Skip to main content
Log in

The diagnosis and management of medial tibial stress syndrome

An evidence update

Diagnostik und Therapie des Schienbeinkantensyndroms

Update zur Studienlage

  • Leitthema
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript


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.


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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Moen MH, Tol JL, Weir A et al (2009) Medial tibial stress syndrome: a critical review. Sports Med 39:523–546

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  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 32:772–780

    Article  PubMed  Google Scholar 

  4. Johnell O, Rausing A, Wendeberg B et al (1982) Morphological bone changes in shin splints. Clin Orthop Relat Res 167:180–184.

    Article  Google Scholar 

  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):712–715

    Article  CAS  PubMed  Google Scholar 

  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):596–600

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  8. Winters M (2017) Medial tibial stress syndrome. Diagnosis, treatment and outcome assessment. (ISBN 978-90-393-6880-0)

    Google Scholar 

  9. Winters M (2018) Medial tibial stress syndrome; diagnosis, treatment and outcome assessment (PhD Academy Award). Br J Sports Med 52(18):1213–1214.

    Article  PubMed  Google Scholar 

  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 30:1564–1571

    Article  CAS  PubMed  Google Scholar 

  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 235:553–561

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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):1315–1333

    Article  PubMed  Google Scholar 

  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 2:44–45

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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):12

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gabbett TJ (2016) The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med 50:273–280

    Article  PubMed  Google Scholar 

  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):931–942

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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)

    Article  PubMed  Google Scholar 

  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):40–43

    Article  CAS  PubMed  Google Scholar 

  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):1252–1255

    Article  Google Scholar 

  29. Abramowitz AJ, Schepsis A, McArthur C (1994) The medial tibial stress syndrome: the role of surgery. Orthop Rev 23(11):875–881

    CAS  PubMed  Google Scholar 

  30. Yates B, Allen MJ, Barnes MR (2003) Outcome of surgical treatment of medial tibial stress syndrome. J Bone Joint Surg Am 85(10):1974–1980

    Article  PubMed  Google Scholar 

  31. Detmer DE (1986) Chronic shin splints: classification and management of medial tibial stress syndrome. Sports Med 3(6):436–446

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Marinus Winters MSc, PhD.

Ethics declarations

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.

Additional information


M. Scheltinga, Veldhoven, NL

P. van Eerten, Veldhoven, NL

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Winters, M. The diagnosis and management of medial tibial stress syndrome. Unfallchirurg 123 (Suppl 1), 15–19 (2020).

Download citation

  • Published:

  • Issue Date:

  • DOI: