| Risk Factors
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 may be 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:
These factors increase your chance of MTSS. Tell your doctor if you have any of these risk factors:
Participate in high-impact sports
- Racquet sports
- Military recruits
Female runners with
(absent menstruation) and
- Pronation of feet (feet turn inwards)
- Poor running surfaces
- 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
- Pain when bearing weight on the leg
- Pain after changing workout intensity or running surface
- Symptoms do not go away with rest
Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may be referred to a specialist. For example, a sports medicine physician focuses on sport injuries.
The following test may be administered:
—test that uses radiation to take picture of structures in body, may be used to rule out a fracture
- Bone scan
—test that uses tiny amounts of radioactive material and a camera to take pictures of bones; used to look for bone abnormalities; more sensitive than an x-ray
MTSS is treated with:
- Nonsteroidal antiinflammatory drugs (NSAIDs)
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 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.
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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