garbage term for Tibial Stress Syndrome (TSS) is "shin splints", it seems a
few years ago there was a serious push in the medical community to dump the
phrase "shin splints", but it appears even in the medical community it has won
out over TSS. But we've stuck to our guns here at Stockton, we still use
the TSS identifier.
Speculation is rampant, but
in reality no one really knows. As with any "syndrome" exactly
what is causing the pain is unclear or at least not conclusively
proven. It may be irritation of the outer covering of the
tibia itself, tendinitis of the muscles of the lower leg, or a
combination of both. It also could be any of several other
In most situations the athlete
will have pain on the posterior-medial aspect of the tibia.
The pain is usually in the lower 1/2 of the leg. Normally
the painful area will be 2-5 inches in length. It will be
sensitive to the touch just over the edge of the bone and or the
muscles/ tendons in that area.
does it happen?
TSS is an overuse injury.
It will occur gradually over a period of time. True TSS
will not occur from one day of training. It most often occurs
from repetitive running and on occasion jumping. The direct
causes can vary greatly including, shoes, the running surface,
increasing training too soon, compensating from other injuries,
overtraining, or from structural problems (such as over pronation
of the feet, leg length discrepancy). Structural problems
may need to be corrected with orthotics.
Initially the athlete will
have pain only while running, this is considered stage 1.
If the problem progresses pain will be present while running and
last for a period of time after running is concluded, this is
stage two. Progression past this stage is bad news.
The athlete will have pain before, during, and after training.
Or it hurts all the time. Athletes that truly reach stage
3 warrant referral to an orthopedist.
Any athlete with TSS must be monitored
for a stress fracture of the tibia. Pain along a specific area of
the tibia to palpation covering only 1/2" in length (or less) is a sign
a stress fracture should be suspected. TSS will not present with
any type of altered sensation or numbness or tingling in the leg or foot.
These symptoms require referral to an orthopedic surgeon.
Wrapping ice bags over the
painful area for 20-25 minutes after training is a good place
to start. At Stockton we’ve had a great deal of succes with
the following, strengthening all of the ankle musculature (including
the soleus), working on proprioception (wobble board), increasing
range of motion (plantar/ dorsiflexion). Time off from aggravating
activities is also usually necessary, including additional days
off from training and substituting non-impact activities for running
(biking, swimming, etc.).
Athletes in stage 1 can continue
to participate as tolerated implementing ice and a rehab protocol.
Athletes in stage 2 can also continue to participate but require
rehabilitation and additional days off from training and days
of training with alternate activities. The athlete that
gets to stage 3 should be seen by an orthopedist before regular
running is permitted. If a stress fracture is found by the
physician, the athlete will be out of competition for about 4