Medial Tibial Stress Syndrome
(Shin Splints)

About Shin Splints

Shin splints are a fairly common sports injury that affects the front of the shin along the lower tibia. Shin splints involve inflammation of the muscles, tendons, and bone tissue that runs the length of your tibia. Pain typically occurs where the tibialis muscle attaches to bone, along the tibia’s inner border.

Shin splints are most common among military recruits, dancers and runners — especially novice runners. They also occur in athletes whose sport involves repetitive stress to the lower extremities. Shin splint pain can range from mild to debilitating. Early treatment and shin splint physical therapy can help to accelerate healing and prevent future injury.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Sports Medicine Specialist Dr. Lev Kalika

Dr. Kalika has dedicated his life’s work to revolutionizing the way musculoskeletal pain and injuries are diagnosed and treated. Early training with some of the world’s most renowned human movement scientists set him on the path to finding new and innovative solutions for pain syndromes, movement disorders and injury rehabilitation. Along the way, Dr. Kalika has published multiple scientific papers, making a significant contribution to the body of research on rehabilitative medicine.

Dr. Kalika is certified in musculoskeletal ultrasonography, extracorporeal shockwave therapy (ESWT), dry needling, Dynamic Neuromuscular Stabilization (DNS) and many other therapeutic approaches. He works with elite athletes, runners and ballet dancers, along with everyday patients who want to move better, without pain or disability.

NYDNRehab is a top-rated NYC sports medicine clinic located in Midtown Manhattan. The clinic features some of the most advanced technologies for physical therapy, sports performance training and injury rehab in NYC.

Why NYDNRehab is Your Clinic of Choice for Shin Splint Treatment

At NYDNRehab, our personalized one-on-one approach sets us apart from mainstream physical therapy clinics. We never use cookie-cutter treatment methods or generic timelines to treat sports injuries. Our treatment protocols are case-specific, based on your unique condition and diagnostic results.

Conventional physical therapy clinics often rely on symptoms alone to diagnose shin injuries. However, a symptoms-based approach can overlook critical factors, leading to misdiagnosis and inappropriate treatment that prolongs the patient’s pain and can even do further damage.

At NYDNRehab, we use high-resolution diagnostic ultrasonography to generate dynamic images of the lower leg in real time. Ultrasound lets us detect serious conditions like stress fractures and tumors that require specialized therapy and condition-specific treatment protocols.

Our high-tech performance lab equips us with tools for 3D gait analysis, to detect and quantify motor deficits that are often the root cause of shin splints. We use VR and AI technologies to retrain gait patterns, to restore neural pathways between the brain and muscles, and optimize muscle firing patterns.


Our data-driven approach ensures that our patients get measurable results in the least amount of time. Our personalized treatment approach aims to restore functional movement and optimize performance while reducing your risk of re-injury, so you can return to your favorite sport with confidence.

Shin Splints Symptoms
and Causes

  • Pain and throbbing along the border of the tibia
  • Shin pain during and after exercise
  • Shin that is tender to the touch
  • Visible swelling of the shin muscle
  • Shin that feels hot to the touch
  • Shin pain after a fall or accident
  • Weakness in the lower leg and ankle
  • Worn, unsupportive footwear with inadequate shock absorption
  • Sudden increase in exercise intensity, frequency or duration
  • Flat feet or rigid arches
  • Faulty running gait mechanics
  • Running on hills
  • Imbalances between the shin and calf muscles
  • Myofascial trigger points in the shin

Accurate Diagnosis is Critical for Fast
and Effective Treatment

Shin splint damage can range from mild to severe, and appropriate treatment depends on accurate diagnosis. Due to a high level of inflammation, Xray and MRI are of little use for assessing shin injuries. At the same time, a symptoms-based diagnosis may overlook more serious injuries, resulting in mistreatment that can do further damage.

Conditions that mimic shin splint symptoms include:

  • Trauma to the shin bone
  • Tibial stress fractures

  • Bone bruising

  • Bone tumors (rare)

In addition, shin splints can vary in type and intensity.

Subcategories of shin splints include:

  • Compartment syndrome: Chronic compartment syndrome in the shin can develop from swelling or bleeding within the muscle compartment, made up of muscle fibers, capillaries and nerves, encased by fascia. Because fascia has limited capacity to stretch, pressure builds within the compartment, reducing blood flow to the muscle and nerves.
  • Medial tibial stress syndrome: This condition is caused by inflammation where the anterior tibialis muscle attaches to the tibia. Medial tibial stress syndrome accounts for up to 35 percent of all running injuries, and 60 percent of lower leg pain syndromes.

