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Do you Suffer From Shin Splints? All About Medial Tibial Stress Syndrome aka "Shin Splints" From Dr. Paul Salinas

November 22, 2013

For those of you that have experienced Medial Tibial Stress Syndrome (MTSS), more commonly referred to as “Shin Splits”, you are aware of how debilitating this condition can be.  Initially the pain can impede performance, and ultimately lead to complete cessation from running.

MTSS is one of the most common conditions affecting long-distance runners.  Studies have demonstrated that it accounts for almost 20% of all running injuries.   It is a classified as an overuse syndrome, especially in runners and jumpers.
The pain associated with the condition occurs at the mid to lower part of the leg, either along the medial (middle) border of the shin bone (tibia), or right behind it.  The pain can vary in intensity, depending on the severity of the condition, and the amount of overuse that has occurred.

There is no exact known mechanism of injury.  The following factors have been shown to contribute to the onset of MTSS.

  • “Too Much, Too Fast”- Runners who increase the intensity, frequency or duration of training too quickly
  • Improper Running Form
  • Over-pronation
  • Structural or Postural issues
  • Core Weakness
  • Joint Dysfunction affecting the bones of the spine, pelvis/hips, knees, ankles and/or feet.
  • Poor/Worn-Out Footwear- Not changing running shoes after 250-500 miles or 6-months of use
  • Running on hard or uneven surfaces
  • Females are at greater risk, and irregular menses has been shown to be a risk-factor.
  • Poor Bone Density
  • Pain at the lower leg
  • Pain can occur during running, and can continue during rest
  • In more severe cases, symptoms may not be relieved by rest
  • Swelling in the leg

A comprehensive medical history and orthopedic evaluation are necessary to properly diagnose MTSS.  X-rays are commonly ordered first, but MRIs are considered to be the best way of diagnosing the condition, and ruling out other more serious conditions that affect the lower leg.  **Always consult your doctor if you experience pain during or after running.

Research has shown that resting is one of the most effective ways to relieve the pain associated with MTSS.  Ice can also help relieve symptoms.  In order to return to activity, the biomechanical running errors, structural/postural issues, as well as other training flaws must be addressed to reduce the risk of a flare-up.
Once you are diagnosed by a Sports Medicine Specialist, a course of physiotherapy by a Sports Chiropractor or Physical Therapist that specializes in running injuries, can help you properly return to training.  
Also, you should consider working with an experienced running coach that can help your improve your running form.


Dr. Paul Salinas is a New York City (NYC) based sports chiropractor.  He specializes in the prevention and treatment of sports-related injuries.  He patients range from amateur to professional levels in a variety of different sports.  If you’d like to learn more about sports injuries, please visit his website at, or follow him on twitter


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