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Medial tibial stress syndrome, commonly known as «shin splints», is rarely a difficult condition to diagnose. However, several other conditions can present with similar symptoms, and a thorough examination is recommended.

Medial Tibial Stress Syndrome (Shin Splints) - Diagnosis

Exercise-induced leg pain is common in athletes and military recruits. There are many conditions that can cause similar symptoms to MTSS, including tibial stress fracture and chronic exertional compartment syndrome, and it is important to rule out such potentially more serious causes of leg pain.


There are three criteria for diagnosing MTSS (1,2):


  1. The pain is exercise-induced

  2. The pain is identified along the posteromedial border of the tibia

  3. There is pain with palpation (touch) of the posteromedial border > 5 consecutive centimeters


Pain from MTSS is always exercise-induced (inactive people do not develop MTSS). Leg pain in individuals who are not physically active should be examined by a physician.


The pain from MTSS is aggravated by walking, running and/or jumping. Some might experience an increase in pain even when after a short burst of activity (e.g. running to catch the bus), while others might feel only a mild discomfort at the end of a long run.


If palpation of the tibia provokes pain in an area that is smaller than 5 cm, or if there is a significant increase in pain intensity at a focal point along the anterior or posteromedial border, this should raise suspicion of a stress fracture. A tibial stress fracture requires a completely different treatment approach (see tibial stress fracture) and should not be overlooked.


MTSS is a clinical diagnosis


MTSS can be diagnosed reliably based on patient history and a thorough clinical examination (2). In fact, a diagnosis based on patient history and clinical examination is considered the gold standard in diagnosing MTSS, meaning that and other tests, including plain radiographs, MRI, and CT-scans are merely used to exclude other conditions, including stress fractures and soft tissue pathologies.


The clinical examination may include a variety of clinical tests to rule out other conditions in the lower leg. Typically, a thorough review of the patients exercise history, injury history, nutritional status, and menstrual function and a is needed to identify factors that may have contributed to the development of the condition.


Differential diagnosis


Exercise-induced leg pain is common in athletes and military recruits. Several other conditions can cause similar symptoms to MTSS, out of which tibial stress fracture and chronic exertional compartment syndrome are considered the most important to rule out. In addition, the following conditions may also present with exercise induced pain in the lower leg:


  • Muscle strains

  • Lower limb tendinopathies

  • Popliteal artery entrapment syndrome (PAES)

  • Intermittent claudication

  • Radicular neuropathy/nerve entrapment

  1. Yates, B., & White, S. (2004). The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. The American journal of sports medicine, 32(3), 772-780.

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Last updated: 31.01.2020
Physical therapist, Oslo, Norway
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