At NYDNRehab, we use the highest-resolution ultrasound equipment available to get real-time images of your lower leg. Dynamic ultrasound imaging lets us view the structures of your leg in motion, along the entire path of the tibia. Ultrasound enables us to detect stress fractures and tumors that cannot be detected by X Ray or MRI. Our state-of-the-art ultrasound equipment gives us capabilities for sonoelastography, to measure the density of damaged tissues and monitor the healing process.

Once pain and inflammation have been addressed, we move to our performance lab for 3D gait analysis and biomechanical assessment. We look at joint angles, weight distribution, muscle firing patterns, and other mechanical indicators, in all 3 planes of motion, and create a personalized retraining strategy based on your unique data.

Get Superior Shin Splint Treatment for Fast Results

Prior to beginning shin splint physical therapy, we pretreat your damaged tissue to reduce pain and inflammation, and jump-start the healing process. Your pre-treatment may include:
  • Extracorporeal shockwave therapy (ESWT) to reduce pain and inflammation
  • Localized cryotherapy to numb pain and reduce swelling
  • Regenerative technologies to jump-start healing at the cellular level
  • Myofascial release therapy to restore fascia integrity
  • Ultrasound guided dry needling to eradicate shin splint trigger points
Once we have pain and inflammation under control, we get to work on mechanical factors that can predispose you to shin splints. Your shin splint treatment protocol may include:
  • Gait retraining with C.A.R.E.N, our high-tech feedback environment, to eliminate mechanical gait deficits
  • Resistance exercises to balance calf and shin muscle tension
  • Shin splint physical therapy to enhance ankle strength and range of motion
  • Foot core training to promote foot mobility and stability
  • Dynamic neuromuscular stabilization (DNS) therapy to restore optimal movement patterns

Avoiding Shin Splints

Shin splints can be extremely painful and debilitating — follow these common-sense steps to avoid them:

  1. Ease into new activities like running, gradually increasing duration, frequency and intensity
  2. If you join the military, don’t wait until Boot Camp to start running – shin splints are common in new recruits
  3. Invest in high-end supportive athletic shoes with good shock absorption
  4. Allow for adequate recovery time between training sessions
  5. Get a 3D gait analysis to optimize your running mechanics

If you start to feel shin pain, apply ice and take a break from your sport or activity for a few days. If pain persists, seek professional help. Early intervention can spare you from a worsened condition that keeps you on the bench.


Get Fast and Effective Shin Splint Rehab that Really Works!

Living in a concrete jungle like NYC can take a toll on your body, and the impact of running on concrete can be hard on your shins. At NYDNRehab, our modern technologies are designed to quickly reduce pain and inflammation, and to stimulate your body’s reparative mechanisms at the cellular level.

But don’t wait for shin splints to appear — contact NYDNRehab today to get a 3D gait analysis, and fix your running mechanics to avoid common running injuries like shin splints. Take advantage of our high-tech performance lab, to stay at the top of your game and reduce your risk of injury.

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    Shin Splint FAQs

    What should I do if I think I have shin splints?

    If you think you’ve developed shin splints, it’s a good idea to stop the activity that caused them for 2-3 days. Apply ice to relieve pain and swelling, and elevate your lower leg to reduce inflammation. Remember, 90% of shin splint healing is load management (rest). If pain persists after a few days, seek professional shin splint treatment.

    I’m training for a race. What will happen if I push through my shin splint pain?

    Training through pain is never a good idea – it can lead to acute compartment syndrome, a serious condition that can cause permanent deformity, disability, and infection. As much as possible, try to space out your training sessions, and apply ice immediately afterward. Elevate your legs and get as much rest as possible. You may also benefit from regenerative therapy leading up to and after your race.

    Will walking help or hurt my shin splints?

    While ankle range-of-motion exercises and gentle stretching may help promote healing, excessive walking is probably not a good idea. Rest, ice, compression and elevation are your friends in the early stages of soft tissue injuries like shin splints.

    How do I know if I have shin splint trigger points?

    The tibialis anterior muscle often contains significant myofascial trigger points, which often go under-diagnosed and under-treated. Trigger points can sometimes be detected by palpation – you can feel tiny hard knots just below the skin’s surface. But deep tissue trigger points can only be detected with ultrasound imaging. Ultrasound guided dry needling is a fast and effective treatment for shin splint trigger points.


    In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

    Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

    The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

    Dynamic ultrasonography examination demonstrating
    the full thickness tear and already occurring muscle atrophy
    due to misdiagnosis and not referring the patient
    to proper diagnostic workup

    Demonstration of how very small muscle defect is made and revealed
    to be a complete tear with muscle contraction
    under diagnostic sonography (not possible with MRI)


    Complete tear of rectus femoris
    with large hematoma (blood)


    Separation of muscle ends due to tear elicited
    on dynamic sonography examination

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