Medial Tibial Stress Syndrome

Hi
I am new to the forum.
I have just started to get back into running this summer after a long break. I took the break because I was repeatedly getting problems with my ankles/calf muscles which I now believe to be Medial Tibial Stress Syndrome. Obviously not being a medical man I could be wrong.

http://www.physioroom.com/injuries/calf_and_shin/shin_splints_full.php

When I first started to get this, I had pain down the insides of both my shins. Recently though the left ankle has been ok but the right still gives me problems.
I first started to get problems with this about 6 years ago. At the time I was road running doing about 5 -7 miles about 3 - 4 times a week.
The first thing I did was buy some new trainers from a specialist running shop. I tried resting for a few weeks and then building up my program slowly, but the problem came back again. To try and resolve the problem I went to a Physio who gave me ultrasound which had no effect at all. After several sessions I went to a Podiatrist. After about 2 sessions he then decided that he could do nothing for me saying that sports injuries were not really his area. If he had told me this from the start that would have helped!
At this point I gave up on seeking professional help, although I know I shouldn’t have.
After that I carried on running on and off. I would run for a few weeks, wait till the pain got too bad and then stop for a few weeks. It went on like that for a bit. I then decided to just use treadmills in the hope that this would help. I found that I could last another couple of weeks extra, but even doing this the ankle/calf pain still returned.
I started running again this summer but on treadmills only. I have since noticed that I do not get any pain from the left ankle but the right ankle is the same as before. At the moment I can keep it under control if I do no more that about 3 treadmill runs a week.
So after my long winded introduction;
Has anyone experienced a similar problem? How did they resolve it? Also does anyone know of any top notch Podiatrists in the Bournemouth/Poole area that specialize in lower leg sports injuries? Hopefully someone who could do a bio-mechanical analysis and sort out orthotics if needed?
I desperately would like to start road running again so any input would be gratefully received.

Comments

  • Hi,
    Ask yourself what you are actually doing to prevent MTSS. I realized after days and weeks reading about MTSS that I knew it all - but didn't actually did very much.

    Below are my actions. I strongly believe that most cases can be cured with proper running technique. With one exception of course - biomechanical issues.


    Warm up
    --------
    * Put on calf support 2hours prior to running
    * 5min elliptical trainer (or walking on heals/toes for 5min)
    * Calf stretching

    Running Technique
    -----------------
    * 180 steps a minute (less impact on each step)
    *Foot landing straight under u rather then in front. This is achieve by "pulling" the foot vertically towards bum using hamstring. The foot will naturally land under you.
    http://www.momentumsports.co.uk/
    http://www.posetech.com/pose_method/
    http://www.runfortri.co.uk/theory.htm

    After Running
    -------------
    * I would run slower in the beginning and in the end. (further warm up and cool down)
    * RICE. (Rest Ice Compression Elevated I think it means). I would normally lie down on my back and hold my feet against the wall and pressing my legs together with two ice packs on the inflamed area.
    Calf stretching.

    Strengthening/Stretching
    -----------------------
    On a night when I don't run I would run through a strengthening and stretching program. Toe taps standing with back against a wall. Toe curls. 5min on a balance board. Sitting on my feet. Calf stretching etc.

    Expert Help
    -----------
    I've met different "experts". Physiotherapists and podiatrists.
    I find "Crystal Palace Injury sports Center" very knowledgeable and helpful.
    Flat feet is the most common cause as it's often lead to over pronation.
    My feet are slightly flat, but worse they are falling inwards. My orthotics are being made as we speak.
    http://www.cpsic.co.uk/

    Regards,
    Nik
    niklas@lorentzson.com
  • Tis me again. I've just changed my account details from Paul Lewis 18 to the above.

    Thank you both for the input.

    Nik, I'll put some of your suggestions into practise and see what happens.

    If anyone on the forum can help with the suggestion of a good Podiatrist in the Bournemouth/Poole area though that would be very helpful.
  • Mike1Mike1 ✭✭✭
    Hi all
    Can I please add Southampton to Paul's list of Bournemouth and Poole.
  • Thought I'd pop in to offer my sympathies - I suffer from similar problems

    My *current* solution is to run only twice a week while cycling/swimming the other days - spin classes are great interval sessions.

    I am also paying particular attention to my gait. I have new shoes and I'm also trying to toe/midfoot strike (rather than heel strike) with my feet below my hips (see also Chi Running). If you are flat footed this forces the arch into action so it can take the impact rather than letting the impact hit the shin. (my theory only but it seems to make a difference)

    Nik's comments seem spot on. *At the moment* I'm inclined to agree that running technique is important in prevention but also don't overdoing it. You have to listen to your body and take short breaks long before the pain forces you into a longer break.

    Sorry, I can't help with a pod recommendation though.

