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Autumn means that youth overuse injuries increase as school sports resume, and lower extremity stress is particularly amplified when athletes move indoors onto hard floors. Medial tibial stress syndrome (MTSS), aka Medial Tibial Traction Periostitis, is a common result of this increased load. The diagnosis of MTSS describes exercise-induced pain along the posteromedial border of the tibia. The condition is commonly referred to as “shin splints” and is a familiar malady in athletes and soldiers where it affects up to 1/3 of those populations. (1-4) MTSS is responsible for approximately 15% of all running injuries. (1)