Medial Tibial Stress Syndrome

(MTSS; Shin Splints; Medial Distal Tibial Syndrome, MDTS; Medial Tibial Syndrome; Stress-Related Anterior Lower Leg Pain; Spike Soreness)


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

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