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.

• Acute inflammation of structures in the calf
• Chronic compartment syndrome
• Chronic trauma to structures in the calf

• 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

• 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

1. Your doctor will ask about your symptoms and medical history. A physical exam will be done. The diagnosis can be made by the classic history and physical exam.
2. You may be referred to a specialist. For example, a sports medicine physician focuses on sport injuries.

• Pain reduction: The RICE principle is the first step to recovery (rest, ice, compression, and elevation). Manual therapy and Kinesiotaping may also be used to speed up recovery and reduce swelling.
• Gait and footwear analysis: An analysis of how a person walks and runs in an important part of treatment. The wrong mechanism of walking can transmit a great deal of force through the shin to the knee and hip. In such situations, physical therapists will correct gait patterns and recommend footwear with shock absorbing capacity.
• Muscle stretches and strengthening: The tibial and peroneal muscles are attached to the shin and must be stretched adequately before any form of exercise. Physical therapy includes various stretches of the goot that will help stretch and warm up these muscles. Strengthening damaged muscles can also help.
• Activity modification:  Physical therapists may suggest alternative activities to minimize stress on the shinbones. These can include swimming and cycling.
• Increase Range of Motion (ROM): Exercises for the hip, knee, ankle and foot improve blood circulation, reduce inflammation and relieve pain. A home exercise program may also be implemented.
• Arch support:  The absence or collapse of a normal foot arch can lead to shin splints. Physical therapists will recommend appropriate orthotics that can be custom made for the patient and provide the appropriate amount of arch support.
• Return to sport: If you are an athlete, your therapist may tailor exercises that are specific to strengthening the areas needed to perform your sport. Modified use of your muscles may also be discussed and implemented. Return to your sport may be gradual to prevent re-injury.

• The affected limb has regained strength and flexibility and is now comparable to the unaffected limb.
• There is no pain while jogging, sprinting and jumping.
• X-rays reveal healed stress fractures.

• 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.

• American Academy of Orthopaedic Surgeons

http://www.aaos.org

• The American Orthopaedic Society for Sports Medicine

http://www.sportsmed.org

• American Physical Therapists Association

http://www.apta.org

• Canadian Medical Association

http://www.cma.ca/

• Canadian Orthopaedic Association

http://www.coa-aco.org/

• Canadian Orthopaedic Foundation

http://www.canorth.org/

• AOSSM sports tips. AOSSM website. Available at: http://www.sportsmed.org/secure/reveal/admin/uploads/documents/ . Accessed November 13, 2008.
• Conquering medial tibial stress syndrome. Podiatry Today website. Available at: http://www.podiatrytoday.com/article/5031 . Accessed November 13, 2008.
• Cosca DD, Navazio F. Common Problems in Endurance Athletes. American Family Physician —Volume 76, Issue 2 (July 2007).
• Craig DI. Medial tibial stress syndrome: evidence based- prevention. Journal of Athletic Training . 2008;43(3):316–318.
• Shin splints. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 27, 2009. Accessed June 11, 2009.
• Shin splints. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/shin-splints/DS00271 . Accessed November 13, 2008.