Medial Tibial Stress Syndrome (MTSS), commonly referred to as shin splints, can be a frustrating and persistent injury, especially for runners and athletes. Rehabilitation often involves strengthening specific muscles, enhancing movement control, and improving load tolerance. However, understanding what these terms mean in practice is vital for creating an effective recovery plan.
This article outlines an evidence-based exercise program tailored for a patient, Ben, a middle-distance runner recovering from MTSS. Through targeted interventions, we aim to help Ben return to full training without recurring symptoms.
Case Study: Ben’s Recovery Journey
Ben, a young, dedicated runner, has made significant progress in his recovery. Initially, even jogging on the spot caused him discomfort. Now, he runs up to 40 minutes pain-free. However, runs exceeding 45 minutes still trigger mild discomfort in his medial tibia. To address this, Ben’s rehabilitation plan focuses on strengthening key muscle groups and progressively reintroducing higher-intensity exercises.
Key findings from Ben’s assessment include:
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- Mild weakness in the Soleus, Gluteus Medius, and the posterior chain.
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- Good single-leg balance and control.
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- Aiming for pain-free high-intensity training with guidance from his running coach.
Rehabilitation Goals
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- Enhance local load capacity in the calf muscles.
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- Improve kinetic chain load capacity through targeted strength training.
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- Use weight-bearing exercises to promote bone adaptation.
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- Progressively increase load and impact for optimal bone resilience.
Ben’s Targeted Exercise Program
1. Step-Ups
A foundational exercise, step-ups activate the Gluteus Maximus and Gluteus Medius, which are crucial for absorbing load during running. This exercise also improves balance and proprioception.
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- Progression: Increase step height or add weights.
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- Why It Works: Strengthens the glutes, enhancing control during the stance phase of running.
2. Soleus Lunge
This isometric exercise targets both the Soleus and quadriceps, muscles essential for absorbing running impact.
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- Scientific Insight: The Soleus minimizes tibial bending forces during impact, reducing the risk of bone stress injuries (Warden et al., 2014).
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- Execution Tip: Maintain proper form to engage muscles effectively.
3. Single-Leg Romanian Deadlift (RDL)
This compound exercise strengthens the entire glute complex and hamstrings, while challenging balance.
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- Research Backing: Collings et al. (2023) demonstrated its efficacy in activating multiple muscle groups.
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- Benefits: Improves overall lower-limb stability and strength.
4. Single-Leg Calf Raises
Calf raises target the calf complex, the primary shock absorber for runners. Given Ben’s forefoot strike running style, this exercise is particularly important to build resilience.
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- Progression: Use additional weights or increase repetitions.
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- Insight: Studies show forefoot runners place higher demands on the calf muscles (Almonroeder et al., 2013).
5. Gym Ball Abduction
To address Ben’s Gluteus Medius weakness, this isolated exercise promotes targeted strengthening. The gym ball encourages proper muscle activation by minimizing compensatory movements.
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- Purpose: Fatigue the glutes effectively to address deficits.
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- Placement: Performed at the end of the session to avoid compromising other exercises.
6. Pain-Free Plyometrics
Impact exercises are vital for bone adaptation but must remain pain-free to avoid aggravating symptoms.
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- Methodology: Start with low-intensity plyometrics, focusing on explosive movements with rest periods.
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- Goal: Stimulate bone adaptation and improve load tolerance gradually.
Program Customization and Progression
Ben’s exercise plan includes:
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- Reps and Sets: Work to fatigue within 8–12 repetitions. Increase load, range, or time under tension as needed.
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- Alternate Training: Exercise one leg while the other recovers to ensure balanced progression.
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- Integrated Team Approach: Collaboration with Ben’s Strength & Conditioning (S&C) coach and running coach ensures a holistic rehabilitation strategy.
Additional Considerations
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- Athlete Education: Ben understands the purpose behind each exercise and its role in achieving his goals.
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- Individualization: Exercise prescription should be tailored to the patient’s needs and preferences. A simple yet effective program with 3–4 exercises can often suffice for less motivated individuals.
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- Continuous Monitoring: Regular reviews ensure the program evolves with the patient’s progress.
Conclusion: Beyond Recipes—Reasoning in Exercise Prescription
Effective rehabilitation for MTSS requires a thoughtful, individualized approach. By focusing on reasoning rather than rigid protocols, practitioners can provide exercises that truly address the patient’s needs.
For athletes like Ben, this approach fosters recovery while laying the foundation for long-term resilience. If you’re crafting rehabilitation programs, remember to test them yourself—you’ll gain invaluable insights into their efficacy!
Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice. Always consult a healthcare professional for diagnosis and treatment. For further expert resources and to learn more from him, visit his website at Running Physio.