Definition

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.

MTSS is a treatable condition. Contact your doctor if you think you may have MTSS.

Causes

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:

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

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

Symptoms

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

Diagnosis

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.

Treatment

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.

Prevention

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

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

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

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_Running%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_poisoning/sports_injury/shin_splints.html
Updated October 2014. Accessed December 12, 2014.