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Shin Splints (Medial Tibial Stress Syndrome)

Shin Splints or Medial Tibial Stress Syndrome (MTSS) presents as exercise-induced pain along the posteromedial tibial border (bottom third of the inside of the tibia) caused by repetitive loading stress during running and high impact activities.


  • Overuse/overloading structures and poor single leg biomechanics.

  • Overloading examples including increasing training loads too quickly, change in training surfaces & footwear, inadequate rest time between training sessions

  • Biomechanical factors include foot pronation, poor calf strength, decreased ankle mobility (in particular dorsiflexion), knee valgus during dynamic loading (‘knocked knees’) and poor hip & trunk (gluteal & ‘core’ strength) control during dynamic loading.

Shin Splints Fact Sheet.png

Signs & Symptoms

  • Pain is exercise induced from activities such as running and jumping.

  • Dull ache at start of exercise and can often subside during exercise before increasing following exercise once cooled down.

  • As the injury progresses pain can often become sharp with increase weight bearing movements such as when the foot strikes the ground in running and landing from jumping.

  • Pain can be provoked on palpating along the tibial border.

Differential Diagnosis

  • Bone Stress - stress reaction or fracture

  • Chronic exertional compartment syndrome

  • Popliteal Artery Entrapment

PROmotion Assessment and Outcomes Measures

Assessment of; 

  • Loading & exercise and injury history. 

  • Lower limb muscular strength. 

  • Functional lower limb control in aggravating activities. 

  • Foot biomechanics if appropriate; advice regarding footwear and/or referral to Sports Podiatrist

How to Manage

  • Education & advice surrounding correct loading. This will be dependent on sport for example a detailed return to running program for runners.

  • Manual therapy to improve ankle range of movement & decrease muscle tightness where warranted.

  • Comprehensive rehabilitation program designed to improve single leg biomechanics and functional strength specific to clients functional loading demands.

  • Management may also include referral to Sports Doctor for review for any further medical intervention.


  1. Lohrer, H., Malliaropoulos, N., Korakakis, V., & Padhiar, N. (2019). Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. The Physician and sportsmedicine, 47(1), 47-59. Winkelmann, Z. K., Anderson, D., Games, K. E., & Eberman, L. E. (2016). Risk factors for medial tibial stress syndrome in activ individuals: an evidence-based review. Journal of athletic training, 51(12), 1049-1052.

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