What is Medial Tibial Stress Syndrome (Shin Splints)? Medial tibial stress syndrome (MTSS), more commonly known as shin splints, is an exercise-induced pain that occurs in the lower leg. MTSS commonly occurs in athletes who participate in sports that involve excessive running or impact activities. It is even more common to see the onset of MTSS with an abrupt increase or change in training without proper initiation or progression of such activity. Pain usually is located over the tibia (shin bone) during and following exercise due to the overexertion of the muscles and tendons of the lower leg. It is often due to inflammation of the outside covering of the bone (known as periosteum). This inflammation causes pain over the tibia during activity and to touch. Normally, if recognized and treated in a timely manner, conservative treatment involving rest and rehabilitation will relieve the symptoms of MTSS and allow the athlete to return to sport without shin pain. Unfortunately, it is not uncommon for “shin pain” to be ignored amongst coaches and athletes. If ignored, MTSS can progress from inflammation of the lining of the bone, to a stress fracture of the tibia (shin bone); therefore, appropriate and timely recognition and treatment of MTSS is important for preventing further injury. Causes Overuse injury due to repetitive microtrauma to the lower leg – Often caused by repetitive running Repetitive pulling of muscles and tendons that attach to the tibia lead to inflammation of the periosteum Abrupt, improper increase in training Improper shoe wear Signs and Symptoms Pain over the front portion of the shin Deep pain and ache feeling during and following activity; normally relieved by rest If severe, pain may continue with activities of daily living Normally no swelling or bruising is seen over area of pain Treatment Conservative treatment includes rest from aggravating activity – For alternative activity, initiate low impact activities such as swimming or biking Stretching of the lower extremity is common; with the decrease of pain and symptoms, light strengthening of the surrounding lower leg musculature is recommended Utilize anti-inflammatories as needed to decrease pain Once pain decreases (with activities of daily living), progression of light aerobic exercises may be introduced with a slow, pain-free progression back into sport If symptoms return during this progression, decrease amount and intensity of activity for several days and then continue the gradual progression If symptoms are ignored, and no rest or rehabilitation is done, symptoms may progress to more constant, focal pain with all activities, which may be indicative of a stress fracture. Stress fractures require longer, strict time off from exercise and sport. Stress fractures may require the use of a walking boot or crutches if symptoms do not subside with rest.