# Shin Splints (Medial Tibial Stress Syndrome) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: StatPearls: Medial Tibial Stress Syndrome (NCBI Bookshelf, updated 2025) · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) · MSF Essential Drugs 2024 (colecalciferol oral monograph, prevention and treatment of vitamin D deficiency) · Calcichew 500 mg Chewable Tablets SmPC sections 4.1-4.5 (eMC product 12847) · Shin Splints (Medial Tibial Stress Syndrome) - disease-level clinical article (shin-splints-full.txt) - Verified date: 2026-08 ## Verified against - StatPearls: Medial Tibial Stress Syndrome (NCBI Bookshelf, updated 2025) - Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) - Shin Splints (Medial Tibial Stress Syndrome) - disease-level clinical article (shin-splints-full.txt) - MSF Essential Drugs 2024 (colecalciferol oral monograph, prevention and treatment of vitamin D deficiency) - Calcichew 500 mg Chewable Tablets SmPC sections 4.1-4.5 (eMC product 12847) - MSF Essential Drugs 2024 (ibuprofen oral monograph) ## Treatment metadata - No drug therapy in primary care (Relative Rest & Graded Return) - Ibuprofen — 400 mg — oral.solid - Cholecalciferol — oral.liquid - Calcium carbonate — 500 mg — oral.solid ## Complete treatment card ```text SHIN SPLINTS (MEDIAL TIBIAL STRESS SYNDROME) Sources: StatPearls: Medial Tibial Stress Syndrome (NCBI Bookshelf, updated 2025) · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · StatPearls: Ibuprofen (NCBI Bookshelf NBK542299) · MSF Essential Drugs 2024 (colecalciferol oral monograph, prevention and treatment of vitamin D deficiency) · Calcichew 500 mg Chewable Tablets SmPC sections 4.1-4.5 (eMC product 12847) · Shin Splints (Medial Tibial Stress Syndrome) - disease-level clinical article (shin-splints-full.txt) Review status: REVIEWED against StatPearls: Medial Tibial Stress Syndrome (NCBI Bookshelf, updated 2025), Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560), Shin Splints (Medial Tibial Stress Syndrome) - disease-level clinical article (shin-splints-full.txt), MSF Essential Drugs 2024 (colecalciferol oral monograph, prevention and treatment of vitamin D deficiency), Calcichew 500 mg Chewable Tablets SmPC sections 4.1-4.5 (eMC product 12847), MSF Essential Drugs 2024 (ibuprofen oral monograph) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (2) - Pain runs along the inner shin over its lower two-thirds, appears with or after exercise, and eases with rest - There is no cramping, burning pain, or numbness and tingling in the foot [burning pain · numbness · tingling] SIGNS - what you find (2) - Tenderness that can be reproduced over more than 5 cm along the back-inner edge of the shin supports the diagnosis - Marked swelling, redness, or weak distal pulses are not expected and point away from this diagnosis [redness] TESTS (5) - Plain X-rays are normal in this condition and are often normal early in a stress fracture too - A dark line seen crossing the front of the shin on X-ray marks a high-risk stress fracture needing urgent attention - MRI is the preferred scan, showing swelling of the lining and marrow of the bone - A nuclear bone scan is a less specific alternative that shows a characteristic double-line uptake pattern - Checking vitamin D levels can be worthwhile for cases that will not resolve IF NOT THIS - what else fits (4) - A stress fracture of the shin's front edge causes a focused tender point under 5 cm, unlike the wider tender zone of this condition - Chronic exertional compartment syndrome causes diffuse, often two-sided leg pain with numbness, pale or cold skin, and weak pulses, confirmed by measuring pressure inside the muscle compartment - Functional popliteal artery entrapment causes exertional claudication from