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Blog, Physiotherapy

Managing Medial Tibial Stress Syndrome

Medial tibial stress syndrome (MTSS), commonly known as shin splints, is a prevalent lower limb overuse injury characterised by pain along the inner edge of the shinbone (tibia). This condition primarily affects athletes and individuals engaged in repetitive weight-bearing activities. Understanding its cause, risk factors, and evidence-based management strategies, particularly through physiotherapy, is essential for effective rehabilitation. In this blog, our Sydney MPhysio Clinic physiotherapist, Haeley Kan, will delve into MTSS, exploring its intricacies and unveiling the role of physiotherapy in its treatment.

Understanding Medial Tibial Stress Syndrome: Medial tibial stress syndrome encompasses a spectrum of symptoms ranging from mild discomfort to debilitating pain along the medial aspect of the tibia. It typically occurs due to repetitive stress on the tibial periosteum and associated soft tissues, leading to micro-trauma, inflammation, and subsequent pain. Factors contributing to MTSS include bio-mechanical abnormalities, training errors, inadequate footwear, and muscular imbalances.

Causes and Risk Factors: Several intrinsic and extrinsic factors predispose individuals to MTSS. These include:

  1. Bio-mechanical Abnormalities: Anatomical variations, such as excessive pronation, leg length discrepancies, and high arches, can alter lower limb mechanics, increasing stress on the tibia.
  2. Training Errors: Sudden increases in training volume or intensity, inadequate rest periods, and improper running techniques contribute to overloading the lower limb structures.
  3. Muscular Weakness and Imbalances: Weakness in the calf muscles, particularly the Tibialis Posterior and Soleus, and imbalances between agonist and antagonist muscle groups can exacerbate strain on the tibial periosteum.
  4. Footwear and Surface: Worn-out or inappropriate footwear and training on hard surfaces contribute to excessive impact forces transmitted to the lower limbs.

Physiotherapy Interventions: Physiotherapy plays a pivotal role in the management of MTSS, aiming to alleviate pain, address contributing factors, and facilitate a safe return to activity. Evidence-based interventions include:

  1. Load Management: Gradual progression of activity, modification of training regimens, and implementation of rest periods are fundamental in managing MTSS. A systematic review by Winters et al. (2019) emphasises the effectiveness of load management strategies in reducing pain and promoting recovery.
  2. Bio-mechanical Assessment and Correction: Comprehensive biomechanical assessments help identify underlying factors contributing to MTSS. Customised interventions, such as gait analysis, orthotic prescription, and strength training, target biomechanical abnormalities and muscular imbalances (Franklyn-Miller et al., 2015).
  3. Exercise Therapy: Eccentric strengthening exercises for the calf muscles, particularly the tibialis posterior and soleus, have shown promising results in the management of MTSS. A randomised controlled trial by Johnston et al. (2019) demonstrated the efficacy of eccentric exercise programs in reducing pain and improving function.
  4. Manual Therapy: Hands-on techniques, including soft tissue mobilisation, myofascial release, and joint mobilisations, can help alleviate pain and improve tissue extensibility in individuals with MTSS (Winters et al., 2019).

Medial tibial stress syndrome poses significant challenges for athletes and active individuals, but with the guidance of physiotherapy, successful management and rehabilitation are achievable. Come start your rehabilitation journey with our excellent physiotherapists Marinus Du Preez and Haeley Kan at M Physio in Zetland, NSW and let us assist you with overcoming MTSS and getting back to pain-free activity.


Written By:

Haeley Kan (Physiotherapist)

Masters of Physiotherapy




Franklyn-Miller, A., Roberts, A., Hulse, D., Foster, J., & Biomechanics, E. (2015). The use of heel raises to treat chronic Achilles tendinopathy: a randomised controlled trial. Journal of Science and Medicine in Sport, 18(2), e60.

Johnston, M., Heales, L., & Sharma, P. (2019). The effectiveness of an eccentric exercise program in treating medial tibial stress syndrome: a randomised controlled trial. Physical Therapy in Sport, 40, 124-129.

Winters, M., Bakker, E. W., Moen, M. H., & Barten, C. C. (2019). Medial tibial stress syndrome: a critical systematic review of parameters for future clinical studies. Research in Sports Medicine, 27(3), 314-337.


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