Medial tibial stress syndrome (MTSS), commonly referred to as “shin splints,” is a common overuse injury in impact sports. MTSS is often defined clinically as exercise-induced pain along the middle to distal posteromedial tibia. Though this definition is widely utilized, MTSS is a highly variable condition with no defined etiology or gold standard for treatment. Research has suggested MTSS as a precursor stage to tibial stress/fatigue factors and has proposed a variety of etiologies ranging from cortical bone microtrauma to muscle-tension-induced tibial periostitis. 

The present literature review aims to corroborate the existing literature on the known and theorized causes, prevention, and treatments of MTSS. Peer-reviewed original research, literature reviews, and condition summaries from the last ten years were included. The literature demonstrates that MTSS results from a combination of causes that varies between individuals. Biomechanical factors, such as over-pronation, hip, and ankle range of motion, navicular drop, (intrinsic factors) and training errors, such as overtraining or premature progression (extrinsic factors), can increase one’s risk of developing the condition and treatment should include a combination of, but not limited to, rest, retraining muscle strengthening, and pain management. The literature’s lack of consensus on the etiology and treatment indicates the need for continued research, particularly randomized controlled trials.