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Medial tibial stress syndrome - change run gait??
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I haven't been able to shake post tib shin splints. Take a long recovery, pain free, start running short distances, they come right back.
I've had custom casted orthotics, as well as off the shelf orthotics (Powerstep Pinnacle Plus Met). Both have a lot of support, neither seems to help at all.

I've been doing leg exercises as prescribed by physio, trying to strengthen the 'chain', and doing foot curls with a band.

The other thing physio did was record a video of me on the treadmill. She feels a big part of the issue is that my legs, when in the forward stride, are moving inward, and my foot collapses in at a pretty high angle, which she feels is likely loading the post tib too much. She wanted me to try to change my gait so that my legs go straight forward and back, as well as trying to land such that my heel makes flat contact with the ground (no forefoot running). But I cannot seem to change my gait, it feels incredibly un-natural to try to 'straighten' my stride, like I am waddling.

Screen shot of my foot landing attached, and a link to the treadmill video. Would really appreciate if the resident run experts/physios could have a look, provide any feedback on if I should be changing this and how?. Please excuse the 'sexy' physio clinic borrowed shorts.. :)


https://www.hudl.com/.../gCKBL4r0?e=20670558
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Re: Medial tibial stress syndrome - change run gait?? [SBRcanuck] [ In reply to ]
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Any luck on this? I'm 10 weeks with no running right no, hoping to start back up Nov 25, 2020. I have the same issue, "shin splints" along the inner border of the tibia, a couple inches above the ankle. I got a bone scan a few days ago and am waiting to hear back on the results.
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Re: Medial tibial stress syndrome - change run gait?? [CurrJam] [ In reply to ]
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Hey I've yet to find any real relief from this.
Even if I take time off and let the pain fully subside, the post tib shin splints seem to return.
No idea if I'm wasting my $$, but yesterday I ordered a Mobo Board and the book Running Rewired by Jay Dicharry. Trying the approach of trying to strengthen everything around the post tib including feet.
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Re: Medial tibial stress syndrome - change run gait?? [SBRcanuck] [ In reply to ]
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Update:


I've since gotten a bone scan as I was suspecting stress fractures. I've yet to actually see the results with my own eyes (hoping to soon), but my doctor called and told me there was increased uptake along 1/3 to 1/2 of my tibia bones. From what I understand, this means there is increased metabolism in my shins compared to surrounding bones which is a sign of bone injury. Although no stress fracture was present, which would be identifiable by very concentrated spots of uptake, a diffuse bone injury exists nonetheless. At this point, I figure the best way to "come back" from this is to continue resting (no running, some cross-training, continued calcium and vitamin-d supplementation). I've been incorporating lower body workouts such as squats, lunges, hip work and calf raises. I think I have to place a greater emphasis on stretching my lower legs and strengthening the small muscles of the lower legs (in addition to just the calves).

I'm hoping others will share their own experiences with Medial Tibial Stress Sydnrome (inner shin splints) on this thread.

I'll provide updates as I heal!
Last edited by: CurrJam: Dec 3, 20 8:35
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Re: Medial tibial stress syndrome - change run gait?? [CurrJam] [ In reply to ]
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I had similar in the build up to an IM. I believe I took 2ish months off running then came back very slowly and did all my long runs on soft surfaces.

Also, I discovered I had a slightly collapsing arch in my right foot. What was happening was with every stride, my foot would hit, the arch would flatten, and it would cause a pronation like motion of my foot, putting more stress on the inside of my shin. I got some super feet insoles and that helped immensely.

Long Chile was a silly place.
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Re: Medial tibial stress syndrome - change run gait?? [LCtriguy1] [ In reply to ]
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Which Super Feet product did you buy? I believe my arches collapse very slightly so I purchased the Super Feet Blue, but they felt very awkward in my Hoka running shoes. I may end up purchasing a different Super Feet product with a bit more arch support (I believe the blue offers minimal support, so maybe I was unable to feel the difference and need a more exaggerate arch-support). I just find that putting arch support into a running shoe takes away from how the shoe is supposed to fit/feel, or takes away from the technology of the shoe. I'm hoping that I'll be able to fix my issue without the use of orthotics. The store clerk at Running Room - he is an avid runner - assessed me as I walked 20 steps forward and back and he noted I am likely a neutral runner as he didn't notice any real pronation.

