Medial Tibial Stress Syndrome

Medial Tibial Stress Syndrome: Common Cause of Shin Pain

What is it?

Medial tibial stress syndrome (MTSS), commonly referred to as “shin splints” has received a lot of attention within the literature, often found to be a difficult condition to manage. Shin Splints is a term which has been used to encompass all causes of shin pain including, compartment syndrome, stress fractures and MTSS. It is therefore understandable why such a term can become misleading as to the nature of such a complex and painful condition. The tibia (shin) is the larger of the two long bones located at the front of the lower leg.


MTSS is a chronic overuse syndrome, extremely common in activities, which involve weight bearing such as running. It has also been described as a common source of shin pain in military personnel. Pain associated with MTSS is often as a result of the following:

  • Over pronation: during the stance phase of gait the foot pronates to absorb shock and to adapt to uneven terrain, it is the soleus muscles job to resist unwanted pronation, therefore when the foot over pronates it places a repetitive stress on the tendons insertion on the tibia.
  • Training Errors: New training programs, sudden changes or increases to training, and inadequate recovery can all impact the repetitive overuse placed on the shinbone. Gradual progression and training increases will allow the musculoskeletal system to adapt to the loads imposed on them.
  • Muscle imbalances in strength and flexibility: It is all too common in runners to focus solely on their running and to neglect the strength and flexibility of their muscles. Tightness and weakness of the lower limb muscles can cause improper mechanics increasing the likelihood of developing MTSS.
  • Inappropriate footwear:  Appropriate running shoes should be the most important purchase by any runner, altered foot mechanics such as over pronation can cause internal rotation of the tibia, and fibula, which causes all structures to be forced into unwanted positions.


  • Pain due to MTSS is typically of gradual onset, pain is typically only associated with activity which often goes away once warmed up, that can often return when activity has stopped. The longer the injury goes untreated the more chronic the issue becomes, individuals may begin to notice pain during normal daily activities.
  • Pain is usually diffuse felt along the medial (inside) border of the tibia (shin bone). When a more focal area of tenderness is felt there may be a possibility of a stress fracture.
  • The pain felt can often be quite sharp, which may often be too painful to continue activity


Early management of this condition is essential, initial reduction of the aggravating activity is important to reduce the stress on the tibia and leg musculature. The following are self-management strategies, which can be adopted.

  • In the initial stages when pain is present you may benefit from ice application (15mins every 2 hours) and some non-steroidal anti-inflammatory medication (NSAIDS).
  • Initiation of flexibility and strengthening programmes for the gastrocnemius/soleus complex and the anterior shin muscles. Beginning a proprioceptive training program will assist in regaining stability in the foot and ankle.
  • Correcting any training errors, following a guided program may ensure you don’t take on too much too soon. Altering the direction of your routes to ensure you are not running on the same cambered pavements.
  • Self massage with a foam roller.
  • Wearing the correct footwear, visiting a specialist footwear store such as Run 4 It will ensure you are measured correctly for the most appropriate shoe for your running style.

Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with MTSS, increasing the mobility at the joint and improving the muscles flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure a speedy return to running. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.


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