Medial tibial stress syndrome

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Name Tissue Type of pathologies
Acute and chronic muscle aches and pain Muscle Pain management
Acute and chronic cervical and lumbar pain Muscle Idiopathic cervical and low back pain
Acute and chronic soft tissue wounds Skin Wounds
Adhesive capsulitis Joint Capsulitis
Calcifying tendinitis of the shoulder Tendons Tendinopathy
Cellulite Skin Cellulite
Chronic distal biceps tendinopathy Tendons Tendinopathy
Chronic proximal hamstring tendinopathy Tendons Tendinopathy
Diseases secondary to trigger points and myofascial Pain Muscle Myofascial pain syndrome
Golfer’s elbow Tendons Tendinopathy
Greater trochanteric pain syndrome Tendons Tendinopathy
Insertional Achilles tendinopathy Tendons Tendinopathy
Knee osteoarthritis Joint Osteoarthritis
Medial tibial stress syndrome Tendons Tendinopathy
Mid-body Achilles tendinopathy Tendons Tendinopathy
Osgood-Schlatter disease Bone Disturbance of musculoskeletal development
Patella tip syndrome Tendons Tendinopathy
Plantar fasciopathy Tendons Tendinopathy
Primary and secondary lymphedema Skin Lymphedema
Primary long bicipital tenosynovitis Tendons Tendinitis
Proliferative connective tissue disorders Connective tissue Fibrosis
Spasticity Central nervous system Cerebral palsy and stroke
Stress fractures Bone Fracture
Subacromial pain syndrome Tendons Tendinopathy
Superficial nonunions Bone Fracture
Tennis elbow Tendons Tendinopathy
Trigger points Muscle Myofascial pain syndrome


Medial tibial stress syndrome (MTSS) – commonly known as ‘‘shin splints” – is a frequent overuse injury or repetitive-stress injury of the lower extremity.

The condition is one of the most common causes of exertional leg pain in athletes, and usually presents as diffuse pain of the lower extremity, along the middle-distal tibia associated with exertion. Early courses of MTSS are characterized by pain that (i) gets worse at the beginning of exercise, (ii) gradually subsides during training, and (iii) stops within minutes after exercise. Later, pain may present with less activity and may even occur at rest.

Diagnosis is based on the clinical features of the disease. Diagnostic imaging should be considered to rule out other causes of exertional leg pain, or to establish the diagnosis of MTSS when in doubt.

Training errors (“too much, too fast”) appear to be the most common factors involved in MTSS. The condition is most often found in runners, soccer and basketball players, and in dancers. Notably MTSS is almost always associated with biomechanical abnormalities of the lower extremity including knee abnormalities, tibial torsion, femoral anteversion, foot arch abnormalities or a leg-length discrepancy. However, improper footwear (including worn-out shoes) can also contribute to shin splints. A variety of tibial stress injuries can be involved in MTSS including tendinopathy, periostitis, and dysfunction of the tibialis posterior, tibialis anterior and soleus muscles. Women appear to be more affected than men, and have an approximately threefold risk for progression to stress fractures.

The treatment of MTTS should start with rest and ice in the acute phase, followed by low-impact and cross-training exercises during rehabilitation and a modified training program (decreased intensity, frequency, and duration, regular stretching and strengthening exercises, wearing proper-fitting shoes with good shock absorption). Orthotics, manual therapy, injections and acupuncture may also help to alleviate the symptoms. Patients not responding to conservative treatment for six months should then be subjected to radial shock wave therapy (RSWT). Surgery should also be considered for recalcitrant cases of MTSS.



Rompe et al., Am J Sports Med 2010;38:125-132

Low-energy extracorporeal shock wave as a treatment for medial tibial stress syndrome.



Number of treatment sessions 3 to 5
Interval between two sessions 1 week
Air pressure Evo Blue® 2.5 to 4 bar
Air pressure Power+ 2 to 4 bar
Impulses 2000 - 3000 on the painful spot
Frequency 8Hz to 12Hz
Applicator 15mm
Skin pressure Light to moderate

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