Running is a fantastic way to stay fit and clear your mind, but it’s not without its challenges, especially when it comes to injury. One common issue among runners that I often see in my clinic is Medial Tibial Stress Syndrome (MTSS), also known as shin splints. However, sometimes what appears to be MTSS can actually be something more serious, such as a tibial stress fracture. I’d like to share a particular case to illustrate how we identify and manage these conditions to help runners return to their best form.
A patient with Medial Tibial Stress Syndrome
A patient recently came to see me with persistent shin pain that he assumed was just a bad case of MTSS. He’d been increasing his mileage significantly and attributed the pain to that. However, during our initial musculoskeletal consultation, I suspected there might be more going on. The pain was localised to a specific spot on his tibia, and he experienced pain even when walking, which raised a red flag.
To get a clear picture, we performed a comprehensive assessment, starting with a 3D gait and biomechanics analysis. We analysed and then re-analysed his gait, identifying areas for improvement. This allowed us to see if there were any abnormalities in his running technique that could be contributing to his pain. We also tested his strength and range of motion, which are vital in understanding the overall health of the lower limb and its capacity to handle the stress of running.
Given the nature of his symptoms and the results from our initial assessments, we decided to go ahead with further imaging. An MRI confirmed what we suspected: a tibial stress fracture.
Treatment of Medial Tibial Stress Syndrome
With the diagnosis in hand, we moved on to developing a tailored treatment plan. Our approach was holistic and multi-faceted. First and foremost, we emphasised rest from running to allow the fracture to heal properly. We incorporated strength training, focusing on lower limb stability and resilience to prevent future injuries. Plyometrics were gradually introduced to improve his dynamic control and shock absorption capabilities.
Nutrition played a key role in his recovery. We worked closely to ensure his diet supported bone health and overall healing. This included increasing his intake of calcium and vitamin D, which are essential for bone repair. Proper hydration and overall balanced nutrition were also emphasized to optimize his recovery.
We didn’t work in isolation. Input from a wider medical team also contributed to his rehabilitation. The patient’s dedication to following the plan and the close monitoring of his progress were key factors in his successful return to running.
What’s even more rewarding is that through this process, the patient didn’t just return to running — he came back stronger and more efficient than before. Our combined efforts paid off, and he’s now running pain-free with improved performance.
*This is a very basic overview of some of the things we did and does not constitute medical advice which is given on a case to case basis.
We were delighted to receive this review from our patient:
“After suffering with what I thought was shin splints from running I turned to RS Podiatry to get answers…and I did.
Ricky was excellent in helping me quickly get a private MRI which discovered a complete tibia fracture.
After this news Ricks help and guidance in advising complete rest/crutches before returning to running has been second to none..I’m currently running about 17k a week now…it’s a slow return but his guidance on strength work (along with an S&C coach) and running form have been excellent. I wouldn’t have safely got this far injury free without him and am still working with him nowI would highly recommend RS Podiatry”.
This case highlights the importance of seeking professional help when persistent pain occurs. As podiatrists, we have the tools and expertise to diagnose and treat such conditions effectively. Our thorough assessments, including improving his running trainers, and holistic treatment plans can make a significant difference in recovery and performance.
If you’re experiencing similar symptoms or have any concerns about your running, don’t hesitate to reach out. Together, we can develop a plan to get you back on track and running better than ever.
By sharing this story, I hope to raise awareness about MTSS and tibial stress fractures, and the vital role a podiatrist can play in diagnosing and treating these conditions. If you’re a runner facing persistent shin pain, remember that early intervention can prevent a minor issue from becoming a major setback.