    Good luck!
  • Re the podiatrist, have you contacted your local running club? They may be able to recommend someone with experience of running injuries.
  • Thanks anyway Mike but Southampton is a bit far for me.

    Pink. I have also been trying looking at my gait trying to make sure that my foot strikes under instead of in front. Nik also mentioned this above. Unforunately without a mirror at the front/side of my treadmill it is quite difficult to assess my technique.

    I have also been cycling if possible between my "run days" because it gives any inflammation a little extra time to go down.

    At the moment I'm not sure whether I should see a Podiatrist now whilst I am managing to control but not solve the problem. Or alternatively, just go out and hit the road doing the same sort of distance/times 3 times a week and see if it really flares up properly. Otherwise I could see the Pod now whilst I'm treadmill running. He/she might solve the problem and I then think everything is ok. But then after a few weeks of road running I might find I am back to square one.

    What do you think?
  • Mike

    Then again I might consider Southampton if Bournemouth/Poole throws up a blank!
  • Mike1Mike1 ✭✭✭
    Paul
    Sorry if I confused. I was simply looking for anyone's recommendation for a podiatrist for Southampton on the back of your earlier 'plea'.
  • Doh! I thought that you might know of one in Southampton. Sorry.

    I still haven't come up with one for my area. I might just have to take a chance and pick the first one I see in the Yellow Pages.
  • Can Nik Lorentzson or someone else on the forum explain to me exactly how to do the exercises listed below please?

    Sorry if I am being a bit thick!

    1. Toe taps standing with back against a wall. 2. Toe curls.
  • Hi Paul,

    After plenty of reading I picked up a few exercises you can do. I'll try to explain them.

    To Taps (Wall Shin Raises)
    ------
    1) stand with your back against a wall
    2) feet shoulder-width apart
    3) feet placed a foot's length away from the wall in front of you
    4) Try to slowly lift your toes towards your knees with the heels still resting on the floor. Start out with a set of 15 first time. Build it up. As you get stronger you can speed up and tap the toes lightly against the floor. When it all becomes to easy start doing it with standing on only one leg.

    Toe Curls
    ----------
    1) Just stand up
    2) lift one leg and simulate that you are gripping something with your toes.
    3) alternatively, (what I do) take your sock off and grip one of them and lift it over to the other foot. 50 per set.

    Don't forget the calf stretching. After all, the MTSS is caused by the foot over- pronating (falling in excessively) and over stretching the tibialis posterior.

    Loads of more excrcises at
    http://www.pponline.co.uk/encyc/0161.htm
    http://www.baconfat.co.uk/one-offs/shines.htm

    What's your stride candence?

    Nik
  • Thanks Nik. You really have been a great help. I'll take on board all this info you have given me and see how I fair.

    As for my stride cadence. I'm not sure. By this do you mean my strides per minute? If yes I'll see tonight when I am running and get back to you with an answer.

    Thanks again

    Paul
  • Hi Nik

    I am afraid I will not be able to work out what my stride cadence is, as I have just had my sacroiliac joint popped back in to place for the 3rd or 4th time by the Osteopath.

    He has advised against running for at least a month!!!

    I can't even cycle for 2-3 weeks.

    So I'll have to get back to you on that one.

    Thanks for all your help though. I'll remember your advice when I start running again and hopefully won't have the same problems.

    Paul
  • Paul,
    Haveyou ever had your gait analysed? I assume thatyou still haven't had a recommendation for a podiatrist that specialises in sports injuries. I found my podiatrist through the local running shop.

    My shins have been a bit sore recently and I'm off to the physio next week for a proper diagnosis but all your symptoms sound familiar.
  • Hi Steady Edwina

    The only time my gait was analysed was in my local running shop just over a year ago. No gait problems were suspected at the time. My local running shop has also advised seeing a sports massuer first and then seeking a Podiatrist if that doesn't help.

    The be honest though I have seen improvement already from starting my run's with a gentle jog for the first mile and then pushing the speed up. In the past I used to do a standing warm up and then pelt straight into a run getting up to my optimum running speed almost straight away. That was probably half the problem.

    Nik has left some good tips above which have also helped.

    It's just a shame that I am now sidelined for the next month due to an unexpected back injury.

    If its not one thing its another!!!

  • I know what you mean I've had problems with my lower back as well but all these things can be related to our feet.

    Good luck but sounds like you are doing things right.
  • Hi there,

    I wanted to enquire about a minor injury I'm having....or when to stop running/recover?

    So i have minor shin splints on the inside of my left leg. It doesn't bother me at all when I'm running but I have a dull ache when resting.

    Im training for a marathon and keen to keep running but wondering if rest would be the better option...Or to run through?

    I want to stress the pain is minor but annoying. I'm keen to train.

    I look forward to your comments.

    Thanks,

    Alex
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