What are shin splints?

Shin splints are commonly used to describe medial tibial stress syndrome (MTSS).

It is a bone stress-related condition affecting the lower part of the tibia, usually along the inner border of the shin.

Rather than being caused by one specific injury, shin splints generally develop when the tissues around the tibia are exposed to repetitive loading that exceeds their current capacity.

This commonly occurs when someone suddenly increases their:

• Running distance
• Running frequency
• Running speed
• Hill running
• Jumping
• Walking
• Training volume

What causes shin splints?

Shin splints are usually related to a change in loading rather than a single traumatic event.

Common triggers include:

• Starting a running programme
• Increasing weekly mileage
• Returning to running after an injury
• Increasing running speed
• Introducing hill sessions
• Running on harder surfaces
• Increasing training frequency
• Increasing jumping or plyometric exercise
• Rapidly increasing walking activity

Your individual strength, training history, recovery and previous injuries can also influence how well your lower leg tolerates increased loading.

Shin Splints Symptoms

Typical symptoms include:

• Pain along the inside border of the shin
• Aching or tenderness during running
• Pain that develops during or after exercise
• Tenderness along a relatively broad area of the shin
• Symptoms that improve with rest
• Pain when increasing running volume
• Occasionally mild swelling or tenderness

Early in the condition, pain may only appear towards the end of a run.

As symptoms progress, pain can begin earlier during exercise and may take longer to settle afterwards.

Where do shin splints hurt?

Shin splints typically cause pain along the inner border of the lower two-thirds of the tibia.

The painful area is usually relatively broad rather than being limited to one very small point.

This distinction can be useful when differentiating shin splints from a tibial stress fracture, which often causes more focal bony tenderness.

However, there can be overlap between the symptoms, so persistent or worsening shin pain should be assessed.

Shin Splints vs Stress Fracture

Shin splints and stress fractures can cause similar symptoms, but they are different conditions.

Shin splints typically produce pain over a broader area along the inner shin and are commonly associated with running or other repetitive impact.

A stress fracture may cause more localised pain directly over the bone and can progressively become painful with everyday activities.

Pain that is severe, increasingly localised, present at rest or occurring during normal walking should be assessed promptly.

If there is concern about a stress fracture, medical assessment and potentially imaging may be required.

Shin Splints Assessment

A physiotherapy assessment will look at your symptoms and the factors that may have contributed to them.

Your physiotherapist may assess:

• Location and behaviour of your pain
• Tibial tenderness
• Ankle movement
• Calf strength
• Foot and ankle function
• Single-leg control
• Hip strength
• Running technique
• Training volume
• Recent changes in training
• Previous lower-limb injuries
• Running footwear and training surfaces

The aim is to determine whether your symptoms are consistent with shin splints and identify why your current training load may be exceeding your capacity.

Shin Splints Treatment

The main principles of treatment are load management and progressive rehabilitation.

Simply stopping all activity until the pain disappears does not necessarily address why the problem developed.

Instead, rehabilitation aims to reduce the current aggravating load while progressively rebuilding your ability to tolerate running.

Modify your training load

Initially, you may need to reduce activities that significantly aggravate your symptoms.

This could involve temporarily reducing:

• Running distance
• Running frequency
• Speed work
• Hill running
• Jumping
• High-impact training

You may still be able to maintain fitness through alternative activities such as cycling or swimming, depending on your symptoms.

Calf Strengthening

The calf muscles play an important role in absorbing and producing forces during running.

Improving calf strength can therefore be an important part of rehabilitation.

Exercises may include:

• Double-leg calf raises
• Single-leg calf raises
• Seated calf raises
• Bent-knee calf raises
• Loaded calf raises
• Progressive resistance exercises

Strength should be gradually increased rather than simply performing large numbers of low-load repetitions.

Foot and Ankle Strength

The muscles of the foot and ankle also help manage forces during running.

Rehabilitation may include:

• Foot strengthening
• Single-leg balance
• Tibialis anterior strengthening
• Calf strengthening
• Controlled single-leg exercises

The aim is to improve the capacity of the entire lower limb rather than focusing on one muscle in isolation.

Hip and Lower-Limb Strength

Strength around the hip and knee can also be relevant to running mechanics and overall lower-limb capacity.

Exercises may include:

• Squats
• Split squats
• Step-ups
• Single-leg exercises
• Hip abduction exercises
• Romanian deadlifts

The exact exercises will depend on your individual assessment.

Return to Running After Shin Splints

Once symptoms have settled sufficiently and your strength and impact tolerance have improved, running can be gradually reintroduced.

A typical progression might be:

Walking → brisk walking → walk/jog → continuous easy running → increased duration → increased mileage → hills → faster running

The progression should be based on how your symptoms respond rather than following a fixed timetable.

If pain repeatedly returns when you reach a particular distance, this can indicate that your current running load is still exceeding your capacity.

