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Shin Splints (Medial Tibial Stress Syndrome)

What is Shin Splints (Medial Tibial Stress Syndrome)?

Medial tibial stress syndrome develops when too much stress is placed on the tibia (main shin bone). The muscles that attach to the tibia can cause an overload of stress on the bone. 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 while standing (over-pronation)
Being an athlete who participates in repetitive jumping and/or running
Being female
Excessive hip range of motion
Smaller calf girth in males
A high body mass index (>20.2)

How Does it Feel?

You may have MTSS if you feel pain in the middle or bottom third of the inside of the shin. The pain may be sharp when you touch the tender area, or occur as an ache during or after exercise. When MTSS is developing, the pain may be present during the beginning of exercise and less noticeable as exercise progresses. Over time the condition can worsen and pain may be felt throughout any exercise regimen, and it also may continue after exercise.

How Is It Diagnosed?

Your physical therapist will perform a thorough evaluation and take your health history. Your therapist will assess your overall strength, mobility, flexibility, and your walking and running movements. Your physical therapist will apply gentle pressure to the shin, ankle, and foot areas to diagnose MTSS. The most reliable symptom of MTSS is pain felt when pressure is applied to certain parts of the shin.

How Can a Physical Therapist Help?

Your physical therapist will determine what risk factors have caused your MTSS and will teach you how to address those causes. A treatment plan will be developed that is specific to you and what your body needs to recover and to prevent reinjury.

To relieve pain, your physical therapist may prescribe:

Rest from the aggravating activity or exercise
Icing the tender area for 5-10 minutes, 1-3 times a day
Exercises to gently stretch the muscles around the shin
Taping the arch of the foot or the affected leg muscles
Hands-on massage of the injured tissue

To help strengthen weak muscles, your physical therapist may prescribe:

Exercises that increase hip rotation, abduction (lifting the leg away from the other leg), and extension (lifting the leg behind your body) to decrease stress to the lower leg
Exercises that increase your arch and shin muscle strength to decrease the overpronation (flattening out) of the arch of the foot

Your physical therapist may also prescribe:

Calf and foot muscle stretches
Single-leg exercises including squats, reaching exercises, or heel raises
Modified take off and landing techniques for jumping athletes
Modified leg and foot control during walking and running
New footwear to provide better support when walking or exercising
Your physical therapist may also prescribe orthotics or shoe inserts that support the arch of the foot if your feet flatten out too much, or if your foot muscles are weak.

Can this Injury or Condition be Prevented?

Physical therapists recommend that to prevent MTSS you should:

Get an annual functional fitness examination, including strength, flexibility, mobility, and sport-specific analyses
Perform dynamic stretches before exercising and static stretches after exercise
Perform strength and endurance exercises for the foot, hip, and pelvic muscles
Perform balance exercises on each leg
Follow a recommended training program when starting or progressing your exercise program
Your physical therapist can teach you all of these exercises to ensure maximum strength and health, and prevent MTSS.

Real Life Experiences

John is a 35-year-old recreational runner who is training for his third half-marathon. John begins to feel shin pain in both legs during the first mile of his runs, which goes away during the remaining miles. Over the next few days, the pain lasts longer during his run. Concerned that he might be injuring himself, John contacts his physical therapist.

John’s physical therapist conducts a thorough examination to assess his pelvic, trunk, hip, leg, foot, and ankle strength. She asks him to try to hold test positions as she applies pressure to different areas. John can’t hold his position when she applies pressure to the hip area. During further tests, John demonstrates excessive flattening of each of his feet, and his knees show weakness. John’s physical therapist applies pressure to the muscles surrounding the shins and reproduces pain over the muscles on the lower one-third of the inside of the shin on each leg. She diagnoses MTSS in both legs.

She prescribes massage for the painful area in both shins, and teaches John strengthening exercises for the hip and foot muscles. She shows him how to apply ice to the painful areas for 5-10 minutes, 1-3 times a day. She recommends that he modify his training program to run fewer overall miles, and prescribes a change in footwear for better support and cushioning.

Since John sought help when his symptoms began, after two weeks of treatment his pain is much less, and he is slowly rebuilding his training program back to its former level. He continues his prescribed exercise regimen and his physical therapy treatments. The following month, John competes pain free in the half-marathon, and is proud of his finishing time!


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