Exercise Induced Leg Pain


Medial Tibial Stress Syndrome (MTSS) (Shin Splints)

Medial tibial stress syndrome is the most common form of exercise-induced leg pain.  It represents a bone stress reaction of the tibia, the major weightbearing bone of the leg.  It often results from a rapid increase in level of weight bearing exercise.  The pain from MTSS is usually expressed as a dull ache following exercise that may last hours to days, and may even persist during normal activities of daily living.  In the early stages of MTSS, pain resolves with rest.  However, without rest, pain may transcend previous levels into severe, sharp and persistent symptoms.  People affected by MTSS often undertake periods of rest only for pain to recur with resumption of exercise.

The majority of patients suffering from MTSS can be treated conservatively.  The mainstay of conservative management of MTSS involves rest from weightbearing activities followed by a gradual return to activity.  Proposed adjunctive treatment for MTSS includes heat/ice, massage and extracorporeal shockwave therapy. 

Biochemical examination is essential for those with MTSS.  It has been shown that those with pronated (flat feet) foot postures are up to three times more likely to experience MTSS.  Orthoses are advocated for those exhibiting excessively pronated feet.  Treatment of MTSS also include proper footwear and elimination of training errors (see gradual resumption to exercise handout).

More recent evidence suggests that those with MTSS have deficiencies in calf muscle endurance.  Consult with your Clinician to assess your level of endurance.

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