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Running is a popular activity among individuals over 40, offering numerous physical and mental health benefits. However, it can sometimes lead to overuse injuries, one of the most common being Medial Tibial Stress Syndrome (MTSS), often referred to as shin splints. This blog will explore shin splints signs and symptoms, underlying causes, evidence-based treatment options, and effective recovery strategies for MTSS, with a focus on recreational runners in the UK.
What is Medial Tibial Stress Syndrome?
MTSS is a common overuse injury characterised by pain along the inner edge of the shinbone (tibia). It occurs when repetitive stress causes inflammation of the periosteum (the outer layer of bone) and surrounding tissues. This condition is especially prevalent among runners due to the repetitive impact forces experienced during running.
Research estimates that MTSS accounts for 13–20% of all running-related injuries (Newman et al., 2013), with older runners more susceptible due to age-related changes in bone density and tissue resilience.
Signs and Symptoms
Recognising the signs of MTSS early can prevent it from progressing into more severe injuries, such as stress fractures. Symptoms include:
Dull, aching pain along the inner shinbone that develops during or after running. Normally medially and in the distal one third of the shin, covering 10cm or more.
Tenderness or swelling along the medial (inner) side of the tibia.
Pain that worsens with activity but may subside with rest initially.
In more advanced cases, discomfort can persist even at rest.
If left untreated, MTSS can lead to stress fractures, which require significantly longer recovery periods.
Risk Factors for MTSS in Over 40s Runners
While MTSS can affect runners of all ages, the over-40s demographic faces specific risk factors:
Biomechanical Changes: Age-related changes such as reduced joint mobility and muscle flexibility can alter running mechanics, increasing stress on the tibia.
Bone Health: Bone density naturally decreases with age, which may make older runners more prone to bone-related overuse injuries (Warden et al., 2014).
Training Errors: Abrupt increases in mileage, intensity, or frequency are common triggers, especially for recreational runners returning to running after a break.
Footwear: Worn-out or inappropriate running shoes fail to provide adequate shock absorption and stability.
Running Surface: Hard or uneven surfaces amplify impact forces, placing additional strain on the lower legs.
Underlying Causes
MTSS develops due to a combination of repetitive stress and insufficient recovery. The primary mechanisms include:
Increased Tibial Strain: Repeated loading of the tibia without adequate recovery leads to micro-damage. Over time, this can progress to inflammation and pain.
Muscle Dysfunction: Overworking of the soleus or deep flexor muscles (such as the tibialis posterior) can pull on the periosteum, leading to irritation.
Poor Biomechanics: Overpronation (excessive inward rolling of the foot) or other gait abnormalities can exacerbate tibial stress.
A 2009 systematic review by Moen et al. concluded that MTSS is multifactorial, often involving a combination of biomechanical, training, and anatomical factors.
Treatment of MTSS
Treating MTSS requires a multidimensional approach, combining rest, targeted therapies, and modifications to training habits. The following evidence-based methods are commonly recommended:
Activity Modification:
Temporarily reduce or stop running to allow the tibia to heal.
Substitute with low-impact activities such as cycling or swimming to maintain cardiovascular fitness (Winters et al., 2018).
Muscle Strengthening:
Strengthening the muscles surrounding the shin and ankle is crucial for reducing tibial stress. Exercises targeting the calf muscles (gastrocnemius and soleus), tibialis anterior, and posterior muscles improve shock absorption and running mechanics.
Focused strengthening has been shown to reduce overuse injuries by correcting imbalances and enhancing lower-limb stability (Sharma et al., 2015). Examples include calf raises, toe taps, and resistance band exercises.
Bone-Strengthening with Plyometrics:
Plyometric exercises, such as bounding, hopping, and jumping, are evidence-based methods to improve bone density and resilience.
Research by Turner et al. (2007) demonstrates that high-impact activities stimulate bone remodelling by applying controlled mechanical stress to the tibia. Begin with low-intensity drills (e.g., single-leg hops, skipping) and gradually increase intensity as pain subsides. Plyometrics should only be introduced after the initial inflammation resolves to avoid aggravating symptoms.
Footwear and Orthotics:
Replace old running shoes with ones that provide adequate arch support and cushioning.
For overpronators, custom orthotics may help correct biomechanical imbalances.
Pain Management:
Ice therapy to reduce inflammation and swelling.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), if appropriate.
Shockwave Therapy:
Recent studies (Rompe et al., 2010) highlight extracorporeal shockwave therapy as a potential option for persistent MTSS cases, promoting tissue healing and reducing pain.
Cross training with lower impact activities can keep you active whilst reducing load
Preventing Recurrence: Management Strategies
For runners over 40, prevention is as important as treatment. Incorporating the following strategies can minimise the risk of recurrence:
Gradual Progression in Training:
Follow the 10% rule: increase mileage or intensity by no more than 10% per week. This allows the body to adapt gradually to increased demands.
Listen to Your Body:
Your body is incredibly good and communicating to you when it is feeling overloaded too much, too soon. If you ignore low level niggles, they can develop in to more significant injuries.
Cross-Training:
Include low-impact activities such as swimming or cycling in your routine to reduce cumulative tibial stress.
Strength Training:
Regularly strengthening both the muscles and bones of the lower leg, hips, and core improves shock absorption and running efficiency. Evidence supports resistance training to enhance bone health and reduce injury risk (Sharma et al., 2015).
Surface Choice:
Initially you may want to run on softer surfaces like grass or trails to reduce impact and then progress on to firmer surfaces with time.
Regular Footwear Updates:
Replace running shoes every 300–500 miles to maintain proper support.
Warm-Up and Cool-Down:
A proper warm-up improves circulation and prepares muscles for activity, while a cool-down aids recovery.
When to Seek Professional Help
If pain persists despite rest and conservative measures, consult a physiotherapist or musculoskeletal professional. Persistent symptoms may indicate a stress fracture or other underlying issues requiring specialised care, such as imaging or advanced therapies.
Conclusion
Medial Tibial Stress Syndrome is a common challenge for recreational runners, particularly those over 40. Understanding the signs, addressing risk factors, and adopting evidence-based treatments can significantly reduce recovery time and prevent recurrence. If you’re experiencing shin pain or want to optimise your running performance, consider consulting with a physiotherapist for personalised guidance. By taking proactive steps, you can enjoy running well into your later years—pain-free and with confidence.
If you’re based in the UK and looking for tailored advice or treatment for running-related injuries, our clinic is here to help. Get in touch to schedule an appointment and take the first step towards healthier, happier running!
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