artery compression behind the knee, confirmed by stress arteriography - Peripheral arterial disease also causes claudication but from atherosclerosis, confirmed by arteriography or Doppler ultrasound Source StatPearls "Medial Tibial Stress Syndrome" - disease-level clinical article Status traced to the source above Rx: Main treatment | Bone health - vitamin D alongside calcium | Bone health - calcium alongside vitamin D MAIN TREATMENT 1. NO DRUG THERAPY IN PRIMARY CARE (RELATIVE REST & GRADED RETURN)[1st line] Adult Relative rest from the aggravating impact activity (running, marching, jumping) until it settles; substitute low-impact cross-training (swimming, cycling) to maintain fitness; ice the area for 15-20 minutes after activity; correct training errors (a sudden increase in mileage or intensity, worn or unsupportive footwear, a hard or unfamiliar running surface); arch-support foot orthotics can accelerate recovery. Only return to full training gradually, once pain-free at rest and with daily activity. - Variable - the source declines to name a rest period and says so. Most settle over several weeks; the graded return is guided by symptoms, not by a calendar Peds Common in adolescent athletes and school sports; the same relative-rest and graded- return approach applies. Involve a parent or coach in adjusting training load, since the young athlete often cannot reduce it unilaterally. Source StatPearls: Medial Tibial Stress Syndrome (NCBI Bookshelf, updated 2025) Why Shin splints is fundamentally an overuse/training-load injury, not a drug-treatable disease - rest, activity modification, and correcting the training error are what actually resolve it. Medication below only manages pain in the meantime and does not substitute for this. Caution RED FLAG - distinguish from a tibial stress fracture before managing as shin splints: shin splints causes tenderness spread diffusely over more than 5 cm along the medial tibial border, while a stress fracture causes a focal, pinpoint area of bony tenderness under 5 cm across. A positive 'hop test' (pain reproduced by a single-leg hop) together with focal tenderness is strongly associated with stress fracture and needs imaging (plain radiograph; MRI if radiograph is normal but suspicion remains), not conservative shin-splint management (clinical practice - not stated in the cited source.) Symptoms that persist or worsen despite 2-3 weeks of relative rest, rather than gradually settling, should prompt referral for imaging to exclude a tibial stress fracture rather than continuing conservative management unchanged. Correct the underlying training error (rapid increase in mileage/intensity, worn or unsupportive footwear, sudden change of running surface) or the condition will recur once training resumes. Common in new military conscripts starting basic training and in athletes or gym-goers rapidly increasing load - a real change in the training programme, not rest alone, is what prevents recurrence. RED FLAG - The 'dreaded black line' on anterior tibial radiograph indicates a high-risk stress fracture requiring prompt evaluation and management, distinct from ordinary MTSS rest/activity-modification management. 2. IBUPROFEN [add-on - not a substitute] Adult 400 mg three times daily with food, for pain relief only - Short course, 5-7 days; do not use it to mask pain that allows training to continue through the injury Peds 5-10 mg/kg/dose [child max 400 mg] (Child 3 months-11 years: 5-10 mg/kg per dose 3-4 times daily; shin splints itself is chiefly an adolescent and young-adult presentation. Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily, maximum 30 mg/kg daily. The suspension's own label caps pain-and-fever use lower still, at 20 mg/kg/day. Never exceed 400 mg in a single dose.) 3kg -> 15-30 mg/dose 4kg -> 20-40 mg/dose 5kg -> 25-50 mg/dose 6kg -> 30-60 mg/dose 7kg -> 35-70 mg/dose 8kg -> 40-80 mg/dose 9kg -> 45-90 mg/dose 10kg -> 50-100 mg/dose 11kg -> 55-110 mg/dose 12kg -> 60-120 mg/dose 13kg -> 65-130 mg/dose 14kg -> 70-140 mg/dose 15kg -> 75-150 mg/dose 16kg -> 80-160 mg/dose 17kg -> 85-170 mg/dose 18kg -> 90-180 mg/dose 19kg -> 95-190 mg/dose 20kg -> 100-200 mg/dose 21kg -> 105-210 mg/dose 22kg -> 110-220 mg/dose 23kg -> 115-230 mg/dose 24kg -> 120-240 mg/dose 25kg -> 125-250 mg/dose 26kg -> 130-260 mg/dose 27kg -> 135-270 mg/dose 28kg -> 140-280 mg/dose 29kg -> 145-290 mg/dose 30kg -> 150-300 mg/dose 31kg -> 155-310 mg/dose 32kg -> 160-320 mg/dose 33kg -> 165-330 mg/dose 34kg -> 170-340 mg/dose 35kg -> 175-350 mg/dose 36kg -> 180-360 mg/dose 37kg -> 185-370 mg/dose 38kg -> 190-380 mg/dose 39kg -> 195-390 mg/dose 40kg -> 200-400 mg/dose 41kg -> 205-400 mg/dose (upper capped) 42kg -> 210-400 mg/dose (upper capped) 43kg -> 215-400 mg/dose (upper capped) 44kg -> 220-400 mg/dose (upper capped) 45kg -> 225-400 mg/dose (upper capped) 46kg -> 230-400 mg/dose (upper capped) 47kg -> 235-400 mg/dose (upper capped) 48kg -> 240-400 mg/dose (upper capped) 49kg -> 245-400 mg/dose (upper capped) 50kg -> 250-400 mg/dose (upper capped) Source Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) for the adult dose: "The recommended dose is 200 mg-400 mg (10-20 ml), up to three times a day as required... do not take more than 1200 mg (60 ml) in any 24 hour period". That label's paediatric section gives weight bands and a 20 mg/kg/day pain-and-fever ceiling but states no mg/kg per dose, so the paediatric 5 to 10 mg/kg per dose is from MSF Essential Drugs 2024 (ibuprofen oral monograph): "Child over 3 months: 5 to 10 mg/kg 3 to 4 times daily (max. 30 mg/kg daily)". Why Symptom relief only - it does not treat the underlying overuse injury. Relative rest and correcting training load (above) are what resolve shin splints; an NSAID's role is to make the rest period more tolerable, not to enable continued training on a painful shin. Caution Ibuprofen gives symptom relief only - it does not treat the underlying overuse injury, and must not be used to enable training through pain, which risks progression to a stress fracture. Take with food; avoid in active peptic ulcer disease, severe heart failure, or significant renal impairment. If pain is not settling with simple analgesia and relative rest within 2-3 weeks, reassess for a stress fracture rather than continuing the NSAID and activity unchanged. The 400 mg per-dose ceiling comes from the reference literature, not from the suspension label - that label's largest paediatric single dose is 200 mg. Below about 40 kg the weight calculation binds first and the ceiling never comes into it. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid BONE HEALTH - VITAMIN D ALONGSIDE CALCIUM - give alongside 3. CHOLECALCIFEROL [add-on - not a substitute] Adult 600 IU once daily as the preventive dose; where deficiency is established, 6,000 IU once daily for 3 months or 300,000 IU as a single dose, then continue the preventive dose Peds Under 12 months: Prevention: 400 IU once daily. 