Medial Tibial Stress Syndrome - (Shin Splints)

Medial tibial stress syndrome (MTSS), commonly called “shin splints,” is a condition in which pain occurs over the shin bone (the tibia) with running or other sports-related activity. It is usually due to overuse and occurs in athletes who participate in repetitive activities, especially running and jumping. The condition can also develop in athletes who have suddenly increased the duration or intensity of their training. It is quite common and occurs more often in females. 

What causes Medial Tibial Stress Syndrome? 

Medial tibial stress syndrome develops when there is irritation where the calf muscles attach to the shin bone. It can also occur when running on a slanted surface or downhill, or when someone participates in a sport with frequent starts and stops. Training errors, shoe wear, and changes in training intensity, duration, and surface can contribute to the development of medial tibial stress syndrome.  Risk factors for developing medial tibial stress syndrome include abnormalities of ankle and foot alignment, lower extremity flexibility, and strength.  

What are the symptoms of Medial Tibial Stress Syndrome? 

Most people complain of pain along the shin bone. The pain can range from a dull ache to a sharp, intense pain. Commonly, the pain is located along the inside border of the shin bone, usually in the middle or lower third. Pain may be present with early activity and subside with continued exercise, but may also persist throughout the activity. Typically, the pain goes away when the athlete rests, though in very severe cases, the pain can occur throughout the day (without activity) and continue even during rest. These more severe symptoms can also occur with stress fractures, a more serious injury. 

How is Medial Tibial Stress Syndrome diagnosed? 

Medial tibial stress syndrome is diagnosed based on a review of the patient's history and physical examination of the lower leg. X-rays appear normal in people with shin splints. If the doctor is unsure of the diagnosis, an x-ray, MRI, or bone scan may be used to rule out a more serious condition, such as a stress fracture. 

How is Medial Tibial Stress Syndrome treated?  

Treatment includes a period of rest and modification of activities to allow the inflammation and pain to resolve. Ice can also be helpful, as well as anti-inflammatory medication. Physical therapy may be prescribed, with the patient following a lower extremity strengthening and stretching program. Some people benefit from special shoe inserts (orthotics) that redistribute pressures during activity.  


Yates B, White S. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sports Med. 2004;32(3):772-80. 

Reshef N, Guelich DR. Medial tibial stress syndrome. Clin Sports Med. 2012;31(2):273-90.