The Complete Guide to Recovering from Medial Tibial Stress Syndrome for Runners in Lake Country, Wisconsin

Introduction

Medial tibial stress syndrome (MTSS, or Shin Splints) is a very common injury related to increased stress on our shin bone. It can be commonly due to a large increase in training over a short period of time, resulting in periosteal edema on our shin bone and ultimately pain. 

It’s more than likely that you’ve heard of someone experiencing “shin splints” before. Lake Country in Wisconsin is a very active population and the change in seasons can encourage people to go from long periods of no training to a quick increase in running.

It is extremely important to get properly diagnosed with MTSS so that you can begin rehab and prevent this from transitioning to a true bone stress injury such as a stress reaction or stress fracture.

MRI may be useful in diagnosis if it is a higher grade of MTSS, but you will likely get diagnosed by a physician or physical therapist who will use a physical exam and subjective history to diagnose you. You may have been told that all you need is to rest, however, undergoing an individualized rehab program is essential for recovering from MTSS.

What is Medial Tibial Stress Syndrome?

MTSS or Shin Splints is inflammation and stress along the tibia bone and surrounding tissues. This inflammation can cause pain that may be made worse with activity, specifically running or high impact activities.

If you fall under any of these categories, you may be more prone to MTSS: 

• Adolescent athlete
• Female
• Higher BMI
• Previous history of MTSS
• Recent increase in training intensity or volume

Symptoms of MTSS: 

• Dull-aching
• Diffuse pain along the shin
• Tenderness
• Worsening discomfort with activity and weight bearing 

What Happens if You Ignore It?

It Could Get Worse

Although MTSS affects our shin bones, it is not considered a true bone stress injury. However, if you ignore it, the repetitive stress can progress to a tibial bone stress injury. A bone stress injury is a much more serious condition in which there has been a small crack or fracture in the bone that has been shown with imaging. Bone stress injuries require a multi-disciplinary approach, time off from your activity, and a slow return to sport guided by a physical therapist and physician. 

It Could Alter Your Running Mechanics

When you have pain due to MTSS, your body may begin to compensate through other joints such as your hips, knees, ankle, or feet in order to get the job done. Eventually, this can lead to pain in other regions of your body. Secondary injuries may include tendonitis, IT band syndrome, or patellofemoral pain. 

The biggest secondary injury we worry about is stress fractures. If there is no decrease in running volume and no loading program, shin splints can ultimately lead to stress fractures.

It Could Impact Your Performance and Durability

Whenever you have pain, your muscles go into protection mode. They may become tighter or you may have secondary weakness due to the pain. Ultimately, pushing through pain is going to affect your running performance and likely lead to further injury. If you’re experiencing ongoing shin splints, there’s a chance that you have bone weakness in other areas of your body as well. If this goes unaddressed, we can experience other injuries such as fractures later on in life. 

How do I know if I have MTSS or a Bone Stress Injury?

While these injuries share some common symptoms, there are very different treatment paths for each of them. It is important to correctly identify if you have MTSS (Shin Splints) or a Bone Stress Injury (BSI). Here are the common identifiers for each injury:

• MTSS (Shin Splints)
  • Common in adolescence
  • Common to feel pain in both legs
  • Recent increase in training volume - specifically long distance running or speed work
  • Generalized pain along the shin bone 
  • May or may not be able to diagnose with MRI - pain 
• Bone Stress Injury
  • Energy deficiency often plays a role 
  • Common to feel pain in one leg
  • Localized, pinpoint pain, can feel sharp at times
  • Recent training spike
  • Higher BMI
  • History of stress fracture or stress reaction 
  • Able to diagnose from MRI

Rehab Exercises for Medial Tibial Stress Syndrome

Mobility Work

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• Calf Stretching (Gastroc and Soleus)
  • 3-Way Straight Leg Calf Stretch
    
• Ankle Mobility Drills
  • ½ Kneeling 3-Way Ankle Dorsiflexion to Wall
    

Strengthening Exercises

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• Tibialis Anterior Strengthening
  • Kettle Bell Ankle Dorsiflexion
    
• Soleus and Gastrocnemius Strengthening
  • Double Leg Heel Raise on Step
    
  • Double Leg Soleus Heel Raise
    

• Hip and Glute Strengthening (for improved shock absorption)
  • Glute Bridge March 
    
  • Wall Mini-Band Fire Hydrant
    

Neuromuscular Control & Running Specific Drills

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• Single-leg balance and stability work
  • Single Leg RDL Kettle Bell Switches
    
• Foot Intrinsic Muscle Strengthening
  • Single Leg Band Arch Raise
    

Rehab Strategies to Recover and Return to Running

Load Management

• Temporary reduction in running volume and intensity.
• Using a heel lift to temporarily decrease tibial stress
• Wearing a high drop or rocker soled shoe to temporarily decrease tibial stress
• Using pain as a guide to modify activity.
• Guided tibial loading program led by a specialized physical therapist. Muscle strengthens bone! A good tibial loading program should include targeted strengthening exercises and plyometrics that gradually expose your bone to more stress.

Cross Training Options

• Pool running, cycling, or rowing to maintain fitness.

Gradual Return to Running

• Walk-to-run progressions and increasing mileage cautiously.

Gain Retaining (if needed)

• Adjusting cadence, foot strike, or running posture to reduce tibial stress.

How to Train Around the Injury

• Strength training and mobility work to stay active without worsening symptoms.
• Alternative cardio workouts are great to maintain endurance while minimizing impact. This can include activities such as biking, swimming or rowing. It is important to maintain aerobic endurance while rehabbing from an injury in order to make your full return to running an easier transition. 
• Using soft surfaces, treadmill running or walking, or downhill running as an intermediate step back to full training. Incorporating these things into your plan temporarily can help maintain your activity levels while decreasing stress on your tibia.

The Benefits of an Objective Evaluation & 3D Running Analysis at Kinetic Sports Medicine

• Comprehensive Movement & Strength Assessment: Identifying imbalances that contribute to MTSS. Muscle imbalances can cause increased stress in other areas of the body, resulting in overuse and pain over time.
• 3D Running Analysis:
  • Detecting biomechanical inefficiencies contributing to tibial stress.
  • Making data-driven adjustments to stride, cadence, and impact mechanics.
• Personalized Treatment Plans:
  • A structured, individualized approach for faster and safer recovery.
  • Specific bone loading and strengthening program to get you back to pain free running

Conclusion

If you are experiencing persistent shin pain, don’t wait to talk to a professional. You could save yourself lots of time away from your activity. 

Proper rehab and a full running analysis can help you identify areas of weakness, range of motion deficits, movement compensations, and training errors. Having this knowledge can give you the power to manage your injuries, prevent secondary injuries, and ultimately level up your performance!

If you are in pain and need support, we are here to help you understand what is causing your pain, get you out of pain and get back to the things you love pain-free. If you would like to learn more, call us to book an injury consultation call or a visit with one of our Doctors of Physical Therapy today!