Medial Tibial Stress Syndrome (Shin Splints): Causes, Symptoms & Recovery Through Movement

Medial Tibial Stress Syndrome, more commonly known as shin splints, is one of the most frequent complaints in runners, dancers, and anyone involved in high-impact activities. It’s frustrating, persistent, and, if not managed correctly, can become a long-term issue that interferes with your movement goals.

In this blog, we’ll break down what causes MTSS, how to identify it, and most importantly, what you can do to recover and stay injury-free through smart rehab and movement strategies.

What is MTSS?

MTSS is an overuse injury that affects the inner border of the tibia (shin bone). It’s typically the result of repetitive stress or load that exceeds the body’s capacity to adapt, often made worse by poor biomechanics, training errors, or insufficient recovery.

Causes of MTSS

MTSS can arise from several interrelated factors:

• Overuse or rapid increases in training load (e.g. sudden jump in running distance or frequency)

• Poor foot mechanics- flat feet, overpronation, or lack of shock absorption

• Weakness or tightness in the lower leg muscles, especially the soleus, tibialis posterior, and foot intrinsics

• Hard training surfaces- concrete or asphalt increase ground reaction forces

• Inadequate footwear- old, unsupportive, or inappropriate for your foot type

Common Symptoms

• Dull, aching pain along the inner side of the tibia, often the lower two-thirds

• Tenderness on palpation of the shin bone

• Pain during or after running/jumping activities

• In early stages, pain may ease with warm-up but worsens post-activity

• In more chronic cases, pain can persist even at rest

Note: If pain becomes sharp, localized, and doesn’t improve with rest, it may be a sign of a tibial stress fracture, get assessed promptly.

Rehabilitation Plan: Restore, Rebuild, Prevent

A successful rehab plan for MTSS should reduce pain, correct imbalances, and gradually reintroduce loading to build tolerance.

Phase 1: Settle the Symptoms

Goals:

• Decrease inflammation and pain

• Modify load

• Begin gentle mobility work

Plan:

• Relative rest: Swap running for low-impact options (cycling, swimming, elliptical)

• Ice massage (5-10 min) along the tibia post-activity

• Calf & foot releases using massage ball or foam roller

• Supportive footwear or orthotics if needed to reduce pronation

• Gentle soleus & gastroc stretching (hold 30 sec x 2–3)

Phase 2: Rebuild Strength & Control

Goals:

• Strengthen key muscle groups

• Improve foot and ankle stability

• Enhance movement control

Plan:

1. Foot Intrinsics Activation

   • Towel scrunches or short foot exercise

   • 2 sets of 10-15 reps

2. Tibialis Posterior Strengthening

   • Resistance band foot inversion (keep heel planted)

   • 3 sets of 10-12 reps

3. Soleus Strength

   • Bent-knee heel raises (double then single leg)

   • 3 sets of 15 reps

4. Hip & Core Control

   • Glute bridges, side planks, and clamshells

   • Build up to 3 sets of 10-15

5. Balance Work

   • Single-leg balance with eyes open/closed

   • Add dynamic elements (toe taps, reach outs)

Phase 3: Return to Running & Reinjury Prevention

Goals:

• Reintroduce impact gradually

• Improve tissue load tolerance

• Maintain long-term mobility and strength

Plan:

1. Plyometric Progression

   • Start with line hops, progress to skipping and jump squats

   • 2-3 times per week, low volume initially

2. Running Reload

   • Use a return-to-run walk/run program

   • Increase distance <10% per week

3. Ongoing Strength Maintenance

   • Include 1-2 strength sessions weekly (focusing on lower limb and core)

   • Include calf raises, balance drills, and foot control exercises

4. Mobility & Recovery

   • Continue with foam rolling, stretching, and active recovery days

Final Thoughts: Movement is Medicine

MTSS can feel limiting, but it’s also an opportunity to tune into your body and build resilience. By addressing the root causes, whether that’s muscle imbalances, overuse, or biomechanical faults, you can not only recover, but come back stronger than before.

As always, if you're unsure where to begin or want a tailored plan, reach out. A Myotherapy assessment can help identify the specific drivers behind your pain and fast-track your recovery.

Do you need help overcoming shin splints? Book a session and let’s get you moving better, pain-free.