To date, I am over 13 weeks with no running at all and I have been on-off running since June 2020 trying to figure this all out. I still have tenderness along my posterior shins, alongside my inner tibias. I'll also note I increased my mileage excessively in March 2020 as I thought I was invincible at this time, which was when I first started to feel the pain in my left shin followed by pain in my right. I took three weeks off and returned to running and tried to run through the pain only for it to get worse. I'm currently frustrated as I have taken multiple 2-4 week stints off (no running at all) prior to my current 13 week, and I still have symptoms.
Last edited by: CurrJam: Dec 3, 20 8:46
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Re: Medial tibial stress syndrome - change run gait?? [LCtriguy1] [ In reply to ]
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I still suffer from post tib shin splints. I wouldn't be surprised if I've had more stress fractures since my first one was diagnosed a while back. But the treatment is the same regardless, rest.
I've tried so many different orthotics, including at least three sets of customs. My foot still collapses inward. My physio videotaped me running both with and without my orthotics and there was very little difference in how I collapsed inward (video link in first post of this thread).
Last edited by: SBRcanuck: Dec 3, 20 8:46
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Re: Medial tibial stress syndrome - change run gait?? [SBRcanuck] [ In reply to ]
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My bone scan was November 11, 2020, whereas my shins were at their absolute worst May 31, 2020 when I had to walk the final 3km home due to pain. As such, the bone scan would have showed results after 6 months of minimal running, 3 months of which were no running at all. I suspect that if I were to have gotten a bone scan in mid-June, the results would have been drastically worse showing possible stress fractures.
Last edited by: CurrJam: Dec 3, 20 8:54
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Re: Medial tibial stress syndrome - change run gait?? [CurrJam] [ In reply to ]
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I went with orange, with is a stiff support. It is important to differentiate between probation and arch collapse - they are not the same thing. I'm a neutral runner as well. Your foot doesn't actually roll in like in pronation, you just have more pressure on the inside of the tibia. But if you look at the wear on your shoes it will appear normal. It took a sports doctor to notice that, after trying different physios and other treatments.

It does kind of suck having the insole, but, not nearly as much as having shin splints. Good luck to you

Long Chile was a silly place.
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Re: Medial tibial stress syndrome - change run gait?? [SBRcanuck] [ In reply to ]
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1) Orthotics aren't necessarily a fix for medial tibial pain...as you've found out, in fact at times orthotics exacerbate injuries.

2) Clinically the degree a runner "collapses" inward isn't strongly predictive of injury. Unfortunately, there has been this perpetuated myth that runners "shouldn't pronate" and it's gotten a lot of folks into a mess. I see it all the time.

As far as stress fractures go....It's really about the rate of loading. Folks who "stomp" the ground when they run are more likely to suffer stress fx since the "rate" of force production is high upon contact. Look up the research from Irene Davis...good stuff.

CB
Physical Therapist/Endurance Coach
http://www.cadencept.net
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Re: Medial tibial stress syndrome - change run gait?? [SBRcanuck] [ In reply to ]
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This is a selfish question.

May I ask how your injury is presenting? As in, are the splints worse with exercise or do they present at rest? Oddly enough, I came across MTSS earlier this week when looking at things on the internet. In August, I started waking up with pain along the medial side of the tibia, but it was out of nowhere - no issues when running, etc. I saw and ortho and after MRI he said “there’s something going on there”, and radiologist write up didn’t indicate stress fracture or stress reaction. After 10 weeks no running I went for follow up as I still had some pain - no follow up scan though. What I’ve noticed is my veins bulge pretty badly along the medial tibia and the veins are actually what is hurting, not the bone or muscle when I touch. Does any of this sound familiar for your experience?

For reference, I did see a vascular surgeon who has me in compression socks and said we could strip the veins if they still bother me. I’m fairly certain mine is a separate issue than MTSS, but seeing this pop up surprisingly in the same week I first heard of it prompted the question.

