Medial Tibial Stress Syndrome (MTSS) (Shin Splints)

What is medial tibial stress syndrome?

Medial Tibial Stress Syndrome (MTSS) occurs due to excessive stress on the tibia, the primary bone in the shin. The muscles connecting to the tibia, such as the posterior tibialis, soleus, and flexor digitorum longus, can put extra pressure on the bone and cause strain at their attachment points.


What causes Medial Tibial Stress Syndrome?

Medial Tibial Stress Syndrome (MTSS) occurs due to irritation at the point where the calf muscles attach to the shin bone. It is common in sports with frequent stops and starts, running on slanted or downhill surfaces, and can be exacerbated by training errors, worn shoes, and changes in training intensity, duration, and surface. Other risk factors for MTSS include improper ankle and foot alignment and lack of lower extremity flexibility.

What are the symptoms of Medial Tibial Stress Syndrome?

Individuals usually experience pain along the shin bone that can range from a dull ache to a sharp and intense pain, commonly located on the inside border of the shin bone, usually in its middle or lower third. The pain may start early in the activity and diminish with continued exercise or persist throughout. Resting usually relieves the pain, but in severe cases, it may persist even without activity and during rest. This persistent pain and other symptoms could indicate a stress fracture, a more severe injury.

How is Medial Tibial Stress Syndrome Diagnosed?

Your physical therapist will conduct a comprehensive evaluation, which includes taking a complete health history and observing you during activities that cause symptoms, such as running or jumping. To assess your musculoskeletal system, they will also perform tests to evaluate your strength, mobility, flexibility, and pain response. Applying pressure to specific areas on the shin produces the most indicative symptom of MTSS: pain.

Based on the examination results, your physical therapist will discuss your treatment goals and develop a personalized rehabilitation program if MTSS is suspected. In case of a possible underlying severe condition, referral to a physician for additional tests may be necessary.


Can This Injury or Condition Be Prevented?

Yes, Medial Tibial Stress Syndrome (MTSS) can be prevented. Here are some steps you can take to reduce your risk of developing MTSS:

  • Gradual increase in physical activity: Increasing physical activity gradually, rather than suddenly, can help prevent MTSS.
  • Proper footwear: Wearing shoes that fit well and provide adequate support can help avoid MTSS. It is also important to replace shoes regularly, especially if they show signs of wear.
  • Cross-training: Mixing up your physical routine with activities such as cycling or swimming can ease the stress on your shin bones.
  • Stretching and strengthening exercises: Regular stretching and strengthening exercises for your legs, feet, and ankles can help improve flexibility and reduce the risk of MTSS.
  • Proper form and technique: Using proper form and technique when engaging in physical activities can help reduce the risk of MTSS.
  • Avoid running on hard surfaces: Increase the stress on your shin bones by running on hard surfaces like concrete. Reduce this stress by running on softer surfaces such as dirt trails or grass.
  • Monitoring your training: Paying attention to changes in your training routine, such as increases in intensity or duration, can help you prevent MTSS.

How is Medial Tibial Stress Syndrome treated?

Treat Medial Tibial Stress Syndrome (MTSS) typically with a combination of rest, physical therapy, and other non-invasive methods. The main goal of treatment is to reduce pain and inflammation, promote healing, and prevent recurrence. The following are some of the common treatment methods for MTSS:

  • Rest: Reducing or stopping activities that worsen symptoms is essential. Depending on the severity of MTSS, this may mean taking a break from running or other weight-bearing activities for a few days or weeks.
  • Ice therapy: Reduce pain and inflammation by applying ice to the affected area.
  • Physical therapy: Improve the strength, flexibility, and alignment of the affected area with a personalized exercise program from a physical therapist.
  • Orthotics: Custom-made shoe inserts (orthotics) can help correct any underlying foot or ankle problems that may contribute to MTSS.
  • Medications: Relieve pain and decrease inflammation with over-the-counter pain relievers like ibuprofen.
  • Taping or bracing: Taping or wearing a brace can provide support and relieve stress on the affected area.

Surgery may be recommended in severe cases or if conservative treatments are ineffective. Working closely with a healthcare provider to determine the best treatment plan for your specific issue is important.

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