Medial Tibial Stress Syndrome (MTSS) is a common running injury which can become a persistent nuisance. You might know it better as ‘shin splints’. There are a lack of treatments for MTSS that have been shown to be effective in the research but recent evidence suggests kinesio tape may have a role…
There is still some debate about the exact pathology of MTSS. The general consensus at present appears to be that is a form of bony stress reaction. In runners this is often in response to an increase in training and, anecdotally, is more common in those just taking up the sport.
In most running injuries there is a link between the load going through the tissues and the development of pain. If the load is too much for the tissue to cope with, or it has inadequate time to adapt and recover the tissues have a reactive response which usually involves pain. So if we are able to find a way to reduce load on the injured tissue to a level it can manage, this may help symptoms and allow the tissue time to adapt. Kinesio tape may be able to help in reducing load…
Griebert et al. (2014) studied loading during walking in 20 healthy participants and 20 with a history of MTSS. They reported a higher loading rate on the medial midfoot in those with MTSS and found this was corrected by the application of kinesio tape. The tape was kept in place and the reduction in loading rate remained when retested 24 hours later. Many critics of taping suggest its effects are short lived but the results of this study suggested it lasted at least 24 hours.
Technique; “No tension was applied on the proximal and distal ends of the tape, while the remainder of the tape was applied with 75% tension”
Now, this does sound promising and Griebert et al. (2014) suggest it provides evidence to support the theory that kinesio tape can correct biomechanical factors associated with injury but it does come with a host of limitations. There is no sham treatment to compare to and no way to determine the mechanism by which this loading change took place. The study only tested loading in walking which isn’t usually a particularly provocative activity for MTSS. It would have been interesting to see if load changes occurred during running. The effect sizes were small to medium, time to peak force was increased by a small to moderate amount. Is this enough to significantly reduce load on the medial tibia? Is it enough to reduce symptoms? While this study provides some evidence of a change in load what we’d like to see is that this results in improvement in symptoms and function in patients with MTSS.
The bigger picture with kinesio tape
When we examine a study we need to consider it within the rest of the evidence surrounding the topic. At present there is some evidence that kinesio tape may reduce pain in the short term, in some injuries (Kalron and Bar-Sela 2013). However a recent study by Howe et al. (2014) found that while rigid tape appeared to effect hip and knee biomechanics during running, kinesio tape did not.
There have been 5 systemtic reviews of kinesio tape in the last 2 years, all reach similar conclusions – that there is currently limited evidence to support the use of kinesio tape in clinical practice but further studies are required. The most recent review by Parreira et al. (2014) concluded,
“Although Kinesio Taping is widely used in clinical practice, the current evidence does not support the use of this intervention… large and well-designed trials are greatly needed.” Parreira et al. (2014)
While considering the bigger picture with kinesio tape we should do the same with MTSS. A recent systematic review highlighted a lack of evidence based treatment options,
“None of the studies are sufficiently free from methodological bias to recommend any of the treatments investigated” Winters et al. (2013)
Without high quality evidence demonstrating clinically significant improvement with specific treatments we have to base our approach on well established principles with a sound evidence base. In MTSS this involves first reducing the training to comfortable level, in some this may mean rest from impact based activity for a period of time. In fact, within what evidence there is for MTSS, rest appears as effective as any other intervention. In addition to modifying training it’s important to identify and address the cause of the issue. This can be training error, biomechanics, running gait or a number of other factors. We’ll be discussing this more in upcoming pieces on MTSS. Our overall aim is to balance the amount of load going through the leg during running, with the amount of load the leg can actually cope with. This is likely to involve strength and conditioning and a gradual return to running, potentially with some gait retraining if indicated.
Closing thoughts; So, should we use kinesio tape for MTSS? I think you could argue it either way and I welcome people’s views in the comments section. My personal stance is that kinesio tape, in general, can be a useful adjunct to other treatments with a more robust evidence base. It does appear, within a clinical setting, to reduce pain. If you do choose to use it though be sure not to rely on it entirely, address the cause of the issue rather than just the symptoms. MTSS is complex and often misdiagnosed. There are reportedly around 30 different causes of shin pain, see a health professional for accurate diagnosis and treatment specific to your needs. By all means use tape if it helps, but don’t just strap the leg up and hope for the best, get some proper treatment too!
Final word of warning…one potential cause of shin pain with similar symptoms to MTSS is a stress fracture, another good reason to seek assessment and advice! As ever on RunningPhysio if in doubt, get checked out!