Persistent MTSS


Perhaps someone can help me with this please?

In March of this year, I started to experience a nagging ‘ache’ on the inside region of my right shin (approximately 2-3 inches above the ankle) subsequent to increasing my weekly mileage (using a set of ‘newish’ Asics 2160s with custom orthotics).  The pain was tolerable and only a mild discomfort, so (like any true athlete) I carried on running regardless, in the false hope that the symptoms would settle down.  Needless to say that they didn’t and, after consultation with my Physio, I was diagnosed with ‘Shin Splints’ - or more specifically, MTSS.

I was advised to take a period of 2 weeks rest from impact activity, in conjunction with the use of Ice application & NSAIDs etc.  I did as I was told, and returned to running shortly thereafter only to find that the symptoms immediately re-manifested.  I shifted my approach to training and focused specifically on running on grass, in addition to investing some time into transitioning to minimal footwear (Nike Free’s).  This made a positive impact on my ability to maintain a reasonable mileage whilst minimising the pain during the course of summer period.

However, roll forward to September and the pain still hadn’t subsided significantly.  I decided to fork out for a specialist and duly coughed up to have an MRI scan done.  A stress fracture was ruled out, so I was prescribed a set of strength and conditioning exercises.  I followed this programme for one month and noted only a minor improvement; the symptoms returned on any attempt to run.  At this stage, I agreed upon a period of 6 weeks consolidated rest with my consultant.

I am now at Week 5 and, concerningly, have yet to experience any discernible a decrease in the tenderness of the affected area.  I have been partaking only in non-impact activity, applying Ice on a regular basis and spending minimal time on my feet during my day job.  In a follow-up discussion with the consultant, it was mentioned that surgery may be a viable option at this point.  However, it doesn’t take much reading of the peer-review Medical Literature to gather that this is not a recommended course of action.

All that said, I am therefore at a bit of loss as to what I am missing here.  I can fully appreciate the factors (TMTS, poor bio-mechanics etc) that no doubt contributed to the development of this injury in the first place, but I cannot understand why a concentrated period of rest has failed to be effective in resolving this.  I feel surgery should only be considered the last possible solution once all other alternatives have been exhausted, especially given the risk of complications and the financial commitment required.

So... any thoughts?  Any secondary opinion/viewpoint on this would be greatly appreciated.

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