The diagnosis and management of medial tibial stress syndrome

An evidence update
  • Marinus WintersEmail author


Medial tibial stress syndrome is a common overuse injury in jumping and running athletes. It is defined as exercise-induced pain along the distal posteromedial border of the tibia and the presence of recognisable pain on palpation over a length of 5 or more centimetres. This overview article provides an evidence update on the diagnosis and management of athletes with medial tibial stress syndrome.


Medial tibial stress syndrome Shin splints Diagnosis Treatment Management 

Diagnostik und Therapie des Schienbeinkantensyndroms

Update zur Studienlage


Das Schienbeinkantensyndrom ist eine häufige Verletzung durch Überbeanspruchung bei Sportlern, die springen und laufen. Definiert ist es durch belastungsinduzierten Schmerz entlang des distalen posteromedialen Rands der Tibia und durch das Vorliegen eines erkennbaren Schmerzes bei Palpation über eine Länge von mindestens 5 cm. In der vorliegenden Übersichtsarbeit wird die aktuelle Studienlage zu Diagnostik und Management bei Sportlern mit Schienbeinkantensyndrom beschrieben.


Schienbeinkantensyndrom „Shin splints“ Diagnose Behandlung Management 


Compliance with ethical guidelines

Conflict of interest

M. Winters declares that he has no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

The supplement containing this article is not sponsored by the industry.


