Medial Tibial Stress Syndrome (MTSS)

What is Medial Tibial Stress Syndrome (MTSS)?

MTSS is inflammation of the membrane that surrounds the tibia bone. It is caused by unmanaged ground force that strains the connection, thus leading to micro or small tears. MTSS can be thought of as an early warning alarm for stress fractures, if you do not correct the issue causing MTSS now it will likely lead to the serious issue of stress fractures.


Pain on the interior portion of shin at onset of activity

Pain often subsides as activity continues but returns when activity ceases

Tenderness and/or minor swelling of inside of shin

Sensitivity to touch

In extreme cases, pain will not subside even after rest - this is a sign the problem has built into something worse such as stress fractures

Graphic showing where Medial Tibial Stress Syndrome (MTSS) is likely to occur.

Getting Tested

Testing for MTSS is fairly simple – a physician will take into consideration your medical history and perform a physical examination. This is often more than enough to determine if you are dealing with MTSS or something else. In some cases the physician may order an MRI or CT scan of the area in order to rule out other possibilities.


Treating MTSS comes down to rest and strengthening your legs to mitigate ground force. Compression also helps substantially with recovering from MTSS. Because MTSS is caused by overuse, but oddly tends to go away as activity continues, it can be one of the more frustrating and common reasons behind “shin splints”. Continuous mobility and range of motion work within your feet, ankles, and calves is also critical.

In extreme cases where MTSS becomes chronic, surgery to separate the periosteum from the inner side of the tibia may be required. This is not common.


Prevention is straightforward – manage your training volume and intensity. If you go too hard too fast, you are more likely to develop MTSS. You need to give your body adequate time to adapt to your training stimulous. Continue to work on strength and mobility/range of motion to ensure stronger and healthier legs so you can continue to adapt quickly and healthily.

Start Healing

This is an informational website. This is not a replacement for proper medical care and attention by a registered physician. Please contact a sports medicine doctor or qualified physiotherapist in your area to undergo proper testing and diagnosis for your specific issues.