Medial Tibia Stress Syndrome (MTSS) is a condition that causes pain/discomfort to the inside of the lower leg. It is often associated with overtraining and commonly affects runners.
We see an influx of patients presenting with MTSS at Central Health Physiotherapy in the weeks leading up to the London Marathon. People have started to suddenly increase their mileage and their body has not had enough time to adapt.
‘Good’ exercise is in essence controlled stress. If the body is continually pushed past its current capacity without time to rest and adapt it will lead to injury.
There are two main theories of what causes MTSS:
The first theory (anatomical) proposes that certain muscles within the lower leg such as the Tibialis posterior and Soleus contract and pull on the outer surface of the tibia called the periosteum via connective tissue (fascia) causing a stress reaction.
The second theory (biomechanical) implicates the Tibia itself. Bones are strong, very strong. In fact, they are reported to be 8 times stronger than concrete. However, as well as being strong they also need to be able to flex to cope with stress. When landing whilst running the tibia bows at the narrowest point. This point invariably is the site where MTSS symptoms occurs.
It is likely, however, that MTSS is a combination of both theories. Research is on-going.
The literature suggest that MTSS could be precursor to stress fracture. Stress fractures can take a long time to heal and the management can be very disruptive to your day-to-day life. Therefore, it’s sensible to give respect to your initial injury and give it time to heal.
Possible contributing factors to MTSS include……..
Foot posture
Over pronated feet, overload the Tibialis posterior muscle which can irritate its attachment on the medial surface of the tibia. If there is an excessive amount or poorly timed pronation this can result in early muscle fatigue and may lead to increased shock being absorbed through the connective tissue (fascia) and bone.
Reduced muscle strength
If the calf muscles are weak this leads to reduced shock absorption.
Poor lower Limb control
A reduction in control, particularly at the hip and pelvis may result in excessive pronation.
Running biomechanics
It is thought that overstriding and/or excessive heel striking whist running puts increase load through the tibia and connective tissue.
Central Health physios can help diagnose and manage all the problems. So come and see us!
In Part two of this blog we will be covering MTSS management and prevention.
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