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Medial Tibial Stress Syndrome or

Medial Tibial Stress Syndrome or "Shin Splints"

Not all shin pain is actually "Shin Splints"!

Medial Tibial Stress Syndrome (MTSS) is the most common cause of exercise induced lower leg pain. 

Shin splints are tiny stress fractures along the shin bone (tibia) where the stress on the shin bone is at its greatest. This is the 3rd stage of MTSS and only occurs if you continue to train with pain for quite some time and requires complete rest from activity.

The earlier stages of shin pain are more common and can be treated successfully. 1st stage being microtears of the muscles in front of the shin bone, 2nd stage occurs when the microtears and inflammation place increase pressure on the fascia which encases the shin muscles and inserts into the shin bone. If ignored, this increased stress on the shin bone from the tight fascia may lead to ‘shin splints’.

Other less common forms or exercise induced lower leg pain include Chronic Exertional Compartment Syndrome and Popliteal Artery Entrapment Syndrome and are explained in detail here

Signs & Symptoms of Medial Tibial Stress Syndrome

Typically, shin pain begins as an ache along your shin bone following exercise, which gradually progresses until you experience pain during exercise as well. The pain will be exacerbated by high impact activities like running and jumping, and may be accompanied by palpable, tender lumps along the shin, indicating areas of inflammation.

Causes of "Shin Splints"

Shin pain is a common problem during the early stages of an exercise program, which can affect people of all fitness levels. Shin pain often results from doing ‘too much, too soon’, and failing to allow your muscles and bones to recover between sessions.

Other predisposing factors include:

  • Feet that roll in (pronate) excessively, the muscles in your legs become overworked, causing inflammation at their attachment to the shin bone
  • High arch (supinated) rigid feet which offer poor shock absorption, increased shock and stress is transferred to the shin muscles
  • Excessively tight calf muscles, restricted ankle joint
  • Poor proximal control at hips/gluteals
  • Worn-out, poorly cushioned, unsupportive footwear
  • Hard training surfaces, like cement or bitumen
  • Certain running gaits may increase the risk of developing shin pain

Treatment for "Shin Splints"

Treatment for Medial Tibial Stress Syndrome depends on the individual and what stage of shin pain you may have, but may involve the following:

  • Calf and shin stretches, trigger-point rolling and strengthening exercises
  • Massage, Western medical acupuncture
  • Modify training load and intensity (try alternative exercises like swimming, cycling and upper body weights which have less impact on the lower limb)
  • Addressing weakness around hips/gluteals
  • Improve footwear (correct support and midsole cushioning)
  • Improve running gait
  • Custom Foot Orthoses to improve biomechanical factors contributing to shin pain


Because of the complex nature of shin pain it is important to have an accurate diagnosis to treat the shin pain correctly. Don’t drop out of your 12-week boot camp challenge due to annoying shin pain – give Foundation Podiatry a call today!

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