Medial Tibial Stress Syndrome


  • “Shin Splints”
  • More common in runners or running sports such as football, hockey and rugby.
  • An overuse injury to the legs due to increasing training intensity too quickly, harder grounds or insufficient rest.
  • Poor running technique, inappropriate shoes or poor lower limb function can contribute to the condition.
  • There is some evidence that increased rotational forces within the tibia can contribute.

Diagnostic tips

  1. Starts as an ache in the leg during activity or the day after.
  2. Speed of onset, duration and intensity of symptoms gradually increases.
  3. The time it takes to settle after exercise gradually becomes longer and exercise itself may not be possible.
  4. Symptoms are generally on the inside of the lower leg.
  5. Swelling or even redness noted in the front of the shins.
  6. Tight calf muscles.

Tests and Imaging

  1. Clinical examination and a detailed history allow diagnosis.
  2. X-rays of the lower leg may be indicated to rule out any obvious stress fracture (in most instances these x-rays will be negative).
  3. Ultrasound scan or MRI scan can help diagnosis if necessary.
  4. Bone scans can be used (but have generally been replaced by MRI scans).

Immediate Treatment

  1. Analgesia
  2. Advise appropriate shoes.
  3. Reduce activity

Possible Referral

  1. Podiatry for biomechanical assessment, footwear advice, orthotics, stretching/strengthening.
  2. Orthopedic surgery may be required to release the soft tissues from the underlying bone.