What causes MTSS?
MTSS is commonly caused by doing too much training too soon. This can include starting up running after a long break, increasing your running distance or intensity too fast, changing the surface you run on, such as changing from road to trail, or changing the camber eg if running one way on a sloping beach or hill.
There are various factors which can predispose you to shin splints. Tight calf muscles commonly cause shin splints due to the pulling of the attachment point of the soleus as previously mentioned. Also, tight calf muscles mean that the foot tends to flatten more in the weight-bearing phase of running, as movement in the ankle is reduced.
Having feet that overpronate (flatten out) during running can also predispose you to MTSS. This is because more stress is placed on the muscles on the inside of the shin when the foot hits the ground, with less absorption of the forces, so more force is transferred up the leg.
What to do?
It is very important initially to rest from the aggravating activity (in this case running) as if you continue to run, it will not heal, and can progress on to more acute problems such as tibial stress fracture, where there is actually degrading and small stress fractures in the bone.
Ice, compression and elevation in the early stages are important. It is worth seeing a physiotherapist or podiatrist to determine if you have any of the predisposing factors as mentioned above. If you do tend to overpronate, insoles may well assist in alleviating some or all of the pain. Stretches for the calf muscles is an absolute must, and using a foam roller to do some self-massage is a good idea as well. These need to be done daily. Strengthening hip muscles and calf muscles is also important, and your physiotherapist can show you how to do this.
When can I return to running?
Returning to running should only be done when you are pain-free walking, and there is no pain to touch on the area that was tender. Increasing the distance should be done gradually, slowly increasing the intervals of running until you are happy you can run continuously without injury.
Generally MTSS can be treated very effectively, however, it is important to seek help to alleviate symptoms and reduce recurrence, particularly if you are keen to continue running.
Matthew Carr, Chartered Physiotherapist
