Do you have pain in the inside of your calf when you run, jump or since you returned to your physical activity? Pain on the inside of your tibia bone when you touch it? If yes, it could be periostitis or Medial Tibial Stress Syndrome (MTSS).
The Medial Tibial Stress Syndrom is a very common injury in runners, sprinters or any other sports where repetitive impacts are involved (like basketball, tennis, handball…). You usually start feeling pain along your tibia bone that often increases with the volume of your activity.
Let´s try to understand what it is.
MTSS: WHAT ARE WE TALKING ABOUT?
First thing first, Medial Tibial Stress Syndrome is part of the bone stress injuries family and should be explained and treated as such. A bone is layered by a dense and vascularized tissue called the periosteum that supplies the bone in blood and nutrient, allowing bone growth. in MTTS, pain appears when there is an inflammation of that layer. The inflammation happens because of repetitive pressure on the bone and surrounding tissues as welle as when the athletes overcome the load capacity of their tissues.
The main mechanism of that injury is the return to a physical activity too soon. The tissue surrounding the tibia bone will not be able to sustain the load you are asking, hence this inflammation.
It is then very common to encounter this injury where a lot of running is required, because of the load this activity asks for around the tibia and the lower leg in general.
WHAT ARE THE MAIN SYMPTOMS?
The main symptoms of MTSS is a diffuse pain along your tibia bone, very often during the activity, that stops at rest.
Usually the pain is not felt on a specific spot. The clinical criteria requires you to feel pain on about 5cm long zone along your tibia when you touch the inside of your tibia bone.
It is very important to differentiate it from other medial tibial ionjuriese, like stress fracture (where pain is localized on a specific point) or compartment syndrome (increased pressure and burning feeling). If you notice swelling and change of color of your skin, remember to always seek medical help.
THE MECHANISM OF THE INJURY.
It is important to understand that this injury is a load management problem. The infamous “too much too soon” type of problem, causing an important increase in load to your tissues. This increase in load can be a sudden return to sport after a long break, increase in kilometers or number of sessions or a brutal change of terrain.
It is also important to know the difference in muscle activity especially the soleus or plantar flexors play a role in the injury.
But remember, MTSS is a load problem. The load you put on your system is not just from the physical activity. It is also the accumulated stress and fatigue that impact your recovery.
HOW DO YOU KNOW IT´S MTSS?
Well first, answer these questions. Did the pain appear gradually ? Did you increase your running or jumping lately? Did you increase the number of training sessions and/or kilometers? Did you feel pain but pushed through anyway?
Do you feel pain when you run, jump or even walk? Does it go away when you rest ? Is it painful along the bone when you touch it (as seen above)?
If you answer these questions by yes, it is very likely you have developed a MTSS.
HOW TO TREAT IT?
The solution is not in stopping the activity, but in modifing it, temporarily.
If running 30min provokes pain during and the day after, it is important to reduce the time of running, the frequency or the intensity. In some cases, it can be beneficial to replace a session by an activity with less impact such as biking or swimming.
If it is really acute, in some cases ice and/or warmth is helping, but it is not treating the root cause of the problem.
Physiotherapy is a very powerful tool in the treatment of MTSS
During physiotherapy, you will go through a progressive loading program helping you with mobility, strength and return to your activity. Also, you will understand when to push and when to rest so we master your recovery. The data estimates a comeback to the sport after 6 weeks when done correctly. Be aware, it can vary from people to people.
WHAT CAN YOU DO ALREADY AT HOME?
Some easy exercises can be already implemented at home if you recognize the symptoms. The main goal in the acute phase, is to reduce the pain and calm the irritation down. You can start with these three
1. Calf raises – On two legs, take support to a wall. Go up on your toes. Stay on top of that position first (isometric), for 30-45s, 5times. Repeat it on 3 sets 2 to 3 times a day. If it is easy and ok pain wise, move on to one leg.
2. Eversion of the foot – Sit on a chair, Bring your affected leg to your other knee. Leg your feet fall freely. Press against your hand as if you wanted to bring your toe up. Hold the position for 30-45s, 5 times. Repeat it on 3 sets 2 to 3 times a day.
3. Fibularis muscles activation. You can sit on the floor, grab your foot and pull as if you wanted to bring your toes inside. When you found the maximum stretch, push again your hand. Hold the position for 30-45s, 5 times. Repeat it on 3 sets 2 to 3 times a day.