  1. 1.
    Moen MH, Tol JL, Weir A et al (2009) Medial tibial stress syndrome: a critical review. Sports Med 39:523–546CrossRefGoogle Scholar
  2. 2.
    Mulvad B, Nielsen RO, Lind M, Ramskov D (2018) Diagnoses and time to recovery among injured recreational runners in the RUN CLEVER trial. PLoS ONE 13(10):e204742. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Yates B, White S (2004) The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sports Med 32:772–780CrossRefGoogle Scholar
  4. 4.
    Johnell O, Rausing A, Wendeberg B et al (1982) Morphological bone changes in shin splints. Clin Orthop Relat Res 167:180–184. CrossRefGoogle Scholar
  5. 5.
    Magnusson HI, Westlin NE, Nyqvist F et al (2001) Abnormally decreased regional bone density in athletes with medial tibial stress syndrome. Am J Sports Med 29(6):712–715CrossRefGoogle Scholar
  6. 6.
    Magnusson HI, Ahlborg HG, Karlsson C et al (2003) Low regional tibial bone density in athletes normalizes after recovery from symptoms. Am J Sports Med 31(4):596–600CrossRefGoogle Scholar
  7. 7.
    Winters M, Burr DB, van der Hoeven H, Condon KW, Bellemans J, Moen MH (2018) Microcrack-associated bone remodeling is rarely observed in biopsies from athletes with medial tibial stress syndrome. J Bone Miner Metab. CrossRefPubMedGoogle Scholar
  8. 8.
    Winters M (2017) Medial tibial stress syndrome. Diagnosis, treatment and outcome assessment. (ISBN 978-90-393-6880-0)Google Scholar
  9. 9.
    Winters M (2018) Medial tibial stress syndrome; diagnosis, treatment and outcome assessment (PhD Academy Award). Br J Sports Med 52(18):1213–1214. CrossRefPubMedGoogle Scholar
  10. 10.
    Batt ME, Ugalde V, Anderson MW et al (1998) A prospective controlled study of diagnostic imaging for acute shin splints. Med Sci Sports Exerc 30:1564–1571CrossRefGoogle Scholar
  11. 11.
    Gaeta M, Minutoli F, Scribano E et al (2005) CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities. Radiology 235:553–561CrossRefGoogle Scholar
  12. 12.
    Winters M, Bon P, Bijvoet S, Bakker EWP, Moen MH (2017) Are ultrasound findings like periosteal and tendinous edema associated with medial tibial stress syndrome? A case-control study. J Sci Med Sport 20:128–133. CrossRefPubMedGoogle Scholar
  13. 13.
    Winters M, Bakker EWP, Moen MH, Barten CC, Teeuwen R, Weir A (2018) Medial tibial stress syndrome can be diagnosed reliably using history and physical examination. Br J Sports Med 52(19):1267–1272. CrossRefPubMedGoogle Scholar
  14. 14.
    Winters M, Eskes M, Weir A, Moen MH, Backx FJ, Bakker EW (2013) Treatment of medial tibial stress syndrome: a systematic review. Sports Med 43(12):1315–1333CrossRefGoogle Scholar
  15. 15.
    Winters M, Eskes M, Weir A, Moen MH, Backx FJ, Bakker EW (2016) The treatment of medial tibial stress syndrome: an extensive summary and update of a systematic literature review. Sport Geneeskd 2:44–45Google Scholar
  16. 16.
    Winters M (2018) Critically appraising the evidence to help our patients with overload syndromes: should we prioritise knowledge from observational studies and focus on ‘the essentials’? Br J Sports Med 52(22):1414–1415. CrossRefPubMedGoogle Scholar
  17. 17.
    Moen MH, Schmikli SL, Weir A et al (2014) A prospective study on MRI findings and prognostic factors in athletes with MTSS. Scand J Med Sci Sports 24(1):204–210. CrossRefPubMedGoogle Scholar
  18. 18.
    Moen MH, Holtslag L, Bakker EW et al (2012) The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial. Sports Med Arthrosc Rehabil Ther Technol 4(1):12CrossRefGoogle Scholar
  19. 19.
    Gabbett TJ (2016) The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med 50:273–280CrossRefGoogle Scholar
  20. 20.
    Damsted C, Glad S, Nielsen RO, Sørensen H, Malisoux L (2018) Is there evidence for an association between changes in training load and running-related injuries? A systematic review. Int J Sports Phys Ther 13(6):931–942CrossRefGoogle Scholar
  21. 21.
    Vlachopoulos D, Barker AR, Ubago-Guisado E et al (2018) The effect of 12-month participation in osteogenic and non-osteogenic sports on bonedevelopment in adolescent male athletes. The PRO-BONE study. J Sci Med Sport 21(4):404–409. CrossRefPubMedGoogle Scholar
  22. 22.
    Rathleff MS, Mølgaard CM, Fredberg U et al (2015) High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports 25(3):e292–300. CrossRefPubMedGoogle Scholar
  23. 23.
    Smith BE, Hendrick P, Smith TO, Bateman M, Moffatt F, Rathleff MS, Selfe J, Logan P (2017) Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med 51(23):1679–1687. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Winters M, Franklyn M, Moen MH, Weir A, Backx FJG, Bakker EWP (2016) The medial tibial stress syndrome score: item generation for a new patient reported outcome measure. S Afr J Sports Med 28(1):11–16. CrossRefGoogle Scholar
  25. 25.
    Winters M, Moen MH, Zimmermann WO, Lindeboom R, Weir A, Backx FJ, Bakker EW (2016) The medial tibial stress syndrome score: a new patient-reported outcome measure. Br J Sports Med 50(19):1192–1199. CrossRefPubMedGoogle Scholar
  26. 26.
    Järvinnen M, Niittymaki S (1989) Results of the surgical treatment of the medial tibial stress syndrome in athletes. Int J Sports Med 10(1):55–57 (Feb)CrossRefGoogle Scholar
  27. 27.
    Holen KJ, Engebretsen L, Grondvedt T et al (1995) Surgical treatment of medial tibial stress syndrome (shin splints) by fasciotomy of the superficial posterior compartment of the leg. Scand J Med Sci Sports 5(1):40–43CrossRefGoogle Scholar
  28. 28.
    Wallenstein R (1983) Results of fasciotomy in patients with medial tibial stress syndrome or chronic anterior compartment syndrome. J Bone Joint Surg Am 65(9):1252–1255CrossRefGoogle Scholar
  29. 29.
    Abramowitz AJ, Schepsis A, McArthur C (1994) The medial tibial stress syndrome: the role of surgery. Orthop Rev 23(11):875–881PubMedGoogle Scholar
  30. 30.
    Yates B, Allen MJ, Barnes MR (2003) Outcome of surgical treatment of medial tibial stress syndrome. J Bone Joint Surg Am 85(10):1974–1980CrossRefGoogle Scholar
  31. 31.
    Detmer DE (1986) Chronic shin splints: classification and management of medial tibial stress syndrome. Sports Med 3(6):436–446CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Rehabilitation, Physiotherapy Sciences & SportsUniversity Medical Centre UtrechtUtrechtThe Netherlands
  2. 2.Research Unit for General Practice in Aalborg, Department of Clinical MedicineAalborg UniversityAalborg ØstDenmark

Personalised recommendations