Medial Tibial Stress Syndrome (aka Shin Splints)

Medial tibial stress syndrome (MTSS) is an overuse injury or repetitive-stress injury of the shin area. Various stress reactions of the tibia and surrounding musculature occur when the body is unable to heal properly in response to repetitive muscle contractions and tibial strain.

MTSS occurs in 10-15% of running injuries and in  60% of leg pain syndromes. Pain is usually located along the distal and posteromedial tibia.








Risk factors

  • runners without enough shock absorption (running on cement or uneven surfaces, improper running shoes)
  • training errors (sudden increase in training intensity and duration)
  • running >20 miles/week
  • hill training early in the season
  • history of previous lower extremity injuries
  • over-pronation or increase internal tibial rotation


  • activity modification
    • decreasing running distance, frequency and intensity by 50%
    • use low-impact and cross-training exercises during rehab period
    • regular stretching and strengthening
    • run on synthetic track
    • avoid running on hills, uneven or hard surfaces
  • shoe modifications
    • change running shoes every 250-500miles as shoes lose shock absorbing capacity at this distance
    • orthotics may be helpful in patients with pes planus
  • therapy
    • focus on strengthening of invertors and evertors of the calf





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