Diagnosis: Medial Tibial Stress Syndrome (MTSS)

 In Running

What is MTSS?

Medial Tibial Stress Syndrome (MTSS), more commonly known as shin splints is a common overuse condition seen in running activities, where the shin (tibia), becomes inflamed and painful1.

Medial Tibial Stress Syndrome (MTSS), more commonly known as shin splints #performbetter @pogophysio Click To Tweet

Symptoms of MTSS

Many with MTSS present with one or more of the following symptoms:

  • Pain and stiffness in the front and/ or in the inner portion of the shin1
  • Pain worsens with running, walking or jumping2
  • Pain walking up and down hill or stairs or on uneven surfaces2
  • In severe cases: walking with a painful limp2

How is MTSS Diagnosed?

MTSS is commonly diagnosed based on talking to the physiotherapy about the history of the pain and the physical examination2. On physical examination, pain will be present when feeling the inside and front of the shin, and pain on walking/running. There are also other conditions that may increase the risk of developing MTSS, the physiotherapist may look or ask about at these aspects on examination they include: pronated (outturned) feet, supinated (in turned) feet, suddenly increasing exercise intensity, running on hard or uneven surfaces, tight calves or hamstrings3. Imaging the shin can be used to rule out conditions such as fractures of the shin2.

Medial Tibial Stress Syndrome

What Causes MTSS?

There are many muscles that attach to the front of the shin, during walking or running; these muscles pull on the shinbone repeatedly and cause it to become painful and inflamed. MTSS can be caused by many factors that are mainly due to abnormal movement patterns and errors in training. Some of the most common include1:

  • Over pronation of the feet
  • Over supination of the feet
  • Inappropriate footwear
  • Increasing the amount of training too quickly
  • Running on hard or angled surfaces
  • Poor knee alignment
  • Poor buttock control during walking/running
  • Tight calf muscles and hamstrings
  • Weak quadriceps, foot arch muscles

How is MTSS treated?

MTSS treatment involves many factors. One major aspect is to correct the abnormal movement patterns and training in error3. These factors will be identified by the physiotherapist and may be included in the treatment to prevent recurrences. Some of these many include; changing shoes, easing into a new training routine and taping. In the early stages it may be difficult to walk or run, so it is important to decrease the amount of activity in the early days and ice the area to target any swelling2. As mentioned, MTSS can occur due to foot movement patterns. It  is very important to target these as they play a major role in the condition.  The  physiotherapist may also provide stretching and strengthening exercises to the muscles  around the shin and the hips to prevent recurrences. An example of a strengthening exercise that can be used is using a resistance band to strengthen the calf muscles and using a towel to stretch the calf muscles1.

Shanam Nisha
Student Physiotherapist


  1. http://physioworks.com.au/injuries-­‐conditions-­‐1/shin-­‐splints
  2. http://www.physio-­‐com/Shin-­‐splints
  3. http://www.physioadvisor.com.au/injuries/lower-­‐leg/shin-­‐splints/

pain free performance Gold Coast physio

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