Shin splints, also known as medial tibial stress syndrome, are a rare condition that causes pain on the inside of the shin of the lower leg. MTSS is commonly referred to as “shin splints” due to the location of pain over the shin bone. Pain can be felt on the inside or the front of the shin bone and is actually one of the most common athletic injuries. It affects both the muscle on the inside of the shin and the bone to which it attaches, causing the connection between them to become irritated or even develop minor tears due to overuse. MTSS may affect athletes who run and jump, such as distance runners, sprinters, gymnasts, basketball or tennis players. Also, military personnel, dancer, and other active people can develop MTSS. Physical therapists can help individuals who develop MTSS to recover pain-free movement and learn exercises to prevent re-injury.

Medial tibial stress syndrome can develop when too much stress is placed on the tibia. The muscles that attach to the tibia can cause an overload of stress on the bone, and strain themselves at their insertion onto the bone as well. These muscles include the posterior tibialis muscle, the soleus muscle, and the flexor digitorum longus muscle.

The most common risk factors of MTSS include:

• Flattening of the arch of the foot when weight bearing (such as standing, walking, and running).
• Participation in a sport that requires repetitive jumping and/or running.
• Excessive hip range of motion.
• A previous running injury.

How do I know if I have MTSS?

If you have developed MTSS, you may feel pain in the middle or bottom third of the inside of the shin. The pain may be sharp when touching the tender area or occur as an ache during or after exercise. Typically, the pain is initially provoked with activity and decreases with rest. However, when MTSS is developing, the pain may be present during the beginning of exercise and less noticeable as exercise continues. Over time, the condition can worsen, leading to pain throughout any exercise regimen and continue after exercise.

What can a physical therapist do for MTSS?

• Teach you modifications to the leg and foot in order to better control biometrics during take-off and landing tasks.
• Suggest proper footwear that provides adequate support when exercising.
• Prescribe orthotics or shoe inserts that support the arch of the foot better if your feet flatten out too much, or if your foot muscles are weak.
• Help educate athletes with MTSS to alter their training schedules to safely return to the sport and offer specific guidance for reducing the possibility of re-injury as well as ensuring maximal strength in order to prevent re-occurrence of MTSS.

A physical therapist can determine what risk factors have caused your MTSS and will teach you how to address and modify those causes. An individualized treatment plan will be developed for you that focuses on what your body needs to recover and to prevent re-injury. Physical therapy treatment will focus on receiving pain, stretching tight muscles, and strengthening weak muscles. Pain relief will be obtained by resting appropriately and avoiding aggravating activities or exercise. Modalities such as taping the arch of the foot and soft tissue massage to the injured tissue may aid in pain relief as well. Strengthening the hip musculature will help decrease the stress placed on the lower leg. Also strengthening the arch of the foot as well as the lower leg muscles will decrease flattening of the arch, also known as over-pronation. Furthermore, stretching all the tight muscles around the ankle and shin bone will increase the ability of the muscles to absorb shock during exercise.