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Shin Pain in Runners: Medial Tibial Stress Syndrome

In the latest instalment of our posts on running related injuries we’re looking at one of the most common causes of lower leg pain in runners – Medial Tibial Stress Syndrome (MTSS), which falls under the umbrella term of ‘shin splints’.

Research suggests that MTSS has an incidence of between 13%- 20% in runners and can impact both on enjoyment of running as well as running performance and incur lost time from training and competition. MTSS develops as pain felt on the lower two thirds and inside of the lower shin. It is normally painful during, and sometimes after, running or less commonly walking. It normally settles within a couple of days but will often recur every time you try to run. It is likely to be tender to touch over the site of pain.

MTSS involves the muscles and fascial soft tissue on the inside of the tibia bone; it’s thought the repetitive biomechanical loads of running can cause these tissues to become painful as the capacity of muscles to deal with the strain is exceeded.

There are other causes of shin pain in runners which need to be excluded too: conditions such as bone stress/stress fracture and compartment pain can be serious and require careful management. It’s important to have your diagnosis confirmed by an experienced Physiotherapist or Sports physician before starting treatment.

There are a number of factors which can contribute to the onset of MTSS. A physiotherapy assessment can help identify which of these is most relevant for you which and will help to ensure the best treatment plan is put in place to get you back to running as quickly as possible with minimal risk of re-injury. Here are some of the risk factors to be considered:

Training volume

Sudden increases in the amount of running or the intensity of your running can increase the risk of MTSS. Rapid escalations in training volume is a risk factor for a multitude of repetitive strain injuries as tissues are unable to quickly adapt to the change in demand. Changes in the type of running (e.g; hill or speed work) can also pose problems if introduced too quickly.

Biomechanics - how you move

The inward movement of the foot in walking and running is controlled by the muscles on the inner lower leg. When your foot rolls inwards at high speed or an excessive amount it can cause the muscles to be overloaded and become painful. There are other mechanical features at the foot and ankle which can be related to MTSS. There is some evidence that the amount of hip rotation is a risk factor, particularly for male athletes, though more studies are required to confirm this.

Poor shock absorption capacity

There are key muscle groups in your leg that act as ‘shock absorbers’ for the ground reaction forces we experience when we run. Remember that these forces can be up to five times bodyweight so it’s essential these muscles have capacity to deal with that level of load.


Running in different footwear which is at odds with your individual foot and ankle biomechanics can cause various types of foot, ankle and knee problems.

The good news is that all these risk factors listed here can be influenced by various treatment strategies. Here are some of the things your Physiotherapist will consider as part of your treatment:

Evaluating your foot and ankle biomechanics can be helpful to ensure you have optimal movement qualities to minimise the risk of injury, whether it’s stability, mobility or strength. A physiotherapist can assess this and provide targeted exercise to address any deficits.

There are key muscle groups which can be strengthened to improve your ability to deal with the forces of running; your Physiotherapist can guide you on the best exercises to improve muscle strength qualities to improve force absorption and force generation.

They can also provide advice on footwear and insoles as well as guidance on managing your training type and volume to support your rehab and recovery and a successful return to sport and exercise. Modalities like taping and hands on soft tissue treatment can also be helpful in managing symptoms in the short term.

If you have a running related injury, get in touch here to arrange a comprehensive physiotherapy assessment.

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