MTSS syndrome.

Medial tibial syndrome (MTSS) is an injury that causes pain on the inside of the lower leg (front of the leg between the knee and ankle) aka: the tibia (bone piece in the lower leg). MTSS syndrome occurs in runners and athletes with a lot of jump-related loads, among others. MTSS complaints are approached in modern physical therapy the same way as tendon injuries (example: Achilles tendon injury). With these injuries, pain relief techniques are chosen combined with gradual build-up of load. With prolonged overuse/too little recovery, MTSS-related symptoms can develop. 

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  • Pain at the level of the lower ⅔ part of the shinbone (tibia) 
  • Radiation to the knee and or ankle 
  • Hypersensitivity of the shins when touched (palpation) leading to a sharp painful sensation
  • Dull pain after load that lasts longer
Possible causes: 
  • Enlarged tilt of the foot (overpronation), requiring surrounding muscles to work harder (muscles that are active include: musculus tibialis posterior, musculus soleus and the musculus flexor digitorum longus are active during running). Due to an imbalance where the body must constantly adapt, this can lead to "overuse" symptoms.  
  • Unilateral use of the road (due to road surface drainage). Depending on the type of surface you walk on, this can cause one foot to be loaded more than the other. This uneven distribution of load sometimes contributes to the onset or perpetuation of symptoms.
  • Sports that involve repeated jumping and or running (Repeated pressure on the lower leg can lead to excessive compression).
  • In women, MTSS symptoms are more common than in men.
  • Beginning runner, possibly due to inefficient running technique or sudden increase in load.
  • Overweight
  • Decreased strength in the hip muscles allowing it to provide insufficient stability while running.
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Treatment and rehabilitation. 

    A number of factors are important during the rehabilitation of MTSS. The first is training muscles around the hip and buttock region. A weaker hip provides less stability and is less able to handle the impacting forces of running. The body always finds a compensation strategy for an inadequate movement pattern such as the one we describe above. It may then be that this compensation causes symptoms in other areas such as the muscles in the tibia. 

    Stages of pain MTSS 
    • stage 1; particularly pain and stiffness after exercise
    • stage 2; pain during warm up, it disappears after a good warm up 
    • stage 3; pain during sports
    • Stage 4; daily pain symptoms and pain symptoms that persist longer than 24 hours after exercise


    Acting on time
    The earlier these complaints are identified, the less chance the injury has to develop. With these complaints, slowly building up the load (rehabilitation) is crucial. 

    Continue to excite
    Tendon repair in MTSS involves rest, but not complete rest. Continued "stimulation" of tendon tissue is essential to proper tendon recovery. Gradual and dosed loading is really the key to success. Symptoms may be felt during exercises but in moderation. So consult well with your physical therapist what is possible within the pain limit. So in many cases this means taking a step back in intensity, but only rarely do we opt for a temporary complete stop. With a personalized exercise schedule, you build step by step to a full recovery and a good load capacity of the shin so you can play sports again pain free.

    Stretching for MTSS complaints
    Stretching the shin muscles can provide relief. In some cases, another option is a massage in which the affected tissue (the shin) is gently massaged. This has a pain-relieving effect. 

    Strength building
    Training for MTSS symptoms is twofold. For example, training muscles around the hip and buttock region is important, because a weaker hip provides less stability and cannot handle the impacting forces of running as well. In addition to global strength training, it is also important to make the muscles at the tibia itself as load-bearing as possible. 

    Gait Analysis
    We also look at the quality of movement through a gait analysis. From here we can give targeted advice on running technique and thus reduce the risk of injury.

    Finally, we look at the specific skills needed within your sport. Depending on the type of sport, your treating physiotherapist will create training forms that mimic the sport-specific situations as closely as possible so that you won't have any more surprises. 

    Rehabilitating together

    At Fysio Fitaal in Tilburg we will help you get back on the track, field or hall as soon as possible! Together we will plan your training to get your body used to the specific load. This will get you back on track as soon as possible. Do you recognize yourself in these complaints and are you looking for a (sports) physio? Send an email to Or call 013-3020191. 

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