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
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MTSS is a treatable condition. Contact your doctor if you think you may have MTSS.
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 syndromeChronic trauma to structures in the calf
Factors that may increase your chance of MTSS include:
Participation in repetitive, high-impact sports:
RunningGymnasticsBasketballRacquet sportsMilitary recruits
Female runners with
(absent menstruation) and
osteoporosisPronation of feet (feet turn inwards), or other leg or foot abnormalitiesPoor (hard) running surfacesPoor footwearOvertraining or recent increase in workout or miles runHeel cord tightness
MTSS may cause: Shin pain at a very specific pointPain when running which gets more severe with continued exercise
Pain when bearing weight on the legPain after changing workout intensity or running surfaceSymptoms may not go away with restSwelling
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.
MTSS is treated with: RestNonsteroidal anti-inflammatory drugs (NSAIDs)IceCrutches
may be given for severe pain
Arch supports and shock-absorbing insoles may be recommendedWhen 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.
To help reduce your chance of MTSS:
Wear shock-absorbing insoles when running or during other high-impact exerciseStretch before and after exercisingWhen starting a new sport or increasing your workout, do so graduallyChoose footwear that is best for the activity and your footCross train
Conquering medial tibial stress syndrome. Podiatry Today website. Available at:
http://www.podiatrytoday.com/article/5031. Accessed December 12, 2014.
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.
Last reviewed December 2014 by John C. Keel, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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