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Medial Tibial Stress Syndrome (MTSS)

Medial tibial stress syndrome (MTSS), more commonly referred to as ‘shin splints’ is an activity induced pain condition that affects the lower third of the inside aspect of the shin bone (tibia). It is aggravated by the repetitive stresses distributed through the lower leg during running and jumping. Running/jumping on hard surfaces, a sudden increase in training load, and improper caloric intake to meet energy demands increases the risk of developing MTSS.

MTSS is the most common musculoskeletal injury sustained by sprinters, middle, and long distance runners with a prevalence of up to 20% experiencing symptoms of MTSS at some point in their training. Furthermore, up to 35% of individuals new to running will develop MTSS. Athletes with decreased endurance and strength through the calf and ankle musculature have an increased pre-disposition for developing MTSS.

MTSS is thought to be caused by inflammation of the periosteum (periostitis of the connective tissue around the tibia) due to excessive traction from the tibialis posterior and/or soleus muscles. Additionally, it is thought that the bone is experiencing microtrauma and undergoing a remodelling phase of healing.


The primary symptoms are as follows

  • Dull pain at the bottom third of the inner shin. The pain is usually palpable over at least a 5cm area.
  • Pain at the beginning of a workout that slowly dissipates, only to return at the end of the workout during cool down.
  • Increasing pain during workouts as the MTSS worsens. Pain can remain present for hours or days after aggravating activities.


In the acute phase it is vital to allow for rest and recovery. Depending on the severity of your MTSS, your physiotherapist might advise the cessation of bodyweight cardiovascular training, such as running/jumping/skipping, for 4 – 6 weeks. Other forms of exercise such as swimming and slow weighted workouts are still fine to undertake. During this time, cryotherapy (ice packs), topical creams (Dencorub, Deep Heat, Voltaren) and NSAIDs (Panadol/Nurofen) are the most effective way to manage symptoms (speaking with your Physiotherapist and Pharmacist to ensure this appropriate for you).

Following a period of rest, your physiotherapist will work closely with you to graduate your return to sport to ensure symptoms do not
recur. Modification of training conditions is vital in the treatment of MTSS and must be adhered to closely. Your intensity and frequency of
running/jumping/skipping should be decreased by 50% in the sub-acute phase. Supportive shoes with adequate shock absorption, orthotics and taping can also be effective in managing pain and decreasing re-injury.


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Shin Splints (Medial Tibial Stress Syndrome)

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