Shin Splints – Have We Been Getting It All Wrong? (with Laura Anderson)

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 injuries
• Why 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 injury
• The hypothesised tissue sources (soft tissue traction, deep crural fascia, cortical bone changes) and why none are conclusive, given similar findings in people without symptoms
• How the name “medial tibial stress syndrome” may drive bone-focused management and be nocebic for patients
• The main differentials: tibial bone stress injury, compartment syndromes, popliteal artery entrapment and nerve-related presentations
• Typical 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 injury
• Why LIMP and bone stress injury can co-exist, and why the athlete’s story, training load history and symptom behaviour over time matter for diagnosis
• Why LIMP is typically persistent and recurrent, and why a previous history is a risk factor
• Risk 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 history
• The state of the treatment evidence (shockwave, strengthening, graded running programs) and why effects often fade over time
• Why Laura treats LIMP as a load-based problem, and the challenge of balancing capacity-building with continuing to run
• How 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 settle
• Why 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 RCT
• Why complete rest isn’t generally helpful unless pain prevents everything else
• The biggest load levers: intensity, frequency (rest days between runs) and volume, and why “easy” runs need to be genuinely conversational pace
• Why gait retraining isn’t the most important lever, and how technique changes can shift load to other tissues
• Gym work: find the biggest deficit first, and combine strengthening with progressive plyometrics where testing isn’t available
• Where the term LIMP may go, and why accurate language helps patients, coaches and parents understand the injury
• Laura’s three tips each for runners and clinicians
• Laura’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 and volume
41:26 – Gait retraining
44:16 – Gym work: finding the deficit, strength and plyometrics
48:05 – Where will LIMP go from here?
49:29 – Why terminology matters
51:22 – Three tips for runners and three for clinicians
54:40 – Laura’s physical challenge
56:10 – Laura’s PhD timeline and contact details
58:04 – Episode close

Join The Physical Performance Show LEARNINGS membership through weekly podcasts here: https://www.patreon.com/TPPShow

Our goal is to get you back to your Physical Best. Find out more about Telehealth Consultations and book online.

YOUR HOSTS:
🏃‍♂️‍➡️ Timothy Studley – Pogo Physiotherapist: Instagram @timothy_physio
🔬 Laura Anderson – Physiotherapist and Researcher, The Injury Clinic, Geelong ([email protected])

The Physical Performance Show can be found at:
Facebook: facebook.com/thephysicalperformanceshowpodcast
X: @tppshow1
Instagram: @physicalperformanceshow

Please direct any questions, comments, and feedback to the above social media handles.