Medial Tibial Stress Syndrome



MTSS happens when muscles and tendons over the shin become irritated and inflamed. It is caused by a sudden increase in activity levels.

Risk Factors

This problem is more common in people who do repetitive, high-impact activities, such as:

  • Running
  • Basketball
  • Dancing
  • Gymnastics
  • Military training

Other things that may raise the risk are:

  • Increasing activity levels too quickly
  • Flat feet or stiff arches
  • Poor footwear



The main problem is sharp or dull pain along the shinbone. Other problems may be:

  • Swelling
  • Pain during and after activity
  • Pain when touching the shin


The doctor will ask about your symptoms and health history. A physical exam will be done. It will focus on the shin. This is often enough to make the diagnosis.

Images of the shin may be taken to check for other problems. This can be done with:

  • X-rays
  • MRI scan
  • Bone scan



The goal of treatment is to manage symptoms and promote healing. Rest will be needed for several weeks. Other choices are:

  • Supportive care, such as cold packs, bandages, and elevating the leg
  • Medicines to ease pain and swelling
  • Supportive shoes, a brace, or a walking boot to take pressure off the shin as it heals
  • Physical therapy to help with strength, flexibility, and range of motion in the lower leg

People who do not get better with these methods may need surgery. This is not common.


The risk of this problem may be lowered by:

  • Slowly increasing physical activities
  • Wearing proper footwear for sports and activities

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Edits to original content made by Denver Health.