Medial Tibial Stress Syndrome (MTSS)


A.K.A. “Shin splints”


    Running Clinic       Sports Physiotherapy                                 

Common in runners to varying degrees, medial “shin splints” is a generic term given to pain on the inside of the lower leg.  We do also get anterior shin splints but this article talks about the pain on the inside or the medial (inside) aspect of the tibia. Medial tibial stress syndrome is perhaps a more appropriate term since is describes exactly what is going on – Stress!  Its a condition associated with over training and is therefore common place for some individuals. 

Historically, it was thought to be the result of periositis or inflammation of the periosteum or membrane that surrounds the bone for muscle and tendon attachment.  However, histological studies failed to identify any signs of such pathology.  We now know that the stress causes breakdown in the balance of bony production and remodelling.  Resorption of bone outpaces the formation of bone in the tibial cortex.  Oddly, the physical exam is enough for diagnosis.  MRI, Xray and CT add little value in how to manage it.

Because of the loss in balance between production and resorption of bone there appears to be a factor of over-training involved. So, train too much and too often with little rest and you might end up with MTSS.




Risk Factors

  1. Female athletes have greater likilhood for development
  2. Possibly greater pronation or loss in its control
  3. There is a relationship between excessive hip rotation
  4. Body Mass Index (BMI)
  5. Previous history of pain in the same region



At Core Body Clinic we subjectively assess every patient so you can tell us about the pain, its behaviour and how it started. We will assess training methods to ensure we correct training mistakes and ensure they don’t happen again.  We screen every patient who comes through the door for biomechanical factors.  We look at whole lower chain biomechanics and also assess footwear.  Poorly fitting shoes can cause the lower chain to behave in a very different way and therefore make your nervous system and muscles work a lot harder.  The result is an eventual failure and a loss of purposeful and appropriate functional posture. The tissues are abnormally loaded and pose a risk to MTSS.  We look at running styles as part of our specialised Running Clinic but more importantly we assess muscle length, strength and endurance to give us a clearer picture of how your body functions during sport.



  1. Pain in the lower medial 1/3rd of the tibia
  2. Pain on palpation of the tibia
  3. Possible signs of swelling / odema
  4. Generalised tenderness in the while shaft of the bone and even calf
  5. Pain on running with the foot striking the floor or on foot take off
  6. Pain with descending stairs more than ascending
  7. Pain in the morning with the first steps
  8. In severe cases the patient may wake at night



After diagnosis the first line is to re-schedule your training regime.  Correct over training methods and work out a plan for appropriate rest and then graduated return to activity.Correction of foot biomechanics using tape, orthotics or change of shoes is highly effective at reducing pain and preventing future problems.Massage and dry needling have been shown in our clinic to be effective in reducing pain in the short term.Graduated strengthening of local and global muscles – from the foot to the head…….we kid you not! What good is a strong ankle if your neck fatigues and you cant balance properly??? – not thought of that? Well, maybe not quite but the theory is a good one.  Essentially we are saying we like our patients to think about every aspect of their training before returning to sport.



A couple of week off of running is usually enough to start a graduated return to running program.  We recommend for moderate cases that a 6 week program be followed. More severe cases need to follow a more graduated regime to ensure the problem does not return. Remember, this is bone stress and not just a muscle pull.  


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