Can I Run With Shin Splints?

It depends on the severity of your symptoms.

Some people can continue running with a significant reduction in volume and intensity.

However, continuing to run through progressively worsening shin pain is not recommended.

If pain becomes increasingly severe, starts earlier during each run or begins affecting walking, you should reduce your impact load and seek assessment.

Do Running Shoes Cause Shin Splints?

Footwear can influence how loading is distributed through the lower limb, but shin splints are rarely caused by shoes alone.

Potentially relevant factors include:

• A sudden change in footwear
• Changes in running load
• Changes in running surface
• Shoe age and condition
• Individual running mechanics

There is no single type of running shoe that prevents shin splints in everyone.

Does Running Technique Cause Shin Splints?

Running technique can influence the loads placed through the lower limb, but there is no single "correct" running style that prevents shin splints.

Your running technique may be considered alongside your training volume, strength, footwear, previous injuries and other individual factors.

In some runners, modifying aspects of running technique or temporarily changing cadence can be useful, but this should be individualised rather than applied routinely.

How Long Do Shin Splints Take to Heal?

Recovery varies depending on how long you have had symptoms and how much the condition has progressed.

Some people improve within several weeks after appropriately modifying their training and beginning rehabilitation.

More persistent cases can take several months.

Trying to return to your previous running volume too quickly can cause symptoms to return.

Can Shin Splints Become a Stress Fracture?

Shin splints and bone stress injuries exist on a spectrum, and the distinction is clinically important.

Persistent high levels of loading may contribute to progression of bone stress.

If pain becomes increasingly focal, severe or starts occurring during normal daily activities, a stress fracture should be considered and medical assessment may be appropriate.

Preventing Shin Splints

The most important principle is to increase training gradually.

Helpful strategies include:

• Avoiding sudden increases in mileage
• Gradually introducing faster running
• Progressing hill running slowly
• Maintaining calf and lower-limb strength
• Allowing sufficient recovery
• Gradually returning after periods away from running
• Avoiding sudden large changes in training surfaces

For runners who have previously experienced shin splints, maintaining strength and managing training load throughout the year can help reduce recurrence.

Frequently Asked Questions

What is the fastest way to get rid of shin splints?

There is no instant treatment for shin splints.

The most effective approach is usually to reduce the aggravating load, allow symptoms to settle and progressively rebuild your strength and running capacity.

Should I stop running with shin splints?

Not necessarily.

Mild symptoms may allow you to continue running with an appropriate reduction in training load. However, if pain is worsening, becoming more focal or affecting your walking, running should be stopped and the injury assessed.

Should I massage shin splints?

Massage may provide temporary symptom relief for some people, but it does not address the underlying loading problem.

Progressive strengthening and appropriate management of running volume are generally more important.

Should I stretch my calves for shin splints?

Calf stretching may be appropriate for some people, particularly if ankle mobility is restricted, but it is not a standalone treatment.

Strength and load management are usually more important components of rehabilitation.

Are shin splints caused by weak calves?

Reduced calf capacity can contribute to difficulty tolerating running loads, but shin splints are usually caused by multiple factors.

Training load, recent changes in activity, strength, recovery and individual biomechanics can all contribute.

Can I cycle with shin splints?

Cycling is often a useful alternative activity because it involves considerably less impact than running.

However, if cycling itself aggravates your symptoms, it may also need to be modified.

How do I know if I have shin splints or a stress fracture?

Shin splints typically cause tenderness over a broader area along the inner shin.

A stress fracture may produce more focal pain directly over the bone and can progress to pain during walking or at rest.

Because the symptoms can overlap, persistent or worsening pain should be assessed.

Do I need an MRI for shin splints?

Most cases of shin splints do not require an MRI.

Imaging may be considered when symptoms are atypical, severe, persistent or when a stress fracture is suspected.

Can shin splints come back?

Yes.

Shin splints can recur if running volume or intensity is increased faster than your lower leg can adapt.

Maintaining strength and progressively managing training load can reduce the risk of recurrence.

When should I see a physiotherapist for shin splints?

Consider an assessment if your shin pain is persistent, keeps returning when you run, is affecting your training or is becoming progressively worse.

A physiotherapist can help determine the likely cause and develop a structured return-to-running programme.

Shin Splints Physiotherapy in Newcastle

At NE Physio, we provide assessment and rehabilitation for shin splints, running-related lower-leg pain and stress injuries in Newcastle.

We look at your training load, strength, running demands and lower-limb function to understand why your shin has become painful.

Your rehabilitation programme will be tailored to your goals, whether you want to return to running, increase your mileage, prepare for a race or exercise without shin pain.

Page Created and Reviewed by Clinician: Matthew Ivin PH 118421

Book Your Shin Splints Assessment

If you have persistent shin pain when running or exercising, book an assessment with NE Physio in Newcastle.