12 months and over: Prevention: 600 IU once daily. Established deficiency, 12 months to under 12 years: 3,000 to 6,000 IU once daily for 3 months or 150,000 IU as a single dose. (MSF preventive dosing: child under 12 months, 400 IU once daily; child 12 months and over, 600 IU once daily. For established deficiency, child 12 months to under 12 years 3,000 to 6,000 IU once daily for 3 months or 150,000 IU single dose.) Source MSF Essential Drugs 2024 (colecalciferol oral monograph, prevention and treatment of vitamin D deficiency) Why The article's claim is that getting vitamin D and calcium right lowers how often stress fractures occur in military recruits, and that it is worth doing. The link to shin splints rests on the article rather than on the vitamin D monograph, whose own indication is deficiency; that was settled in favour of the article-only link, so the entry mirrors the lactose-intolerance precedent. Named Cholecalciferol rather than MSF's Colecalciferol because that is the Egyptian register's spelling. Caution Do not administer to patients with hypercalcaemia, hypercalciuria, calcic lithiasis, severe renal impairment. Stop treatment if signs of overdosage occur: headache, anorexia, nausea, vomiting, increased thirst, polyuria. Do not exceed 600 000 IU yearly. This is prevention of the stress fracture that shin splints can become, not treatment of the shin pain itself. Relative rest and a graded return remain the treatment. MSF's indication is prevention and treatment of vitamin D deficiency (rickets, osteomalacia); it does not name shin splints, and that link comes from the disease article. The article's supporting observation: trials in military basic-training recruits have tied vitamin D deficiency to a raised risk of stress injury. Egypt UR-D 200 I.U./ML ORAL DROPS 25 ML HI-PHARM 21.60 EGP D3 BOX DROPS 15 ML ORGANIX INDUS... 22.00 EGP VIDROP 2800 I.U./ML ORAL DROPS 15 ML MUP 26.00 EGP ONEFEROL BONE 2800 I.U./ML ORAL DROPS 30 ML PHARMAZAD > PHARMA ONE 46.00 EGP CHILDAL ORAL DROPS 30 ML BRAND PHARMA ... 60.00 EGP CHOLETRIX-D3 400 IU ORAL DROPS 30ML COPAD EGYPT > IBM PHARMA 75.00 EGP VITAMIN D 2000IU 30ML ORAL DROPS ORGANIX > SOU... 165.00 EGP KIDDO 3 ORAL DROPS 10 ML PRO-BIO PHARMA > 300.00 EGP D3-TAG 1000 IU/ML ORAL DROPS 30ML > TAG PHARMA 27.00 EGP -> ? strength differs, ? different route - not oral liquid PEDYANO D SYRUP15ML ORGANIX > PED... 35.00 EGP -> ? strength differs, ? different route - not oral liquid BONE HEALTH - CALCIUM ALONGSIDE VITAMIN D - give alongside 4. CALCIUM CARBONATE [add-on - not a substitute] Adult 500 mg chewable tablets, 2 to 3 tablets daily Peds The label gives the same 2 to 3 tablets daily for paediatric prevention and treatment of calcium deficiency, without an age floor; no shin-splints paediatric figure exists in any document held here. Source Calcichew 500 mg Chewable Tablets SmPC sections 4.1-4.5 (eMC product 12847) Why The article pairs the two - getting vitamin D and calcium right lowers how often stress fractures occur in military recruits, and it is worth doing - so adding the vitamin D without the calcium would carry half the recommendation. The dose is the cited label's own: 2 to 3 tablets daily, for preventing and for treating calcium deficiency. Caution CONTRAINDICATED, from section 4.3 of the label: any disease or condition that produces hypercalcaemia or hypercalciuria - hyperparathyroidism, an overdose of vitamin D, a decalcifying tumour such as plasmacytoma or skeletal metastasis - together with severe renal failure not being treated by dialysis, and osteoporosis caused by immobilisation. Renal calculi too. The label's indication is as a calcium supplement, to correct a dietary shortfall or to cover a period when the requirement is unusually high; the link to shin splints comes from the disease article. Taken together with vitamin D there is a risk of hypercalcaemia and milk-alkali syndrome; the label asks for monitoring, especially with cardiac glycosides or diuretics. Caution in anyone with a history of renal stones. Egypt OSCASEEF 500MG 30 CAPS. SAFE PHARMA 21.75 EGP (0.72/unit) CALCIMATE 500 MG 12 CAPS. EL NASR 20.00 EGP (1.67/unit) CARIBO 500MG 50 CHEW. TABS. AL ESRAA PHAR... 18.00 EGP CALCINEX PLUS SYRUP 120 ML FAMILY PHARMA... 59.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)