What is: Medial Tibial Stress Syndrome?

Medial tibial stress syndrome (MTSS) is a bone stress injury to the tibia (the main weight bearing bone below the knee), which involves oedema/swelling of the bone. MTSS is commonly seen in people participating in sports and activities that involve high impact movements such as running and jumping. Biomechanics of the leg including the strength and function of muscles can contribute to the onset of MTSS, as well as training errors such as a sudden increase in training load.

Signs and symptoms
MTSS is characterised by diffuse pain along the inside border of the tibia, typically around two thirds down the bone. The pain usually decreases after a warm up but is worse after activity and the following morning. If not treated, MTSS can develop into a bone stress fracture which tends to have a more focal/localised area of pain with constant or increasing pain with activity.

Diagnosis
Diagnosis will involve your practitioner taking a thorough history of activity levels, training loads and footwear. A close observation of the leg, palpation, and assessment of lower limb biomechanics, joint range of motion and muscle strength will follow. We may ask you to jump, hop, or even get you on the treadmill to look at how you run. Our findings will help us determine your diagnosis. MRI can confirm the diagnosis of both MTSS and stress fractures.

Treatment
Treatment involves a combination of symptom relief, determining and addressing the risk factors which led to the development of MTSS and allowing optimal recovery of the injury. Ice and analgesia may be warranted in the early stages of treatment, as well as manual therapy (including soft tissue techniques) and cross-training (cycling or swimming instead of running) to maintain fitness. In more painful conditions where even walking is painful, crutches might be utilised. A thorough rehabilitation program targeting muscle strength, length and control will then be developed to address foot and lower leg biomechanics. Importantly, a suitable training program will be discussed and developed to return you to your sport or activity and guide you to further progress your training safely and appropriately.

If you have a niggle or are experiencing new pain, don’t hesitate to book in with one of our wonderful Physiotherapists here.