Ep 169 – Shin splints (medial tibial stress syndrome)

Shin splints are a common type of leg pain caused by repetitive stress on the bones and muscles in the lower leg, particularly around the tibia. The condition, also known as medial tibial stress syndrome (MTSS), is characterised by pain and tenderness along the inner or front of the lower leg. It is often triggered by activities like running, jumping or other high-impact sports. In this episode, Dr Roger Henderson looks at risk factors, how to diagnose it, typical treatment options and prognosis.

Key take-home points

• MTSS or shin splints is characterised by pain along the inner edge of the tibia, typically the distal two-thirds.
• This pain is related to repetitive stress loading of the tibial bone, resulting in a bony overload injury and inflammation of the periosteum.
• It is not a stress fracture but a precursor on the continuum of bone stress injury.
• Among runners, the incidence ranges from 13% to 20%.
• Risk factors include a BMI above 30 kg/m², excessive foot pronation, limited ankle plantar-flexion range of motion, increased hip external rotation, being female and having a prior history of shin splints.
• Diagnosis hinges primarily on taking a thorough history and doing a detailed physical examination.
• Patients typically report a dull, aching pain along the medial tibial border that is provoked by physical activity and relieved by rest. The pain usually develops gradually, initially surfacing after exercise and potentially progressing to persist during activity or even at rest in more severe cases.
• When severe, climbing stairs can also be painful.
• X-rays are often the initial imaging choice, but these may appear normal in early or moderate cases.
• If advanced imaging is needed, magnetic resonance imaging scanning is the preferred choice due to its high sensitivity for detecting periosteal and bone marrow oedema associated with bone stress injuries.
• Treatment remains largely conservative, focusing on modifying or reducing the physical activity that triggered the symptoms.
• There is no universally prescribed duration of rest, as the timeline for recovery varies significantly among individuals depending on severity, underlying biomechanics and compliance with therapy.
• The prognosis is generally excellent when recognised early and managed appropriately.

Key references

1. Cosca DD, Navazio F. Am Fam Physician. 2007;76(2):237-244.
2. Reinking MF, et al. Sports Health. 2017;9(3):252-261. doi: 10.1177/1941738116673299.
3. Winters M, et al. Sports Med. 2013;43(12):1315-33. doi: 10.1007/s40279-013-0087-0.
4. Yeung SS, et al. Cochrane Database Syst Rev. 2011:(7):CD001256. doi: 10.1002/14651858.CD001256.pub2.
5. Patel DS, et al. Am Fam Physician. 2011;83(1):39-46.