Shin Splints

Medial Tibial Stress Syndrome (MTSS) or shin splints is activity induced pain along the inside of the shin. It is an overuse injury coming from repeated loading of the fascia of the lower leg pulling on the bone. The repetitive pulling starts an inflammatory reaction in the shin. Over time, this can lead to weakening of the bone and damage to the bone itself. This starts to occur when high demands of activity surpass the body's ability to heal from the previous bout of activity. The most common cause of MTSS is repetitive loading on hard surfaces like running or jumping. It can also be perpetuated by training errors, rapid increases in training load or even poor biomechanics such as cross over gait or foot issues. 


MTSS typically presents with vague, diffuse pain of the middle to bottom of the shin. It is often at its worst with increasing activity, especially at the beginning of a training session. Symptoms will often dissipate throughout that singular training session but as the condition progresses, symptoms will start to linger throughout the session and even into rest. 

Treatment for MTSS consists of reduction of activity and treatment for underlying biomechanical abnormalities. Cross training is highly recommended for athletes that are in season and need to reduce impact while maintaining fitness levels. Low impact skill work can be worked on as well. Manual therapy is used to release muscles that are tight. Manipulation is applied to restricted joints to help improve mechanics. Full resolution of MTSS requires correction of any underlying biomechanical dysfunction. Orthotics are used when appropriate for foot dysfunctions. Return to full activity should be done through a gradual process that does not increase training load by more than 10-15% per week. 

If you have an issue that you would like some guidance with, give us a call at (616) 301-1702.

  1. Mubarak SJ, Gould RN, Lee YF, Schmidt DA, Hargen AR. The medial tibial stress syndrome: a cause of shin splints. The American journal of sports medicine. 1982 Jul;10(4):201-5

  2. Newman P, Witchalls J, Waddington G, Adams R. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open access journal of sports medicine. 2013;4:229. 

  3. Kortebein P, Kaufman K, Basford J, Stuart M. Medial tibial stress syndrome. Med Sci Sports Exerc. 2000;32:S27-S33

  4. Strakowski JA, Jamil T. Management of common running injuries. Physical Medicine and Rehabilitation Clinics. 2006 Aug1;17(3):537-52