Diagnosing Medial Tibial Stress Syndrome (Shin Splints): A Clinical Approach

August’s 5 minute Assessment assistant

Diagnosing Medial Tibial Stress Syndrome (Shin Splints)

In 2019, Winters¹ published an evidence update regarding the diagnosis and management of MTSS. Practical recommendations stated that MTSS can be clinically diagnosed through patient history and physical examination, and that imaging is only required if other exertional lower leg pathologies are suspected.

MTSS diagnosis pathway:

Is there…

1. Exercise induced pain along the distal 2/3 of the medial tibial border

2. Pain can be provoked during or after physical activity and is reduced with relative rest
3. Pain on palpation of the Medial tibial border >5cm

Stress fractures more commonly present with localised pain in the middle Anterior 1/3rd of the Tibia, they can be ruled out by Bone Scan.

In the absence of…


1. Cramping, burning pain over the posterior compartment
2. Paraesthesia in the foot during exercise (which may indicate Chronic Exertional Compartment Syndrome.
3. Other symptoms or signs not typical of MTTS such as swelling .

Hope this helps! Please feel free to give me a call any time!

Michael Rafla
Physiotherapist
Australian Sports Physiotherapy
Ivanhoe, Heidelberg, Coburg, Northcote, Carlton North
1300651256
0431 271 714

Come and see our purpose built rehab facility at 73 Upper Heidelberg road, Ivanhoe!

¹ Winters, M. (2019). The diagnosis and management of medial tibial stress syndrome. Der Unfallchirurg, 123(1), 15-19.

² Reshef, N., & Guelich, D. R. (2012). Medial tibial stress syndrome. Clinics in sports medicine, 31(2), 273-290.