4-35% in runners and military population.


  1. Shin splints is the commonest term used for MTSS, the pain along the inner side of the lower 2/3rd of the leg.
  2. Causes can be high impact or repetitive loading activities like jumping or running.
  3. It is a syndrome that includes multiple causative factors like weak or tight hip and calf muscles, tight lumbar paraspinals, weak lower abdominals, and hip flexors. All these changes lead to altered biomechanics loading the bone thereby leading to a stress reaction leading to a stress fracture.
  4. The main symptom is dull pain at the distal 2/3rd of the leg. It is generally activity-dependent. Pain on palpation is typically present following activity for few days.
  5. The most common complication following MTSS is a stress fracture of the tibia due to continuous micro trauma on bone caused by loading activities.
  6. MRI or Ultrasonography can be used to rule out a stress fracture.


  • Load management is the key to resolving this syndrome
  • To reduce high impact activity and to continue low impact activity and strengthening of the kinetic chain.
  • Icing
  • Dynamic or Kinesio taping to offload tibialis posterior muscle.
  • Release / dry needling for tight and fatigue calf and hip muscles.
  • Strengthening of lower abdominals, hip flexor, and extensor muscles.
  • Proprioceptive and balance training.

A functional fitness training regime needs to be followed to prevent re-injury

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