Medial tibial stress syndrome (MTSS) is a common overuse injury resulting in pain and tenderness along the lower shin bone.
More commonly known as "Shin Splints", MTSS typically affects runners, but is also a common problem for athletes, dancers and military personnel.
With MTSS, repetitive overuse of the muscles that attach to the shin irritates the underlying bone, resulting in inflammation and tenderness.
Here we will look at the common causes, symptoms and diagnosis of medial tibial stress syndrome, and then go on to look at the best shin splints treatment and prevention options.
Medial Tibial Stress Syndrome is defined as a stress reaction to the tibia that is typically caused by overuse.
There are a couple of different things that are thought to occur around the shin bone with shin splints:
There are a number of factors that can lead to shin splints, and some of the most common medial tibial stress syndrome causes are:
It's important to note that these medial tibial stress syndrome causes can often overlap and vary from person to person. Many individuals may have a combination of these risk factors. Medial tibial stress syndrome most frequently affects runners, dancers and military recruits.
Medial tibial stress syndrome is typically characterized by a range of symptoms that can vary in severity which typically manifest along the inner edge of the shin bone. Common shin splints symptoms include:
It's important to note that the severity of these symptoms can vary from person to person. Some individuals may experience mild discomfort that doesn't significantly interfere with their activities, while others may have more intense pain that affects their ability to participate in physical activities.
Diagnosing medial tibial stress syndrome typically involves a combination of clinical evaluation and, in some cases, diagnostic imaging:
Your healthcare provider, often a sports medicine specialist or physical therapist, will start by discussing your medical history and current symptoms. They will want to know about your physical activities, exercise routines, previous injuries and medical conditions. They will ask you about your current symptoms including pain location, nature and severity of your pain, functional limitations and symptom progression
They will carry out a comprehensive physical examination, particularly focussing on muscle strength, flexibility, biomechanics, foot position and your walking pattern. They will also palpate (apply gentle pressure) to the affected area to assess for tenderness. Pain on resisted plantarflexion (where you point your feet down at the ankles against resistance) indicates likely MTSS.
While medial tibial stress syndrome can usually be diagnosed from your history and physical assessment, your healthcare provider may send you for further imaging to confirm the diagnosis and rule out other possibilities:
There are a few other conditions that can present in a similar way to medial tibial stress syndrome but with subtle differences:
The treatment of medial tibial stress syndrome typically involves a combination of strategies aimed at reducing pain, promoting healing, and preventing recurrence. Here's a comprehensive overview of the best treatment options for shin splints:
Rest is a fundamental component of medial tibial stress syndrome treatment. It allows the body time to heal and reduces stress on the affected area. Activities that exacerbate symptoms, such as running or high-impact sports, should be temporarily avoided, usually for around 2-6 weeks.
Activity modification may involve switching to lower-impact exercises during the healing phase, such as swimming or cycling, to maintain cardiovascular fitness without aggravating the condition.
Applying ice to the affected area can help reduce pain and inflammation from medial tibial stress syndrome. Ice should be applied for 15-20 minutes at a time, several times a day. Always wrap ice in a towel – don’t place it directly on the skin.
Rehabilitation exercises play a significant role in the treatment of medial tibial stress syndrome. These exercises are designed to improve lower leg strength, flexibility, and stability. A physical therapist can provide a tailored exercise program based on your specific needs and progress which may involve:
Stretches are an important part of MTSS treatment and usually target the calf muscles and shin muscles, as well as any other tight leg muscles:
Strengthening exercises for medial tibial stress syndrome help to improve the strength, stability and endurance of the lower limb muscles. Strengthening exercises for shin splints usually include:
Custom or over-the-counter orthotic insoles can help provide better arch support and correct any biomechanical issues, such as overpronation, that may contribute to medial tibial stress syndrome. A physical therapist or orthotist will be able to advice you on the best style for you depending on your foot shape and position.
Ensuring that you have appropriate footwear for your activity is essential. Your shoes should provide adequate:
Consider the type of physical activity you engage in and choose shoes designed for that specific activity. Running shoes, for example, are designed to accommodate the repetitive impact of running, while cross-training shoes are suitable for various activities.
And remember, athletic shoes have a limited lifespan as the cushioning and support can degrade over time. It's recommended to replace your athletic shoes regularly, usually every 300-500 miles for running shoes or every 6-12 months, depending on use.
Gait analysis, carried out by a podiatrist or physical therapist, can identify any irregularities in your walking or running pattern, allowing for more targeted treatment and recommendations.
Medication for shin splints, such as over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) e.g. ibuprofen, can be used to manage pain and reduce inflammation. However, their use should be supervised by a healthcare professional.
Massage can you a useful tool when treating medial tibial stress syndrome. Massage for shin splints typically targets tight calf muscles to release any tension, tightness or trigger points. It is important however to avoid massaging the affected area of the shin else that can make things worse!
Once the pain has subsided and strength and flexibility have improved, a gradual return to normal activities can begin. Starting with low-impact exercises and slowly increasing intensity and duration is crucial to prevent a recurrence of symptoms.
There are a number of things you can do when it comes to preventing medial tibial stress syndrome or to reduce the risk of recurrence:
What Are Shin Splints? Medial tibial stress syndrome is an overuse injury that causes inflammation and irritation along the inner border of the lower shin
What Causes Shin Splints? Overuse and repetitive stress on the lower leg, especially during activities like running or jumping, muscle imbalance, poor biomechanics and inadequate footwear
Common Symptoms Of Shin Splints? Dull, aching pain and tenderness along the inner edge of the lower two thirds of the shin that gets worse with activity
How To Treat Shin Splints? Shin splints are treated with rest, RICE protocol (Rest, Ice, Compression, Elevation), rehabilitation exercises, proper footwear, and by addressing any underlying biomechanical issues
Do Shin Splints Go Away? With appropriate treatment and rest, shin splints typically improve and can go away, allowing individuals to return to their regular activities. You may need to rest from aggravating activities for 2-6 weeks and it can take 3-6 months to make a full recovery from medial tibial stress syndrome
Shin Splints Vs Stress Fracture? Shin splints and stress fractures both cause shin pain, but they differ in nature. Shin splints result from overuse and involve inflammation of soft tissues, while stress fractures are actual tiny fractures in the bone due to repetitive stress, often requiring more extensive recovery and potentially immobilization.
How To Prevent Shin Splints? Preventing medial tibial stress syndrome involves gradual progression of activity, proper footwear selection, strength and flexibility exercises, and biomechanical assessment, as well as listening to your body and recognizing early signs to avoid overuse injuries.
Page Last Updated: 11/23/23
Next Review Due: 11/23/25