Hip Weakness and Shin Splints: A Biomechanical Approach

Ethiopia’s Zeineba Yimer in action during the Dubai Marathon REUTERS/Amr Alfiky

Medial tibial stress syndrome (MTSS - commonly known as shin splints) is not medically severe, yet can suddenly sideline an otherwise healthy athlete. Roughly five percent of all athletic injuries are diagnosed as MTSS⁽¹⁾.

The incidence increases in specific populations, accounting for 13-20% of injuries in runners and up to 35% in military recruits^(1,2). Medial tibial stress syndrome is pain along the posterior-medial border of the lower half of the tibia, which is present during exercise and (usually) diminishes during rest. Athletes identify the lower front half of the leg or shin as the location of discomfort. Palpation along the medial tibia usually reproduces the pain.

Causes of MTSS

There are two leading hypothesized causes for MTSS. The first is that contracting leg muscles place a repeated strain upon the medial portion of the tibia, inducing periostitis - inflammation of the periosteal outer layer of bone. While the pain of a shin splint is felt along the anterior leg, the muscles that arise from this area are the posterior calf muscles (see figure 1). The tibialis posterior, flexor digitorum longus, and soleus all arise from the posterior-medial aspect of the proximal half of the tibia. Therefore, the traction force from these muscles on the tibia is unlikely to be the cause of the pain typically felt on the distal portion of the leg.