Medial Tibial Stress Syndrome (Shin Splints)

Medial Tibial Stress Syndrome (Shin Splints)

“Shin splints” simply means shin pain, so it’s not a very useful diagnosis. When people say shin splints, they are usually referring to “medial tibial stress syndrome” (MTSS). MTSS is not considered an inflammatory problem, but rather a stress injury of bone. One of the key muscles involved is the soleus (one of the many muscles in your calf region). Basically, if your soleus is overworked, this pulls excessively on its bony attachment on your shin, causing a stress injury.

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  • A number of risk factors can contribute to this problem:
    • Excessive pronation (flat feet)
    • Training errors
    • Shoe design
    • Surface type
    • Muscle dysfunction (tightness/weakness)
    • Fatigue
    • Decreased flexibility
    • Higher body mass index (BMI)
    • Low bone density
    • Females are commonly more affected than males

Signs and Symptoms

  • Diffuse pain along the inner border of the shin bone (usually two thirds of the way down)
  • Pain is exercise-induced but decreases with warming up
  • Athletes can often complete a session, but pain gradually reoccurs after exercise and is worse the following morning
  • Note: most sportspeople will present with a long history of complaints, having tried a number of home remedies, stretches, medicines, or cold treatment… always tell your physio what has/hasn’t helped in the past.

Clinical Assessment

Assessment may confirm any of the risk factors mentioned above, (e.g. flat feet). This is achieved via observation and hands-on assessment. Referral for imaging (e.g. bone scan) may be appropriate if anything needs to be ruled out (e.g. stress fracture).


Treatment options include:

  • Rest
  • Ice
  • Pain-relief medication (from GP)
  • Load management / activity modification
  • Switching to pain-free cross-training activities (such as swimming or cycling) while temporarily reducing running
  • Taping to support the arch of the foot
  • Footwear changes
  • Orthotics
  • Various massage techniques (e.g. to the calf muscles)
  • Dry needling
  • Muscle strengthening exercises
  • Flexibility exercises
  • Balance exercises
  • Joint mobilisations


Different patients will require a different combination of the options listed above. It is worth noting that you may require treatment to areas that are relative far away from the shin, such as your hip or lower back.


Brukner, P., & Khan, K. (2011). Clinical sports medicine. (4th ed.). North Ryde, NSW: McGraw-Hill Education.

Hamstra-Wright, K. L., Bliven, K. C. H., & Bay, C. (2015). Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br J Sports Med49(6), 362-369.

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