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.

Muscle and Bones of Lower Leg

lower leg compartment

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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