Our previous blog discussed the causes and risk factors that explain why MTSS (shin splints) is one of the leading causes of time lost during military training. Despite many soldiers being told to simply rest it, ice it or stretch it out, a specific evidence-based approach is what actually works.
MTSS is a bone and soft tissue stress reaction caused by an imbalance between loading time and recovery time. It is not a simple muscle tear or inflammatory response that resolves with short rest. If the underlying risk factors are not addressed, symptoms will return as soon as training resumes.
Failure to follow the key principles of MTSS rehabilitation can lead to:
- Persistent pain and loss of function
- Missed training and loss of fitness
- Medical downgrade
- Time spent in rehabilitation platoons
WHAT THE EVIDENCE SUPPORTS
Below is a summary of the best available evidence on MTSS rehabilitation — what to use, what to avoid, and why:
| Strategy | Evidence | Clinical Application |
|---|---|---|
| Relative Rest — Load Reduction | ✅ Strong | Switch to low-impact modalities. Resume running when return criteria are met — not before. |
| Activity Modification | ✅ Strong | Temporary cessation of aggravating activities with structured reintroduction. Avoid total immobilisation. |
| Progressive Return to Run | ✅ Strong | Walking/running intervals with clear criteria-based progression to full running. |
| Strength & Neuromuscular Training | ✅ Strong | Lower body strength, single-leg tasks, neuromuscular control. Gradual, specific loading is key. |
| Cross-Training & Bone-Safe Conditioning | ✅ Strong | Cycling, pool running, elliptical during rehab. Avoid full detraining — reduced aerobic capacity predisposes to re-injury. |
| Vitamin D / Calcium | ✅ Strong | Screen and supplement in deficient individuals. Consult your GP before supplementing. |
| Psychological Support / Education | ✅ Moderate–Strong | Education around load pacing, expectations and self-monitoring is critical for adherence and outcomes. |
| Shockwave Therapy | ⚠️ Moderate | Not first-line. Consider only if symptoms persist beyond 6 months. Refer to physio or sports medicine. |
| Orthotics | ⚠️ Mixed | Only if biomechanically indicated following individual gait assessment. |
| Manual Therapy / Myofascial Release | ⚠️ Limited | May provide short-term symptom relief as an adjunct. Does not address underlying cause. |
WHAT AN EFFECTIVE RECOVERY PLAN LOOKS LIKE
There are many factors to consider when designing an optimal Shin Splints Plan for military populations. Soldiers and recruits face high physical demands with limited recovery time, which makes a structured approach even more important — not less. The key principles are:
- Intelligent load modification — not avoidance. Maintain fitness through off-feet conditioning while protecting the tibia.
- Progressive impact reintroduction — structured return to running with clear criteria at each stage.
- Targeted strength and conditioning — specific to the muscle groups involved in MTSS.
- Aerobic fitness optimisation during injury — avoid detraining. Come back fitter than before.
- Military-relevant return to training criteria — benchmarks mapped to the demands of service, not generic running targets.
The PREP Shin Splints Plan was built to take the guesswork out of this process entirely. It provides a clear, military-specific solution that adopts all of the evidence-based principles discussed across this blog series — structured, progressive, and designed to get you back to full duties without symptoms returning.