Shin Pain (Medial Tibial Stress Syndrome)

Medial tibial stress syndrome (MTSS), commonly known as “shin splints,” is a frequent injury of the inside of the shin bone and one of the most common causes of leg pain.

Often, the cause of MTSS is multi-factorial and can involve training errors and various biomechanical abnormalities.

The most common complaint of patients with MTSS is vague, diffuse pain of the lower leg, along the middle and end of the shine bone associated with exertion or activity.

In the early stages of MTSS, pain is worse at the beginning of the exercise and gradually settles during training and within minutes of starting of exercise. As the injury progresses, however, pain presents with less activity and may occur at rest.

Previously it was thought the cause of MTSS involved underlying inflammation (periostitis) of the connective tissue that surrounds shin bone  (tibia) due to tibial strain when under a load.

However, more recently new evidence indicates that there is a variety of causes including; tendinopathy, and dysfunction of the tendons and muscles that run behind the shin bone. (Tibialis posterior, Tibialis anterior, and Soleus muscles).

These have been shown to alter the load going through the tibia and as repeated loading occurs chronic, repetitive loads cause abnormal strain and bending of the tibia.