Medial tibial stress syndrome

Medial tibial stress syndrome (MTSS) - commonly known as ‘‘shin splints” – is a frequent overuse injury or repetitive-stress injury of the lower extremity.

The condition is one of the most common causes of exertional leg pain in athletes, and usually presents as diffuse pain of the lower extremity, along the middle-distal tibia associated with exertion. Early courses of MTSS are characterized by pain that (i) gets worse at the beginning of exercise, (ii) gradually subsides during training, and (iii) stops within minutes after exercise. Later, pain may present with less activity and may even occur at rest.

Diagnosis is based on the clinical features of the disease. Diagnostic imaging should be considered to rule out other causes of exertional leg pain, or to establish the diagnosis of MTSS when in doubt.

The treatment of MTTS should start with rest and ice in the acute phase, followed by low-impact and cross-training exercises during rehabilitation and a modified training program (decreased intensity, frequency, and duration, regular stretching and strengthening exercises, wearing proper-fitting shoes with good shock absorption). Orthotics, manual therapy, injections and acupuncture may also help to alleviate the symptoms. Patients not responding to conservative treatment for six months should then be subjected to radial shock wave therapy (RSWT). Surgery should also be considered for recalcitrant cases of MTSS.