Shin Splits

Introduction

What is Medial Tibial Stress Syndrome (MTSS)?

MTSS, commonly known as shin splints, causes pain along the inner and lower part of the shinbone (tibia). It’s a typical overuse injury, especially in runners, dancers, and military recruits. The pain often starts during or after exercise and is a sign the tibia is under too much stress, potentially on its way to a stress fracture.

How Common Is It?

• MTSS affects 13% to 20% of runners and up to 35% of military recruits.

• Dancers and new athletes are also at high risk, especially if training load increases quickly.

Key Risk Factors:

• Female sex

• History of shin splints

• High body weight

• Foot structure issues (like a dropped arch)

• Weak or tight calf muscles

• Poor hip mobility

• Hard training surfaces

• Worn or inappropriate shoes

What Causes the Pain?

Think of your shinbone like a metal rod. Repeated stress without rest can lead to tiny cracks or inflammation of the outer layer of the bone (periosteum).

Two main theories:

1. Inflammation due to muscle pulling on the bone (especially tibialis posterior and soleus).

2. Microdamage from overloading the bone—like hairline cracks before a full break.

Signs and Symptoms

🩺 Key Assessment Clues:

• Pain along the inner shin, lower 2/3

• Pain that starts with exercise and lingers after stopping

• May feel better while running (in early stages)

• Pain gets worse with more frequent training (later stages)

• Tenderness along the shinbone (more than 5 cm)

• Pain with hopping = likely stress fracture if hopping is unbearable

• Flat feet and tight calf muscles are often seen

Imaging

MRI may show signs of inflammation (periosteal reaction) and swelling.

Treatment Overview

🛌 Rest is key, but total rest isn’t ideal for active people. Modify your training instead:

• Swap high-impact for low-impact activities (like swimming or cycling)

• Use ice or pain-relief gels after activity

• NSAIDs can help reduce pain in the short term

Avoid corticosteroid injections—they may worsen tissue healing.

Recovery Phases

🟡 Acute Phase (2–6 weeks)

• Reduce or stop high-impact activities

• Ice therapy and pain medication

• Avoid uneven ground and hill training

• Don’t push through pain

🟠 Subacute Phase

• Gradually increase training as symptoms improve

• Introduce calf stretches and strengthening

• Strengthen hips and core to support better running form

• Balance training (like standing on one leg or using a wobble board)

• Wear good shoes and replace every 250–500 miles

• Orthotics may help if foot posture is contributing

Physical Therapy Tips

💡 Focus on:

• Graded return to running (running retraining)

• Correcting gait or movement issues

• Building strength in glutes and calves

• Improving flexibility and joint mobility

• Balance and proprioception to prevent relapse

🏋️‍♂️ Sample Exercises:

• Eccentric calf raises

• Hip bridges

• One-leg balance drills

• Core strengthening

Differential Diagnosis: What Else Could It Be?

Summary

Shin splints (MTSS) are a common overuse injury seen in active individuals. It’s usually caused by repeated stress on the tibia without enough rest, leading to pain along the inner shin. While painful, it’s manageable with rest, proper footwear, strength training, and technique adjustments. Early recognition and smart rehab can prevent the condition from progressing into a more serious stress fracture.