For active individuals and athletes, lower leg pain is a common concern. Two of the most frequent causes of this pain are bone stress injuries (BSI) and medial tibial stress syndrome (MTSS), often referred to as “shin splints.” While these conditions share similarities, distinguishing between them is essential for proper treatment and recovery. This blog post will guide you in identifying the differences and help you determine when to seek medical attention.
Understanding Bone Stress Injuries (BSI)
A bone stress injury occurs when repetitive loading exceeds the bone’s capacity to recover, leading to microdamage. If left untreated, it can progress from a stress reaction to a stress fracture. These injuries are most commonly found in runners, military recruits, and athletes involved in high-impact sports.
Symptoms of Bone Stress Injuries:
● Localized pain: Tenderness in a specific area of the bone, specifically, less than a 5 centimeter region or less than the size of a key.
● Pain at rest: Discomfort that persists even when not active
● Pain with weight-bearing: Aggravated symptoms when standing, walking, or running, usually with a correlation between pain intensity and impact intensity
● Swelling: Occasionally present over the affected area
Understanding Medial Tibial Stress Syndrome (MTSS)
MTSS is a soft tissue injury resulting from excessive stress on the tibia and surrounding muscles, often due to overuse. It is commonly seen in athletes who suddenly increase their training intensity or frequency.
Symptoms of MTSS:
● Diffuse pain along the shin: Pain along the inner portion of the tibia over a region greater than 5 centimeters in length
● Pain with activity: Symptoms worsen with exercise but improve with rest
● No focal tenderness: Unlike a BSI, pain is spread over a broader area
● No swelling: Typically, there is no visible swelling associated with MTSS
When to See a Physical Therapist or Doctor
If your pain is focal, persistent, and worsening after impact, it’s essential to seek professional evaluation. A physical therapist can assess your biomechanics and develop a rehabilitation plan. If a BSI is suspected, imaging such as an MRI may be required for diagnosis.
Treatment Approaches
● For BSI: Treatment often includes rest, activity modification, and a gradual return to exercise. Addressing underlying risk factors such as bone density, nutrition, and biomechanics is crucial. This is not usually an injury that you can continue to run through.
● For MTSS: Treatment focuses on reducing inflammation, modifying training loads, and strengthening the lower leg muscles to improve shock absorption. This is usually an injury that you can continue to run through.
Additional Resources to Learn More about Bone Stress Injuries
The link below will take you to the PT Rebels Podcast, hosted by Dr. Gina Fick PT, ScD. In this episode you will learn about all things bone stress injuries from injury identification to recovery steps. Listen to learn about some ways we help athletes stay in peak shape and return to activities safely and effectively.
https://podcasts.apple.com/us/podcast/bone-stress-injuries/id1688065811?i=1000671287546
Final Thoughts
While both BSI and MTSS can cause shin pain, recognizing their differences is key to effective management. If you suspect you have a bone stress injury, seeking early intervention can prevent progression to a full stress fracture. For persistent shin pain, consulting with a physical therapist can help optimize recovery and prevent recurrence. If you’re experiencing lower leg pain and need professional guidance, our physical therapy team is here to help. Contact us today at (720) 480-2866 to schedule an assessment at Fick PT and Performance!
References
- Nattiv, A., Kennedy, G., Barrack, M. T., et al. (2013). Risk factors for stress fractures: A systematic review of the literature. British Journal of Sports Medicine, 47(9), 515-522. https://doi.org/10.1136/bjsports-2013-092210
- Winters, M., Moen, M. H., Zimmermann, W. O., et al. (2018). Medial tibial stress syndrome can be diagnosed reliably using history and physical examination. British Journal of Sports Medicine, 52(19), 1267-1272. https://doi.org/10.1136/bjsports-2016-097037
- Warden, S. J., Davis, I. S., & Fredericson, M. (2014). Management and prevention of bone stress injuries in long-distance runners. Journal of Orthopaedic & Sports Physical Therapy, 44(10), 749-765. https://doi.org/10.2519/jospt.2014.5336