The main complaint is a nagging, stabbing pain on the inside of the lower 1/3rd part of the tibia. This pain occurs with exertion, but as the severity of the injury increases, the pain can also occur after exertion or even at rest.
Medial tibial stress syndrome (MTSS) is one of the most common injuries among runners and military personnel. MTSS is also common among those who practice sports that involve a lot of jumping, such as volleyball, basketball and gymnastics.

The stability of the lower leg during standing, walking, and jumping is provided by an interplay of several muscle groups, including the deep calf muscle (m. soleus), the posterior shin muscle (m. tibialis posterior), and the long toe flexor (m. flexor digitorum). longus). These muscles attach to the inside of the tibia. According to one theory, overloading these muscles by pulling on the periosteum would cause irritation and inflammation of this outer layer of bone to which the muscles attach. A second theory is that the direct impact and torsional force the tibia is subjected to during running and jumping leads to a stress response of the bone. Probably both mechanisms play a role.

A number of underlying factors can contribute to the development of MTSS. The complaints can be the result of properties related to the body (= intrinsic), but environmental factors (= extrinsic) can also play a role. Often, not one factor is responsible for the development of the complaints, but a combination of several.


  • Flat feet and overpronation. Too much walking is done on the inside of the foot, causing the heel to tilt inwards. This creates a great stretch on the muscles on the inside of the lower leg, at the level of the attachment to the tibia
  • Leg length discrepancy. This gives an uneven load on the lower leg muscles, which can result in overload on one side
  • Too short or cramped calf muscles lead to a higher pulling force at the point of attachment of the muscles to the shin bone
  • Ankle problems. Instability puts greater demands on the calf muscles to correct the imbalance


  • Training on hard surfaces. A harder surface is accompanied by a greater shock load on the tissues. Muscles have to absorb this load, which creates great tensile forces on the bone, and the attachment site of the muscles to the bone
  • Sudden increase in training load (intensity and/or duration)
  • Insufficient warm-up, cool-down and too little attention to stretching exercises of the calf muscles
  • Substrate: a surface that is too hard or too soft (loose sand) or slippery can increase the load on the Achilles tendon
  • Wrong footwear: the stability of the shoe is mainly determined by the heel counter and the sole. The sole must suit the foot type, gait, gait and weight of the runner. The wrong shoe can lead to an incorrect settlement of the foot. Old, worn shoes are less stable, have less cushioning, and the gait is negatively affected by a crooked sole

Correcting intrinsic and extrinsic factors is a first step. For example, measuring insoles, adjusting footwear and surface.

Exercise therapy:
This includes stretches of the calf muscles and exercises aimed at improving the strength and stability of the foot and calf muscles.
The exercises should be performed once or twice a day. These can also be continued after the recovery of the injury, so that this injury is prevented in the future.
Cooling the shin with ice for 10-15 minutes after exercise can provide relief. This is best done by massaging an ice cube along the painful areas. Repeat the ice massage about 3 to 5 times a day.

Intensive massage aimed at reducing tension on the calf muscles also reduces the pull on the tibia membrane.

Shock wave therapy:
Recent research has shown that shock wave therapy can accelerate the healing of shin splints. The scientific evidence for this is still thin.

If the complaints keep coming back, an operative treatment can be chosen. The membrane that surrounds the muscles (muscle fascia) is split, so that the muscles have more space.

MTSS and sports
In the early stages of the injury, reducing the training load may be sufficient to heal an incipient injury. Think of reducing the training duration and (walking) speed. The condition can be maintained through alternative forms of training. In sports such as cycling, aqua jogging or stepping, the calf muscles and shin are less stressed.

Once the complaint has disappeared and the causal factors have been addressed, the original sports activities can be resumed. To prevent repetition, the training intensity should be built up slowly and within the pain threshold.

The risk of a shin splint can be reduced by paying attention to the following:
A good warm-up and cool-down reduce the chance of a shin splint. A full warm-up and cool-down can easily take 10 to 15 minutes.

The most common cause is exercising too much, too often, and too hard. This is a pitfall, especially at the start of the season or when returning from an injury. A good training structure is important, whereby the scope of the training is first expanded (the number of hours) and only then the intensity (intensive forms of exercise with a lot of running work). Avoid one-sided forms of training.

Due to its damping effect, forest soil is an ideal surface to walk on, especially when you are just starting to walk.

Choose sports shoes that are suitable for the personal running style and foot shape. Advice from the specialist shop can be valuable here. The average life of a sports shoe is 500 to 750 kilometers. After this, it quickly loses its shock-absorbing effect.

Even if you don’t have an injury, it can be helpful to strengthen the lower leg muscles and improve ankle stability.

Sometimes the body has certain shortcomings (think leg length discrepancy) that can cause an injury. When these are diagnosed and corrected in time, unnecessary injuries can be prevented.


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