Medial Tibial Stress Syndrome: Causes, Symptoms, Diagnosis & Treatments

Numbness, swelling and pain in the fingers or arms? Maybe it’s Carpal Tunnel Syndrome (CTS). We go over symptoms, diagnosing, and possibly treatments. 

Do I have Medial tibial stress syndrome (MTSS), AKA Shin Splints? We go over the common causes, symptoms, diagnosis and treatments. 

Medial Tibial Stress Syndrome (MTSS), commonly known as shin splints is a painful overuse injury that affects the lower leg. 

This condition primarily occurs in athletes and individuals who engage in repetitive activities that place stress on the shinbone (tibia) and the surrounding muscles and tissues. 

In this comprehensive guide, we will explore various aspects of MTSS, including its causes, symptoms, diagnosis, treatment, prevention, and recovery strategies.

Medial Tibial Stress Syndrome, or shin splints, is a prevalent condition characterised by pain along the inner edge of the shinbone. 

This discomfort usually arises during or after physical activities, such as running, and jumping.

While MTSS is a common ailment, it can be debilitating if left untreated.


    Causes and Risk Factors of Medial Tibial Stress Syndrome

    Understanding the causes and risk factors associated with MTSS is crucial in both prevention and treatment. 

    Several factors contribute to the development of Shin Splints;

    • Repetitive Stress: Overuse or repetitive stress on the leg muscles and bones, particularly in activities that involve running or jumping, is a primary cause.
    • Improper Footwear: Wearing inappropriate or worn-out footwear can increase the risk of shin splints.
    • Acute Training Changes: Sudden increases in training intensity or frequency, as well as inadequate rest periods, can strain the shinbone. Menéndez et al. (2020) reported among runners an increase in weekly running distances, more than 30% had a higher prevalence rate for this injury.
    • Biomechanical Factors: Abnormalities in gait or foot structure may contribute to MTSS. For example, an increased pelvic drop can lead to a medial shift of the centre of body mass, which leads to knee valgus and subtalar joint pronation (while increased internal rotation of the hip has also been linked to overpronation of the foot). Furthermore, excessive pronation during motion may increase the stress put on the first metatarsophalangeal joint in plantar flexion, which was common among runners with history of MTSS.
    • Previous History: Previous history of having MTSS can lead to a higher prevalence.

    Symptoms of Medial Tibial Stress Syndrome

    Symptoms of MTSS can vary in intensity but typically include;

    • Pain along the inner shin during or after physical activity


    Discomfort often eases with rest but returns at the start of physical activity. 

    The key difference of MTSS is:

    • The absence of cramping
    • Burning pain over the posterior compartment
    • Numbness/tingling in the foot 


    Diagnosis of Medial Tibial Stress Syndrome

    To reliably diagnose MTSS, there are 2 key criteria

    1. The presence of recognizable pain reproduced with palpation of the posteromedial

    tibial border more than  5 cm.

    1. The absence of other findings not typical of MTSS (severe swelling, erythema,

    loss of distal pulses, etc.)

    The other aspects to be considered are; 

    • Your medical history (activity levels, training routine, prior leg injuries)
    • A physical examination to assess the location and intensity of the pain
    • Leg muscle strength and flexibility tests. 

    Imaging is generally not required unless used to rule out other potential causes of leg pain, such as stress fractures.

    Treatments for Medial Tibial Stress Syndrome

    The treatment of MTSS usually involves a combination of approaches:

    • Activity Modification: Modify exercises with a less repetitive, load-bearing alternative will allow the MTSS to settle.
    • Rest: Rest is essential to allow the injured tissues to heal properly. This may involve a temporary reduction in or cessation of physical activities.
    • Neuromuscular Training: When muscles are weak or fatigued, their natural shock absorption capability is compromised, and underlying bone is at risk of increased strain and potential injury. Improving running technique and reducing muscle fatigue from training will reduce the strain on the tibia.
    • Ice: Applying ice to the affected area can help reduce inflammation and alleviate pain
    • Orthotics: Custom orthotic insoles or footwear modifications may be prescribed to address gait abnormalities or foot structure issues. It is suggested that orthotics reduce foot eversion, which in turn may aid the correction of overpronation. Shock-absorbing insoles might be useful.
    • Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended to manage pain and inflammation.
    • Gradual Return to Activity: As the condition improves, a gradual return to physical activity is essential to prevent a recurrence.

    Prevention Medial Tibial Stress Syndrome

    Preventing MTSS involves various strategies:

    • Proper Footwear: Invest in well-fitting, supportive athletic shoes designed for your specific activity (Deshmukh et al., 2022).
    • Gradual Progression: Gradually increase the intensity and duration of physical activities to allow your body to adapt (Deshmukh et al., 2022).
    • Strength and Flexibility: Maintain a regular routine of strength and flexibility exercises to support leg muscles.
    • Listen to Your Body: Pay attention to any early signs of discomfort and address them promptly.

    Who is most susceptible to getting Medial Tibial Stress Syndrome?

    Medial Tibial Stress Syndrome, or shin splints, is a common and often painful condition that can affect individuals engaged in repetitive, high-impact activities.


    Understanding its causes, symptoms, diagnosis, and treatment options is essential

    for both athletes and those seeking to prevent this condition. 


    By following appropriate prevention measures and seeking timely treatment, individuals can manage MTSS effectively and maintain their active lifestyles.


    Written by Oscar Mah, PT4 student, Monash University for Physio and Fitness Clinic


    Mattock, Steele & Mickle, 2021

    Menéndez et al., 2020

    Deshmukh et al., 2022

    McClure & Oh, 2019

    Kuwabara et al., 2021