In any case, best of luck with your recovery.
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Re: Medial tibial stress syndrome - change run gait?? [CurrJam] [ In reply to ]
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CurrJam wrote:
Update:


I've since gotten a bone scan as I was suspecting stress fractures. I've yet to actually see the results with my own eyes (hoping to soon), but my doctor called and told me there was increased uptake along 1/3 to 1/2 of my tibia bones. From what I understand, this means there is increased metabolism in my shins compared to surrounding bones which is a sign of bone injury. Although no stress fracture was present, which would be identifiable by very concentrated spots of uptake, a diffuse bone injury exists nonetheless. At this point, I figure the best way to "come back" from this is to continue resting (no running, some cross-training, continued calcium and vitamin-d supplementation). I've been incorporating lower body workouts such as squats, lunges, hip work and calf raises. I think I have to place a greater emphasis on stretching my lower legs and strengthening the small muscles of the lower legs (in addition to just the calves).

I'm hoping others will share their own experiences with Medial Tibial Stress Sydnrome (inner shin splints) on this thread.

I'll provide updates as I heal!

I have lots and lots of experience unfortunately. Have had both severe MTSS as well as a tibial stress fracture initially diagnosed as MTSS. Suffered from MTSS multiple times across my relatively short (7 year) running and tri history.
You will get a lot of different opinions as to management and it does very much depend on whether it is just MTSS you are dealing with or if you actually have a stress fracture. The bone scan showing increased uptake is not always diagnostic of a fracture, you really need an MRI, potentially followed by a CT scan, to show the actual fracture. An actual stress fracture will change your management completely. Clinically, if you have pain at rest, an ache at night etc, you are more likely to be in the fracture zone. If it is relieved with some simple pain killers and you can tolerate running on it, you are likely more an MTSS part of the spectrum.
My physio and sports doctor are both keen triathletes so understand what we want to do. Loading up the bone is an important component to maintaining bone strength, so if it is just MTSS, some running may not be too bad (I have run through bouts of it multiple times). I found icing afterwards to be very useful for this, I found some ankle sleeves with ice sleeves built into them which I could wear for an hour or afterwards and they were useful.
If it is a fracture then you have to take your medicine and be out of action for 6-12 weeks. If you have a job where you are on your feet a lot a moon boot can be useful to slow you down and take some weight off things.
Happy to talk more as you need advice etc etc.
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Re: Medial tibial stress syndrome - change run gait?? [Amnesia] [ In reply to ]
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Thanks Amnesia,

To summarize into easy-to-read sections for everyone:

Interpretation of bone scan: Stress fractures are present when highly concentrated “hot spots” appear in the imaging. In my case, there was no evidence of high concentration in one particular area, rather there was diffuse increased uptake along 1/3 - 1/2 of my shins - the inner side of both tibias. Any increase in uptake is a sign of bone injury due to increased bone metabolism, which does not translate directly to fractures or stress fractureS. Based on the countless hours of reading everything shin splint related, my theory is that my bones were “breaking down” faster than they were “rebuilding” (osteoclasts vs osteoblasts). Though this usually results in a stress fracture as the bone is significantly weaker and eventually cracks upon impact, I believe I’ve resulted with decreased bone density on both tibias on the pain area with inflammation of the periosteum and surrounding muscle tissues, along with general injury of my posterior tibialis muscles’.

Theory on healing: Continue to let my bones heal. As so much time has gone by already, I think my best chance is to work on active rehabilitation. This will likely include daily stretching of the lower leg muscles, graston technique, deep massage, daily icing - anything that will naturally decrease what is causing inflammation. I will note that I have been periodically lubing my shins and scraping the posterior tibialis muscle with a hard edge which has been helping tremendously to loosen up the area.

Symptoms: I generally have no symptoms at this point throughout the day - I currently am the best I’ve felt regarding this injury, as to be expected due to my prolonged rest. But I typically have a general tenderness on the area and there is often always some diffuse pain when pushing on the area. I also have what feels like little bumps alongside the inner edge of both tibias. During my most recent runs, There is usually a tenderness or very mild pain that is present. It isn’t until later in the evening or the next day that their is a constant pain even when sitting. Obviously when I choose to “run through it” the problem progressively gets worse with each run.

