What is Medial Tibial Stress Syndrome (Shin Splints)?

Shin splints is a term used to describe pain in the front of the lower legs, often during or after exercise. The name is a general description of the area where the pain is, but not a diagnostic term. Medically this is known as Medial Tibial Stress Syndrome (MTSS). The problem is caused by excessive stress on the shin bone (tibia) and surrounding muscles and is one of the most common causes of exertional leg pain in athletes.

Shin splints are commonly split into three categories:

  • Inside of shin pain (Medial)
  • Front of shin pain (Anterior)
  • Bone pain (Tibial Stress Syndrome)

Signs and Symptoms of MTSS

The most common complaint of patients with MTSS is vague, the diffuse pain of the lower extremity, along the lower third of the shinbone (tibia) with physical exertion. In the early stages of MTSS, the pain usually develops gradually without a history of trauma. It is worse at the beginning of the exercise and gradually subsides during training and within minutes of cessation of exercise. As the injury progresses, however, pain presents with less activity and may occur at rest. If left untreated, MTSS can progress to stress fractures of the shinbone.

Causes of MTSS

Training errors appear to be the most common factors involved in MTSS, especially as athletes attempt to do ‘too much, too fast’. Common training errors include a recent or sudden onset of increased activity, intensity, duration or terrain. Running on hard or uneven surfaces is also a common risk factor. Other contributing factors are:

  • flat feet (pronation)
  • high arch feet (supination)
  • calf tightness
  • lower limb biomechanics
  • worn out or improper shoes

Conservative Treatment for MTSS

The best outcomes of MTSS are achieved through early diagnosis and onset of treatment. It is important that MTSS is not left untreated as the condition can progress to a stress fracture of the tibia. At OnePointHealth we will perform a comprehensive biomechanical assessment that involves taking a detailed history of your weekly physical activity routine (such as running distance, intensity, pace, terrain, and footwear, with careful attention to recent changes in training regimens), along with a thorough musculoskeletal examination. This level of detail allows us to develop highly successful treatment plans specific to you.

Some recommended treatment options include:

  • Activity modification. An initial change to your exercise regime or daily activities may be needed to avoid the condition getting worse. The introduction of a low impact alternate activity may also be of benefit such as swimming, whilst also avoiding hill running.
  • Ice. to ease pain and swelling. Do it for 20-30 minutes every 3 to 4 hours for 2 to 3 days, or until the pain is gone.
  • Compression. compression bandages help to reduce swelling.
  • Elevation. Raising the foot above the level of the heart helps to reduce swelling.
  • Strengthening. It is important that strength is addressed for this condition so that the affected area can tolerate more load. This is done initially with isometric loading to load up the affected area in a pain-free way. When pain has reduced a strengthening program will be incorporated. 
  • Anti-inflammatory. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, naproxen, or aspirin, will help with pain and swelling as per GP instructions.
  • Adequate footwear. Supportive footwear may also be recommended to stabilise the foot and ankle to reduce the stress of the surrounding tibial muscles
  • Taping/Bracing. Taping or bracing can help to stabilise the surrounding structures to reduce the excessive stress of the surrounding tibial muscles.
  • Orthotic therapy: A custom orthotic device placed in the shoe can help stabilise the foot and address possible causative factors such as flat feet
  • AlterG Anti-Gravity Treadmill. Continuation of training on the AlterG to decrease the load on the tibia and the stress of the surrounding tibial muscles whilst maintaining an exercise program.

Prognosis of MTSS (outlook)

With the correct treatment, full recovery from MTSS is often achieved. However, if the underlying cause of your MTSS are not identified and addressed correctly, recurrence is common.


In cases that are non-responsive to conservative treatment, surgical intervention may be required.