Medial Tibial Stress Syndrome (sometimes referred to as shin splints) is an overuse injury of the
lower leg, that is usually associated with an increase in running or jumping loads. When the body is
not accustomed to load, the repetitive stress of jumping and running can cause inflammation and
microtrauma to the tibial bone, periosteum (the connective tissue covering the bone) or the
surrounding muscles. This inflammatory response results in pain and discomfort along the lower third
of the tibia. Your physiotherapist will be able to identify whether you have MTSS through taking a
thorough history, and with a physical assessment.
What are the main signs of MTSS?
- Pain along the inside border of the lower third of the tibia, over an area greater than 5cm
- Pain may be present at the start of a run, but warms up and improves as the run goes on
- Recent increase in running or jumping activities
What classifies as increase in load?
It is important to consider all variables in your training when looking for training errors. Load can be
increased through duration, intensity, frequency, or type of activities within your week. For example,
you may have kept your weekly distance consistent, but increased pace. Change in footwear and
running surfaces can also contribute to the development of shin splints (MTSS).
Are shin splints stress fractures?
In a runner, it is important for your physiotherapist to differentiate shin splints (MTSS) from a stress fracture of the tibia. Stress fractures in the tibia exhibit specific signs, including localised tenderness over an area less than 5cm, pain that intensifies during running and remains constant throughout the run. Stress fractures may also result in pain at night and pain during normal walking. If left untreated, MTSS can progress into a stress fracture, so we recommend a check in with your physiotherapist if you are
experiencing shin pain. It's worth noting that both shin splints (MTSS) and stress fractures necessitate a reduction in running activities. However, a stress fracture typically requires a more extended break from running to facilitate bone healing.
How do I manage MTSS?
The pathophysiology of shin splints (MTSS) is complex, however for most cases, the primary driver of shin splints (MTSS) is related to training errors. Usually, this means doing too much too soon, without adequate time for the tissue to adapt to a training stimulus. Treatment for shin splints (MTSS) varies depending on the individual, but will typically consist of temporarily modifying running loads, increasing capacity of the tissue through strength training and manual therapy if indicated in your case.
What does a rehab plan for shin splints (MTSS) look like?
Our physiotherapists will conduct a thorough assessment of your strength to identify individual
strength deficiencies which may have contributed to your injury. From here, your physiotherapist will
create a tailored strength training plan to your needs. Increased capacity of the muscles used in
running helps to dissipate the loads from the bone, decreasing overall injury risk. A typical program
will focus on developing capacity in the calves, quads, hip flexors, hamstrings, and glutes.
Think you might be dealing with MTSS?
If you suspect you may started developing shin splints (MTSS), don't hesitate to reach out to one of our experienced physiotherapists. They can provide a comprehensive assessment to determine the issue and devise a tailored plan to help you return to pain-free running.
Melbourne CBD Physiotherapy and Sports Medicine Clinic
Holly Pointon is a highly regarded physiotherapist who works full time at Melbourne CBD Physiotherapy and Sports Medicine Clinic. Holly is a keen distance runner herself, which gives her a true understanding of the activity runners want to get back to doing. With the help of the team, it is always our goal to reload patients back into activity as safely and as quickly as possible.