) .

Muscle strength

Torso and hip stability seem to play a role in the development of injuries to the lower limbs (hips, knees, and ankles) (2) . If instability arises from the trunk, your legs will have to work harder to correct this. In athletes with muscle weakness in the triceps surae (muscle muscles) or a reduced muscle endurance, tibia flexion (Tibia) will occur earlier in muscle fatigue.

What can you do about it?

Relatively a lot of rest, because of stopping completely from moving nobody gets stronger. It is important that you give your body the chance to recover. Make sure you do not train through the pain. A good tool for this is to use the VAS pain scale, where you score your pain on a scale of 0-100 where 0 is not pain and 100 the worst possible pain. A maximum pain score of VAS, ≤40, is maintained during all loads. If you go over this, you better stop running and you better go walking.

A treatment will mainly focus on gradually building up the load. This stimulates bone formation and inhibits bone breakdown. The training must be built up very gradually to prevent recurrence. Frequency, size, and intensity are important parameters (4). The walking load can be built up with the help of a physiotherapist (for example according to the Moen scheme) (2). It is often started on a treadmill, given the damping effect of running on a treadmill (2).

In addition, muscle strength training of the trunk and hips can be an important intervention. As a result, you will become less out of balance and the load on the tibia will decrease. In the first treatment stage, exercises are often performed to strengthen the strength of endurance without heavily burdening the tibia. Later in the treatment process (after twelve weeks), when the load ability is increased, these exercises are also used in a more explosive form. It has often opted for complex exercises in which several muscle groups are addressed at the same time. This is also to improve coordination and balance.

However, research has shown that only muscle strength training is not sufficient to adopt a different walking pattern. Loop training will also take place to change motor control (5). A running trainer or sports physiotherapist can help you with this.

Furthermore, changing your fixed round can be an important change. If you always walk on the same side of the road, there may be a greater strain on one leg because the road is often lower on the sides. Simply running your circle on the other side every now and then can already make a difference.

In summary: Do not ignore shin bone complaints, which are often the cause of overuse. By adding a number of relatively simple adjustments in your training schedule, running pattern and strength building, you can quickly go through life without pain.

Sources:

  1. The incidence and risk factors in development or medial tibial stress syndrome among naval recruits. Yates B, White S. 3, SL: Am J Sports Med, 2004, Vol. 32. 772-80.
  2. MH, Moen. Etiology, imaging, and treatment or medial tibial stress syndrome. Nieuwegein: Arko Sports Media, 2012.
  3. NHG Standard Somatic Insufficiently declared Physical Complaints (MUPS). Olde Hartman TC, Blankenstein AH, Miller AO, Bentz van den Berg D, Van der Horst HE, Arnold IA, Burgers JS, Wiersma Tj, Woutersen-Koch H. SL: General Practice Act, 2013.
  4. Bruijn, the MC. The medial tibial stress syndrome in athletes. SL: Association for sports medicine, 2010.
  5. The Effect of a Hip-Strengthening Program on Mechanics During Running and During a Single-Leg Squat. , Willy RW. Davis. 9, SL: Journ Orth & Sports Phys Ther, 2011, Vol. 41.

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