Next two weeks: I am going to aggressively do everything I can between stretching, massaging, scraping and icing and see if I feel any better. If I am confident enough, I’ll go for a 1k or 2k jog. I’m trying to get a hold of my bone scan results and will upload here when I have them.

Cheers
Last edited by: CurrJam: Dec 3, 20 16:33
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Re: Medial tibial stress syndrome - change run gait?? [CurrJam] [ In reply to ]
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CurrJam wrote:
Thanks Amnesia,

To summarize into easy-to-read sections for everyone:

Interpretation of bone scan: Stress fractures are present when highly concentrated “hot spots” appear in the imaging. In my case, there was no evidence of high concentration in one particular area, rather there was diffuse increased uptake along 1/3 - 1/2 of my shins - the inner side of both tibias. Any increase in uptake is a sign of bone injury due to increased bone metabolism, which does not translate directly to fractures or stress fractureS. Based on the countless hours of reading everything shin splint related, my theory is that my bones were “breaking down” faster than they were “rebuilding” (osteoclasts vs osteoblasts). Though this usually results in a stress fracture as the bone is significantly weaker and eventually cracks upon impact, I believe I’ve resulted with decreased bone density on both tibias on the pain area with inflammation of the periosteum and surrounding muscle tissues, along with general injury of my posterior tibialis muscles’.

Theory on healing: Continue to let my bones heal. As so much time has gone by already, I think my best chance is to work on active rehabilitation. This will likely include daily stretching of the lower leg muscles, graston technique, deep massage, daily icing - anything that will naturally decrease what is causing inflammation. I will note that I have been periodically lubing my shins and scraping the posterior tibialis muscle with a hard edge which has been helping tremendously to loosen up the area.

Symptoms: I generally have no symptoms at this point throughout the day - I currently am the best I’ve felt regarding this injury, as to be expected due to my prolonged rest. But I typically have a general tenderness on the area and there is often always some diffuse pain when pushing on the area. I also have what feels like little bumps alongside the inner edge of both tibias. During my most recent runs, There is usually a tenderness or very mild pain that is present. It isn’t until later in the evening or the next day that their is a constant pain even when sitting. Obviously when I choose to “run through it” the problem progressively gets worse with each run.

Next two weeks: I am going to aggressively do everything I can between stretching, massaging, scraping and icing and see if I feel any better. If I am confident enough, I’ll go for a 1k or 2k jog. I’m trying to get a hold of my bone scan results and will upload here when I have them.

Cheers

Sounds like you are well on track.
Sorry should have disclosed, I am an MD, not a sports doc etc, but very much over the literature and data in this area.
You likely have a fair degree of periostitis going on, which will be what is generating most of your pain. It will settle with time, not too much else you can do to improve the recovery trajectory of it. MRI probably the best modality to see this on. Depending on where you are though you may not have good access to an MRI and good musculoskeletal radiologists, I just happen to be the neighbour of one of the directors of a large practice where I live that also sponsor a few of the national sporting teams, so they know their stuff.
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Re: Medial tibial stress syndrome - change run gait?? [Amnesia] [ In reply to ]
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Hi Amnesia and others,

As I noted, I'm sharing the images of my nuclear bone scan results. The below picture are screenshots of the file they gave me. Depending on where I move my mouse within the screen, the lighting/contrast changes to help the radiologist diagnose the patient based on the imaging. I've screenshotted the two images based on different lighting settings. It is my understanding that black represents increased uptake of the radioactive material that was inserted into my bloodstream three hours prior to the scan. The radioactive material goes to areas in my skeletal system where there is increased bone metabolism (i.e. where my bones are trying to heal themselves). A concentrated black spot would indicate a fracture line via drastic increased bone metabolism, whereas diffuse black areas represent increased bone metabolism, just not an actual fracture. It's important to note that the bone scan was taken after 12 weeks of almost no running at all, or 12 weeks from the date my shins were at their worst.

Update: I went for a 2k run on Dec 8, 2020 at a 5:20/km pace. I felt practically no pain except for little twinges which may have just been mental. I feel good today with virtually no pain, but very slight aggravation (which may be due to me having to walk excessively in dress shoes today).

Please feel free to share any thoughts or comments!

CurrJam
Last edited by: CurrJam: Dec 9, 20 9:14
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