Shin splints (medically known as MTSS) is one of the most common injuries in runners — and the rates are even higher in military populations. Research has shown that up to 7.9% of infantry recruits receive treatment for MTSS, though actual rates are expected to be significantly higher due to poor reporting and the reluctance of individuals to seek care within military environments. Female recruits have been shown to have even higher incidence rates than male recruits.
For soldiers, MTSS means more than just pain. It can result in missed training, medical downgrades, prolonged basic training time, and in serious cases, career setbacks or medical discharge. The consequences of getting this wrong are significant.
The good news: MTSS is preventable and treatable when the right factors are addressed.
WHAT ARE SHIN SPLINTS?
MTSS presents primarily as pain along the inside edge of the shin, specifically at the furthest third of the tibia. Pain can be intense and may occur during running or at rest, with localised tenderness at the injury site. It is associated with repetitive loading and load management errors — most commonly too much running, too quickly.
Pain in the anterior shin or higher into the near third of the shin may indicate a stress fracture. Other red flag symptoms include: pain at rest or at night, worsening symptoms resulting in an inability to hop, and significant swelling or oedema. These require urgent medical assessment.
MILITARY-SPECIFIC RISK FACTORS
A number of risk factors have been shown to increase the likelihood of MTSS in military personnel:
- Sudden increase in running volume or intensity — the most common cause
- Low aerobic capacity — poor baseline fitness increases injury risk
- Smoking — impairs tissue healing and recovery
- Higher BMI — increases load through the tibial structures
- History of MTSS — prior injury is one of the strongest predictors of recurrence
- Poor strength in key muscle groups — particularly the calf, tibialis posterior and peroneals
HOW TO ACTUALLY FIX IT
Rest alone is rarely sufficient. Symptoms frequently return quickly after returning to running regardless of time taken away from training. During basic training, selection courses or full duties, the demands do not allow for extended rest periods — which makes a structured rehabilitation approach essential.
THE PREP PROGRAMME
Designing an effective MTSS recovery plan that accounts for all of the above is challenging. Without the right structure, it takes time, trial and error — and getting it wrong can prolong or worsen symptoms.
The PREP Shin Splints Plan was built specifically for aspiring and serving military personnel looking to prevent or treat MTSS. It provides:
- A clear, progressive week-by-week rehabilitation plan — structured from Day 1
- Targeted strength work in the key muscle groups critical to MTSS prevention and recovery
- A planned return-to-running protocol to restore confidence and capacity
- Off-feet conditioning to maintain and improve aerobic fitness even whilst injured
Hamstra-Wright KL, Bliven KC, Bay C. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br J Sports Med. 2015;49(6):362–369.
Sharma J, Golby J, Greeves JP, Spears IR. Biomechanical and lifestyle risk factors for medial tibia stress syndrome in army recruits: a prospective study. Gait & Posture. 2011;33(3):361–365.
Sharma J, Greeves JP, Byers M, Bennett AN, Spears IR. Musculoskeletal injuries in British Army recruits: a prospective study of diagnosis-specific incidence and rehabilitation times. BMC Musculoskeletal Disorders. 2015;16:106.
Farquharson E, Roberts AJ, Warland AI, Parnis N, O'Connell NE. Prevalence of medial tibial stress syndrome in the British Armed Forces: a population-based study. BMJ Military Health. 2024.