Medial tibial stress syndrome (MTSS), commonly known as “shin splints,” involves a bone stress response along the posteromedial border of the tibia — the inner back edge of the shin bone. Repetitive loading causes microscopic fatigue damage to accumulate within the tibial cortex faster than the bone can remodel and recover. This leads to periosteal irritation and bone stress, producing diffuse pain along the inner shin.
MTSS is distinct from a stress fracture, where the same process progresses to a discrete crack within the bone cortex. However, both conditions exist on the same injury spectrum, and poorly managed MTSS can increase the risk of developing a tibial stress fracture.
Training load errors are the most common cause:
Sudden increases in weekly running mileage
Starting running from a low baseline or returning after a prolonged break
Transitioning rapidly to harder running surfaces, such as road or track running
Switching too quickly to minimalist footwear
Biomechanical contributors:
Foot overpronation: Excessive inward rolling of the foot during loading increases rotational stress through the tibia and is one of the strongest recognised risk factors for MTSS
Hip abductor weakness: Can contribute to altered lower limb mechanics and increased tibial loading
Reduced ankle dorsiflexion: Limited ankle mobility increases stress through the shin during running
Lower running cadence: Fewer steps per minute can increase impact forces with each foot strike
Navicular drop: Excessive collapse of the midfoot during loading
Individual factors:
Female sex, partly due to hormonal influences on bone health
Reduced bone mineral density
Higher body mass index
Low energy availability or insufficient caloric intake, particularly in athletes
Previous history of MTSS
Medial tibial stress syndrome (MTSS), commonly known as “shin splints,” involves a bone stress response along the posteromedial border of the tibia — the inner back edge of the shin bone. Repetitive loading causes microscopic fatigue damage to accumulate within the tibial cortex faster than the bone can remodel and recover. This leads to periosteal irritation and bone stress, producing diffuse pain along the inner shin.
MTSS is distinct from a stress fracture, where the same process progresses to a discrete crack within the bone cortex. However, both conditions exist on the same injury spectrum, and poorly managed MTSS can increase the risk of developing a tibial stress fracture.
Training load errors are the most common cause:
Biomechanical contributors:
Individual factors:
Female sex, partly due to hormonal influences on bone health
Reduced bone mineral density
Higher body mass index
Low energy availability or insufficient caloric intake, particularly in athletes
Previous history of MTSS
LPAW’s clinical team includes 19 practitioners, many holding postgraduate qualifications from UCL, King’s College London, and Guy’s and St Thomas’. Lead clinician Mr Arjun Viswanath MSc, MCSP, MPPA – Co-Founder and Consultant Physiotherapist – brings 25+ years of NHS and private experience including BMI London Independent Hospital and Harley Street.
Every clinician joining LPAW completes a mandatory intensive shadowing placement with our Consultant Physiotherapist before seeing patients independently. This is not a standard practice at most clinics – it’s our way of maintaining clinical consistency across the team.
Most back pain is benign and responds to physiotherapy. However, certain features require urgent medical assessment. Seek immediate medical attention if you experience:
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