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by Kellicker PG
(MTSS; Shin Splints; Medial Distal Tibial Syndrome, MDTS; Medial Tibial Syndrome; Stress-Related Anterior Lower Leg Pain; Spike Soreness)


Medial tibial stress syndrome (MTSS) is pain in the shins. It is the irritation of muscles, tendons, and other tissue of the lower leg. MTSS, or shin splints, are most common in those who do intense exercises like runners or military personnel.

Muscle and Bones of Lower Leg
lower leg compartment
Copyright © Nucleus Medical Media, Inc.


MTSS is most often caused by a sudden increase in the intensity or frequency of exercise. The muscles and tendons over the shin become irritated and inflamed. Both the inflammation and the pressure it creates cause pain.

Risk Factors

MTSS is more commonly found in people who participate in repetitive high impact sports, such as:

  • Running
  • Basketball
  • Dancers
  • Gymnastics
  • Military personnel

Other factors that may increase your chances of MTSS:

  • Overtraining or recently increasing the intensity of your workout or miles run
  • A strength imbalance in the leg
  • Amenorrhea (absent menstruation) and osteoporosis in female runners
  • Flat feet, high arches or other leg or foot abnormalities
  • Running on poor (hard) surfaces
  • Improper footwear
  • Tightness in the calf muscle


MTSS symptoms can worsen over time without rest. Early symptoms may pass faster with rest shortly after activity. As MTSS becomes more severe, symptoms will last longer even with rest. It will take longer for severe symptoms to resolve.

MTSS may cause:

  • Shin pain at a very specific point
  • Pain when running which gets more severe with continued exercise
  • Pain when bearing weight on the leg
  • Pain that is intensified by touching the affected area

Pain may be throbbing, aching, or sharp.


Your doctor will ask about your symptoms and medical history. A physical exam will be done. Diagnosis can be made on this information.

Imaging tests may be done to rule out other problems, such as a fracture . An x-ray or bone scan may be used to rule out damage to the bone.


Treatment focuses on comfort measures to reduce inflammation and ease pain. Rest is the main part of treatment. Ice, compression, and elevation may also be used during recovery.

Other treatment methods may include:

  • Medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Supportive devices, such as a brace or walking boot to stabilize the shin
  • Orthotics to correct any foot deformities that contribute to MTSS

Rarely, surgery may be needed if other treatment methods do not work. However, it is unknown if surgery is an effective treatment for MTSS.


To help reduce your chances of MTSS:

  • Wear proper footwear for the sport you play. Different athletic shoes have different functions.
  • Warm-up and cool down before and after exercising
  • When starting a new sport or increasing your workout, do so gradually
  • Vary your workout routine to avoid repetitive stress.
  • Do not continue exercising if you feel pain.
  • Wear orthotics as advised by your doctor.
  • Get prompt treatment for any injuries.


Ortho Info—American Academy of Orthopaedic Surgeons 

Sports Med—The American Orthopaedic Society for Sports Medicine 


The Canadian Orthopaedic Association 

Canadian Orthopaedic Foundation 


Shin pain. EBSCO DynaMed Plus website. Available at:  . Updated March 20, 2017. Accessed November 13, 2017.

Shin splints. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: Updated May 2012. Accessed November 13, 2017.

Shin splints. Merck Manual Professional Version website. Available at: Updated October 2014. Accessed November 13, 2017.

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