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Medial Tibial Stress Syndrome

(MTSS; Shin Splints; Medial Distal Tibial Syndrome, MDTS; Medial Tibial Syndrome; Stress-Related Anterior Lower Leg Pain; Spike Soreness)

Pronounced: me-d-ul tib-e-ul stress sin-drom
En Español (Spanish Version)

Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention


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
Copyright © Nucleus Medical Media, Inc.

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:

Risk Factors

These factors increase your chance of MTSS. Tell your doctor if you have any of these risk factors:

  • 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


If you have any of these symptoms do not assume it is due to MTSS. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

  • 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


Your doctor will ask about your symptoms and medical history. A physical exam will be done. The diagnosis can be made by the classic history and physical exam.

You may be referred to a specialist. For example, a sports medicine physician focuses on sport injuries.


MTSS is treated with:

  • Rest
  • Nonsteroidal antiinflammatory 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.


To help reduce your chance of getting MTSS, you may try the following steps:

  • 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


American Academy of Orthopaedic Surgeons


The American Orthopaedic Society for Sports Medicine


American Physical Therapists Association



Canadian Medical Association


Canadian Orthopaedic Association


Canadian Orthopaedic Foundation



AOSSM sports tips. AOSSM website. Available at: http://www.sportsmed.org/secure/reveal/admin/uploads/documents/. Accessed November 13, 2008.

Conquering medial tibial stress syndrome. Podiatry Today website. Available at: http://www.podiatrytoday.com/article/5031. Accessed November 13, 2008.

Cosca DD, Navazio F. Common Problems in Endurance Athletes. American Family Physician —Volume 76, Issue 2 (July 2007).

Craig DI. Medial tibial stress syndrome: evidence based- prevention. Journal of Athletic Training. 2008;43(3):316–318.

Shin splints. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 27, 2009. Accessed June 11, 2009.

Shin splints. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/shin-splints/DS00271. Accessed November 13, 2008.

Last reviewed December 2012 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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