• Medial Tibial Stress Syndrome

    (MTSS; Shin Splints; Medial Distal Tibial Syndrome, MDTS; Medial Tibial Syndrome; Stress-Related Anterior Lower Leg Pain; Spike Soreness)


    Medial tibial stress syndrome (MTSS) is exercise-related pain in the shins. It may be caused by an irritation of the tendons and muscles near the shin bones. MTSS is commonly known as shin splints. This injury is most often seen among runners.
    Muscle and Bones of Lower Leg
    lower leg compartment
    Copyright © Nucleus Medical Media, Inc.
    MTSS is a treatable condition. Contact your doctor if you think you may have MTSS.


    The exact cause is unknown. MTSS is called an overuse injury. It most commonly occurs from repetitive motion or stress at the shins. Causes may include:

    Risk Factors

    Factors that may increase your chance of MTSS include:
      Participation in repetitive, high-impact sports:
      • Running
      • Gymnastics
      • Basketball
      • Racquet sports
    • Military recruits
    • Female runners with amenorrhea (absent menstruation) and osteoporosis
    • Pronation of feet (feet turn inwards), or other leg or foot abnormalities
    • Poor (hard) running surfaces
    • Poor footwear
    • Overtraining or recent increase in workout or miles run
    • Heel cord tightness


    MTSS may cause:
    • Shin pain at a very specific point
    • Pain when running which gets more severe with continued exercise
    • Pain when bearing weight on the leg
    • Pain after changing workout intensity or running surface
    • Symptoms may not go away with rest
    • Swelling


    Your doctor will ask about your symptoms and medical history. A physical exam will be done. Diagnosis can be made on this information.
    You may be referred to a specialist. For example, a sports medicine physician focuses on sport injuries.


    MTSS is treated with:
    • Rest
    • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Ice
    • Crutches may be given for severe pain
    • Arch supports and shock-absorbing insoles may be recommended
    • When you feel better, slowly return to normal activities—increase your activity level slowly over several weeks
    Your doctor may suggest a different pair of shoes . A brace or walking boot may also be needed.


    To help reduce your chance of MTSS:
    • Wear shock-absorbing insoles when running or during other high-impact exercise
    • Stretch before and after exercising
    • When starting a new sport or increasing your workout, do so gradually
    • Choose footwear that is best for the activity and your foot
    • Cross train


    Ortho Info—American Academy of Orthopaedic Surgeons http://www.orthoinfo.org

    Sports Med—The American Orthopaedic Society for Sports Medicine http://www.sportsmed.org


    Canadian Orthopaedic Association http://www.coa-aco.org

    Canadian Orthopaedic Foundation http://www.canorth.org


    Conquering medial tibial stress syndrome. Podiatry Today website. Available at: http://www.podiatrytoday.com/article/5031. Accessed December 12, 2014.

    Cosca DD, Navazio F. Common problems in endurance athletes. Am Fam Physician. 2007;76(2):237-244.

    Craig DI. Medial tibial stress syndrome: evidence based- prevention. J Athl Train. 2008;43(3):316–318.

    Running and jogging injuries. American Orthopaedic Society for Sports Medicine website. Available at: http://www.sportsmed.org/downloads/tips/AOSSM%5FRunning%20and%20Jogging%20Injuries.pdf. Updated December 12, 2014.

    Shin splints. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 3, 2012. Accessed December 12, 2014.

    Shin splints. The Merck Manual Professional Edition website. Available at: http://www.merckmanuals.com/professional/injuries%5Fpoisoning/sports%5Finjury/shin%5Fsplints.html. Updated October 2014. Accessed December 12, 2014.

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