Overuse or repetitive-stress injury of the shin is medial tibial stress syndrome (MTSS). When the body is unable to repair effectively in response to recurrent muscular contractions and tibial strain, various stress responses of the tibia and surrounding musculature develop. These include bone remodeling, inflammation, and muscle fiber degeneration/regeneration. The three main types of stress reactions that can occur on either end of the tibia are acute injuries, overuse injuries, and stress fractures. Acute injuries involve tears or breaks to the ligaments or tendons that attach to the tibia. Overuse injuries are related to repeated stress on ligaments or bones without an adequate recovery period. Stress fractures are less severe than true fractures but still cause pain when pressure is applied to them. They are located in areas of high pressure such as the bottom of the foot, the back of the knee, and the top of the tibia. Stress reactions may or may not be visible on X-rays. However, they usually heal without treatment if the cause is removed. If you continue to suffer from shin pain even after a routine exercise program has been completed, then see your doctor so that he or she can determine the cause of your problem.