Medial tibial stress syndrome: Addressing shin pain in athletes

What are the primary causes and treatment strategies for medial tibial stress syndrome (MTSS)?

Medial Tibial Stress Syndrome (MTSS), often misidentified as “shin splints,” is a repetitive stress injury that affects the deep posterior compartment of the lower leg. It typically presents as pain along the medial tibia and results from excessive strain on the tibialis posterior muscle and its attachment to the crural fascia. Contributing factors include overuse, improper biomechanics, inadequate warm-up, and environmental considerations such as hard running surfaces or worn-out footwear.

Treatment should focus on reducing tension in the deep posterior compartment. A primary strategy is warming up the gastrocnemius and soleus before working deeper into the tibialis posterior. Active release techniques and stretching, especially those that incorporate movement to target fascial adhesions, can help restore function. Given the fascial involvement, gentle myofascial release is also effective in alleviating strain. It is essential to rule out stress fractures before performing manual therapy and to educate athletes on proper footwear and training progression to prevent recurrence.

This Ask the Expert is an edited excerpt from the course, "Common Sports-Related Injuries: Lower Extremity," presented by Portia Resnick, PhD, ATC, BCTMB.