Medial Tibial Stress Syndrome


Medial tibial stress syndrome (MTSS) is exercise-related pain in the shins. It may be caused by an irritation of the tendons and muscles near the shin bones. MTSS is commonly known as shin splints. This injury is most often seen among runners.

Muscle and Bones of Lower Leg
lower leg compartment
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MTSS is a treatable condition. Contact your doctor if you think you may have MTSS.


The exact cause is unknown. MTSS is called an overuse injury. It most commonly occurs from repetitive motion or stress at the shins. Causes may include:

Risk Factors

Factors that may increase your chance of MTSS include:

  • Participation in repetitive, high-impact sports:
    • Running
    • Gymnastics
    • Basketball
    • Racquet sports
  • Military recruits
  • Female runners with amenorrhea (absent menstruation) and osteoporosis
  • Pronation of feet (feet turn inwards), or other leg or foot abnormalities
  • Poor (hard) running surfaces
  • Poor footwear
  • Overtraining or recent increase in workout or miles run
  • Heel cord tightness


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 after changing workout intensity or running surface
  • Symptoms may not go away with rest
  • Swelling


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

You may be referred to a specialist. For example, a sports medicine physician focuses on sport injuries.


MTSS is treated with:

  • Rest
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Ice
  • Crutches may be given for severe pain
  • Arch supports and shock-absorbing insoles may be recommended
  • When you feel better, slowly return to normal activities—increase your activity level slowly over several weeks

Your doctor may suggest a different pair of shoes . A brace or walking boot may also be needed.


To help reduce your chance of MTSS:

  • Wear shock-absorbing insoles when running or during other high-impact exercise
  • Stretch before and after exercising
  • When starting a new sport or increasing your workout, do so gradually
  • Choose footwear that is best for the activity and your foot
  • Cross train


Please note, not all procedures included in this resource library are available at Allegiance Health or performed by Allegiance Health physicians.

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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A 10-minute walk, 5 minutes on the stairs and 15 minutes of cleaning and vacuuming all count toward your goal of 30-minutes of daily exercise.