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Shin Splints (MTSS) - The Journey Back to Running Pain Free

Medial tibial stress syndrome, commonly known as shin splints, is an injury that many runners fear developing. In reality, shin splints when well managed are easily resolved in most.

Exercise rehabilitation for shin splints running injuries at balanced osteopathy in london ec1

What is Medial Tibial Stress Syndrome?

MTSS is essentially an overuse/repetitive stress injury of the tibia, the larger bone of the lower leg. It results in pain along the inside of the shin bone across a large area, typically the lower third of the tibia.

There are many risk factors for the development of MTSS: training load, running experience, BMI, smoking and biomechanical abnormalities are all relevant, and therefore overcoming the injury must take multiple factors into consideration.

One of the key things to understanding and getting over this injury, is to realise that it is in fact a bone injury. Without allowing it the appropriate conditions to heal, this injury can progress to a more localised bone issue that can ultimately result in a fracture (which of course leads to a much longer time out of sport).

How do our Osteopaths treat shin splints?

1) Load management

When we review a runner in clinic presenting with MTSS, one of the first things that we always look at is training load. This may be looking at the training leading up to the development of the pain, or in patients with chronic or recurrent shin splints, it may be addressing the current training load. Overtraining and training error can both contribute to the development of most lower limb bone stress injuries, and often continued loading makes it difficult for the injury to fully settle down. Working with one of our sports osteopaths to find a balance between reducing load to allow the injury to settle, continued running or cross training to maintain condition of the athlete and minimising training error going forward to prevent recurrence, are key steps in helping a runner recover from shin splints.

2) Lifestyle advice

Reviewing other factors that influence a persons bone health are also recommended to promote healing and prevent recurrence - medication, smoking status, nutrition and hormonal balance are all relevant.

3) Manual therapy and exercise rehabilitation

Biomechanical dysfunction leading to increased stress placed on the medial tibia during walking and running is another key area our osteopaths address. Ankle, knee and hip function all have huge implications on the repetitive load going through the injury site, as does strength and control of the calf, ankle and hip musculature. Osteopathic assessment, treatment and exercise rehabilitation identify and work with imbalances, addressing deficits in mobility, strength and control. A holistic approach to assessment and treatment is a hallmark of osteopathic management, taking into account an individual’s unique biomechanics, injury history, overall health and goals.

4) Sports specific advice and education

Management of our runners presenting with shin splints may also include gait re-education and advice on appropriate footwear.

Often we see runners who are far along into a journey of stretching and massaging their calves after runs, icing and taping, hoping that by treating their injury like a muscle injury it will get better.. unfortunately delaying proper management only kicks the can down the road and at times can result in significant worsening.

If you‘re struggling with shin pain, suspect you have MTSS or are working through any other running related injury, you can book in to see one of our osteopaths via


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