Medial tibial stress syndrome or shin splints, primarily affect the soft tissues surrounding the tibia (shinbone) and, in some cases, may lead to stress-related injuries in the bone with the end stage a stress fracture. Here is a brief explanation of the continuum or progression of the injury.
Soft Tissue Injury:
Repetitive stress and strain on the muscles, tendons, and connective tissues along the inner edge of the tibia lead to microtears and inflammation in these soft tissues.
Muscles, such as the posterior tibialis and soleus, and their associated fascia, experience repeated stretching and pulling during activities, causing injury to the soft tissue structures.
Inflammation and Edema:
The repetitive stress triggers an inflammatory response in the affected soft tissues, resulting in localized inflammation and edema (swelling).
Inflammatory cytokines and cells are attracted to the site of injury, contributing to the acute and chronic inflammatory process.
Traction Periostitis:
The continuous pulling of muscles and fascia on the periosteum (the outer covering of the bone) due to repetitive stress leads to a condition known as traction periostitis.
This periostitis results in localized pain, tenderness, and inflammation along the inner border of the tibia where the muscles and fascia attach.
Bone Stress Injury (Stress Reaction and Stress Fracture):
Prolonged and repetitive stress on the tibia can exceed the bone's ability to adapt and repair adequately, leading to microfractures or stress reactions in the bone.
Over time, these microfractures may progress to more significant stress fractures if the stress on the bone continues or intensifies without sufficient time for healing and recovery.
Continued Stress and Progression:
Without proper rest and recovery, the cycle of stress, soft tissue injury, inflammation, and potential bone stress injury continues and may progress along the continuum of MTSS.
Chronic inflammation and recurrent stress can lead to ongoing pain, functional limitations, and increased risk of more severe stress fractures.
Understanding this continuum is critical for diagnosing and managing shin splints effectively. Feel free to reach out with questions. Treatments options here, besides specific exercise, include shockwave therapy, dry needling, active release technique and other soft tissue techniques, laser therapy, manual therapy and joint manipulation to the associated joints.