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Shin splints

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits- frequently due to overuse.

  • believed to be the result of traction of tibialis posterior muscle origin on the interosseous membrane and tibia
  • characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, most often on the medial border near the junction of the mid and distal thirds of the tibia

Several intrinsic risk factors for MTSS have been identified:

  • hyperpronation, body mass index, female sex, hip internal/external rotation, and hyperplantarflexion


  • may be periostitis of the tibia due to tibial strain, but other evidence points toward a spectrum of tibial stress injuries contributing to MTSS: periostitis, tendinopathy, and stress reaction of the tibia, as well as dysfunction of the tibialis posterior, tibialis anterior, and soleus muscles

Magnetic Resonance Imaging and Bone Scan

  • radiograph results are normal with MTSS
  • magnetic resonance imaging (MRI) and bone scans usually show abnormally high signal along the posterior medial tibial surface or the classic train-track appearance of nucleotide uptake on a nuclear medicine bone scan
    • MRI useful to exclude a possible tibial stress fracture - more sensitive and specific than computed tomography or bone scan for diagnosing stress fractures of the tibia


  • Moen MH, Tol JL, Weir A, Steunebrink M, De Winter TC. Medial tibial stress syndrome: a critical review. Sports Med. 2009;39:523-546.

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