Getting The Best Shin Splint Treatment in Toronto

We have helped dozens of our practice members recovery from shin splints/medial tibial stress syndrome. We always look to correct the underlying problems that cause any health condition and it is no different for shin splints. To get the best shin splints treatment in Toronto make sure that you seek out a provider that is not just going to Band-Aid the symptoms but fix the underlying cause. Your doctor is going to need to address the tight muscles, irritated nerves, weak glutes and disturbed gait amongst other factors that are often the underlying cause of shin splints.

Location of shin splint pain on posteriomedial border of the tiba

What Is Medial Tibial Stress Syndrome (MTSS)

Medial tibial stress syndrome is (one of many) medical terms used for shin splints. MTSS is defined by pain along the posteriomedial (back-inside) border of the tibial that occurs with exercise. It is not pain from an ischaemic (lack of blood flow) origin or signs of stress fracture.

Many of our practice members will say that they have shin splints because of the location of the pain. It is important for your doctor to differentiate between a muscle problem and a bone problem, which we will discuss later. Getting the best shin splint treatment in Toronto will require your doctor to be able to differentiate the underling cause.

How Do I Know If I Have Shin Splints / MTSS?

It is very common amongst runners, military personnel, athletes involved in jumping such as basketball or volleyball players and gymnasts

Symptoms and Signs

Aetiology: Why Do People Develop MTSS?

It was once thought that traction from the solueos, tibilias posterior and flexor digitorum longus muscles were implicated in causing this injury through their pull on the bony attachment of the tibia

As tension in these aforementioned muscles increases, the tension in the connective tissue fascia around the muscles and the bones increases proportionally. More tension in the muscles causes more tension and repetitive strain on the bone and its connective tissue layer called the periosteum. As many studies have indicated with diagnostic imaging and evaluation, inflammation and pain generation from the periosteum, called periostitis, seems to be implicated.

Deep Calf Muscles of the back of the leg
Deep Calf Muscles of the back of the leg

The symptoms are however, not always felt at the site of origin of these muscles. Often the pain is located lower on the distal 2/3 of the tibial below where these muscles attach.

Research have worked to explain this discrepancy and have also demonstrated that MTSS is not just pain coming from the periosteal fascial bone tissue but also results from bony changes. MTSS is also a bone injury to the outer cortical bone likely resulting from bending of the tibia. Your doctor should know this to provide the best shin splints treatment in Toronto!

This is a cross section of bone. It is so f$%king cool because it has incredible high blood flow and nerve activity. The outside is covered by connective tissue called periosteum that is sensitive to pain. The outer compact bone is made out of group of osteon as labelled. The periosteum and compact bone are injured with shin splints
This is a cross-section of bone. It is so f$%king cool because it has incredible high blood flow and nerve activity. The outside is covered by connective tissue called periosteum that is sensitive to pain. The outer compact bone is made out of group of osteon as labelled. The periosteum and compact bone are injured with shin splints

Do I Need An X-ray, Ultrasound or MRI?

Imaging studies have shown that there is tibial cortex osteopaenia and, reduced bone mineral density. MRI shows bone marrow oedema (swelling) and periosteal reaction.

When force is put through the tibia at a greater amount or rate than it can adapt to, because of the aforementioned reasons, the bone becomes less dense, more porous and weakens. These bony changes result in pain over time.

MTSS is both a bone and periosteum injury, resulting from a number of causes.

Studies using MRI have shown the MTSS is similar in presentation to a stress fracture but is unlikely to progress to a stress fracture with continued activity. Thus, while MTSS does appear to involve some insult to the bone, I would not recommend complete rest as some would with a fracture. Relative rest from the most insulting activities is likely the best course of action.

My Explanation Of Why We Get MTSS To Patients | Best Shin Splints Treatment in Toronto

Every time that your foot strikes the ground, forces enter into the lower limb and have to be absorbed and dissipated. The harder one strikes the ground (running > walking), the more force that enters and must be accommodated. If the ground reaction force entering the foot, ankle, leg, knee and thigh is not properly absorbed by the muscles, other structures like the ligaments, joints, bones, menisci or tendons will. These structures are less adapt and managing the acute forces that come from exercise, and are likely to sustain a repetitive strain injury if they continue to be exposed to the impact about their tolerance threshold.

When it comes to MTSS there are a number of issues, that are supported in the literature, that I see.

Often there is some sort of combination of the following

The result is that the calf muscles, ankle and knee are not properly absorbing the force it accepts when the foot hits the ground. An excessive amount of force is delivered into the deep calf muscles, the tibia and the connective covering of the tibia, which results in a repetitive strain injury.

How We Provide The Best Shin Splints Treatment in Toronto

The key is to ensure the joints, muscles, nerves of the leg are working properly so that the impact forces are accepted by the muscles and not being transmitted to the tibia and its periosteum to perpetuate the injury

How We Achieve This

The goal is never to just band-aid your pain, but correct the underlying weakness and dysfunctions so that we eliminate the pain and also stop the problem from coming back.

Risk Factors and Causes of MTSS

No single cause has been identified but multiple determinants including, muscle weakness/tightness, hormone imbalance, altered biomechanics and decreased bone density are implicated.

The most common cause of MTSS appears to be abnormal gait (walking) mechanics – most evidence is inferential and lack amazing definitive studies. Disclaimer, there is varying results on the role of many factors (medial arch drop, tibia varum, limb length discrepancy) and MTSS – some of the things may or may not contribute.

How Do I Know If I Have MTSS For Sure? What Is Needed To Diagnose MTSS?

The diagnosis can be made clinically through a thorough physical examination and history taking. Imagine is not needed to make the diagnosis but may help to rule out other conditions in challenging cases. imaging might demonstrate similar changes in MTSS to stress fracture resulting in false positive diagnoses

References

Moen, Maarten H., et al. “Medial tibial stress syndrome.” Sports medicine 39.7 (2009): 523-546.

Michaud, Thomas C. Human locomotion: the conservative management of gait-related disorders. Newton Biomechanics, 2011.

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