Ep 389: Shin Splints - Have We Been Getting It All Wrong? (with Laura Anderson) copertina

Ep 389: Shin Splints - Have We Been Getting It All Wrong? (with Laura Anderson)

Ep 389: Shin Splints - Have We Been Getting It All Wrong? (with Laura Anderson)

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 In episode 389 of The Physical Performance Show, Timothy Studley, physiotherapist at Pogo Physio, is joined by physiotherapist and PhD researcher Laura Anderson for a deep dive into shin splints, traditionally known as Medial Tibial Stress Syndrome (MTSS). Laura is the owner of The Injury Clinic in Geelong and is wrapping up a PhD on running retraining for runners with MTSS. Tim and Laura explore why MTSS may need a new name, what we do and don't know about the underlying pathology, and how to differentiate it from other causes of lower leg pain, particularly tibial bone stress injury. They also cover risk factors, load management, strengthening and plyometrics, and the limited role of gait retraining. It's a conversation that challenges conventional thinking for runners and clinicians alike. SHOW SPONSOR: 💯 Today's episode is brought to you by Pogo Physio's Telehealth consultations. If you're an endurance runner battling bone, tendon or joint-related concerns, our online telehealth consultations are an ideal platform to help get you back to your physical best. Book online at https://pogophysio.com.au. IN THIS EPISODE YOU'LL HEAR: Why MTSS is so poorly understood despite being commonly cited as one of the top three running injuriesWhy the JOSPT editorial argues MTSS needs a new name, and why "load-induced medial leg pain" (LIMP) was proposed: it's a pain presentation, not a syndrome, and it doesn't imply a bone stress injuryThe hypothesised tissue sources (soft tissue traction, deep crural fascia, cortical bone changes) and why none are conclusive, given similar findings in people without symptomsHow the name "medial tibial stress syndrome" may drive bone-focused management and be nocebic for patientsThe main differentials: tibial bone stress injury, compartment syndromes, popliteal artery entrapment and nerve-related presentationsTypical LIMP characteristics: gradual onset, may or may not warm up, usually eases within about 24 hours, and diffuse tenderness along the medial border (≥5 cm) compared with the more focal tenderness of bone stress injuryWhy LIMP and bone stress injury can co-exist, and why the athlete's story, training load history and symptom behaviour over time matter for diagnosisWhy LIMP is typically persistent and recurrent, and why a previous history is a risk factorRisk factors: dynamic factors (foot function in walking and running, contralateral pelvic drop, plantar flexor endurance, lower limb muscle stiffness) are more convincing than static posture, plus female sex, higher BMI and previous historyThe state of the treatment evidence (shockwave, strengthening, graded running programs) and why effects often fade over timeWhy Laura treats LIMP as a load-based problem, and the challenge of balancing capacity-building with continuing to runHow to decide what level of pain is acceptable by combining pain, function and symptom behaviour, including why Laura is comfortable with around 5/10 if function is maintained and symptoms settleWhy capacity work (plantar flexor strength, plyometrics) may improve symptoms in the short term but isn't clearly linked to a faster return to running, with more to come from Laura's RCTWhy complete rest isn't generally helpful unless pain prevents everything elseThe biggest load levers: intensity, frequency (rest days between runs) and volume, and why "easy" runs need to be genuinely conversational paceWhy gait retraining isn't the most important lever, and how technique changes can shift load to other tissuesGym work: find the biggest deficit first, and combine strengthening with progressive plyometrics where testing isn't availableWhere the term LIMP may go, and why accurate language helps patients, coaches and parents understand the injuryLaura's three tips each for runners and cliniciansLaura's physical challenge for the week QUOTES / TAKEAWAYS: "Language as clinicians is incredibly powerful and we have to be careful." "It's a hell of a lot easier to explain if you just call it what it is." "You just have to get comfortable with, at present, not knowing what it is and realising that that's okay." "There's no blanket giving of gait retraining." "I don't think a period of rest either improves their outcome in the short term or the long term." "Walk more." TIME STAMPS: 00:00 – Episode introduction and overview 01:39 – Guest introduction: Laura's clinical work and PhD 04:54 – Why MTSS needs a new name 06:23 – The proposed name: load-induced medial leg pain (LIMP) 07:51 – Hypothesised tissue sources: soft tissue vs cortical bone 13:31 – Differential diagnoses 16:20 – Typical LIMP presentation vs bone stress injury 22:36 – Diagnostic clues and the athlete's story 24:54 – Risk factors 27:37 – The state of the treatment evidence 30:29 – Treating LIMP as a load-based problem 33:19 – How much pain is acceptable? 36:14 – Does building capacity speed up recovery? 37:43 – The role of rest 38:38 – Load levers: intensity, frequency ...
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