Understanding Shin Splints

What Is Causing Your Shin Pain?

You might have started running more regularly, added hills to your usual route or returned to sport after a break. Then an ache appears along the inside of your shin. It may settle once you warm up, so you keep going. Before long, it starts earlier in your run, lasts longer afterwards or becomes noticeable when you walk.

This is the pattern many people describe as shin splints. It is a common problem, but the name can be misleading. “Shin splints” is a general term, and not every type of shin pain has the same cause or needs the same treatment.

Most cases improve without surgery or complicated treatment. Treatment involves working out what has been overloaded, checking for signs of a more significant bone injury and gradually rebuilding the leg’s ability to cope with running or sport.

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What are shin splints?

What the name means

Shin splints usually refers to medial tibial stress syndrome, or MTSS. This causes an ache or tenderness along the lower inside border of the tibia, which is the shin bone. It is particularly common in runners, dancers and people who participate in sports involving repeated jumping, but it can affect anyone who has recently increased their activity.

Shin splints typically were thought to be caused mainly by inflammation or muscles pulling on the lining of the shin bone. We now understand the condition as more of a bone-loading problem involving the tibia and the tissues around it.

Bone is living tissue that constantly adapts. Running places small, normal stresses through the tibia. Between sessions, the bone repairs itself and gradually becomes better able to tolerate that activity. Problems can develop when the amount of repeated stress being applied increases faster than the bone can recover and adapt.

Think of the shin like a bow

One way to picture this is to imagine your tibia as a slightly flexible bow rather than a completely rigid pole. Each time your foot meets the ground, the bone bends by a tiny, normal amount. The muscles around it, particularly the calf muscles, also contract to absorb force and move you forwards.

A conditioned bow and string can repeat this thousands of times. If you suddenly add more kilometres, hills, speed or jumping without enough recovery, the whole system may become irritated. Tightness can be part of the picture, but the calf muscles are also important shock absorbers. They often need to become stronger and build more endurance, rather than only being stretched.

Why do shin splints develop?

Shin splints usually occur when the load being placed on the leg becomes greater than its current capacity. There is rarely one faulty leg muscle, shoe or running technique to blame.

Common triggers

Symptoms may appear after:

• starting running or jumping after time away
• increasing distance, speed, hills or training days too quickly
• completing several hard sessions close together
• changing to a harder running surface
• suddenly changing footwear
• adding a new sport with more jumping or direction changes
• combining training with long periods of standing or walking
• not getting enough food, sleep or recovery.

It is rarely just one factor

Other factors can affect how the leg handles this load. These may include calf strength and endurance, ankle movement, running technique, previous injuries and general bone health. No single factor tells the whole story. For example, having flat feet does not automatically mean you will develop shin splints, and buying a particular pair of shoes will not necessarily cure them.

For people with repeated shin pain or suspected bone stress injuries, nutrition and bone health may also need attention. The body requires enough energy to support both exercise and bone repair. Under-fuelling, menstrual changes, low vitamin D or a history of bone stress injury are worth discussing with a physiotherapist, GP or sports dietitian.

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Is it shin splints or a bone stress injury?

A tibial bone stress injury occurs when small amounts of bone damage accumulate faster than the body can repair them. At the more advanced end of this process, a fracture line can develop. Although shin splints and bone stress injuries are not the same diagnosis, their symptoms can overlap.

	More typical of shin splints	More concerning for bone stress injury
Where it hurts	A broader area along the inner shin	One small, clearly defined spot
When it hurts	Usually during or after running or jumping	May progress to pain and inflammation with walking, at rest or at night
Tenderness	Spread over several centimetres	Focal and sharply tender
Other signs	Often follows a recent training increase	May include swelling or pain that keeps worsening despite reduced training

These patterns are useful clues, but they cannot confirm a diagnosis at home.

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When should you have it assessed?

You should arrange an assessment if:

• you can identify one sharp painful point on the bone
• walking or everyday weight-bearing is painful
• the pain is present at rest or wakes you at night
• symptoms are getting worse or there is visible swelling
• you have had a previous bone stress injury
• the pain keeps returning whenever you resume exercise.

Trying to diagnose yourself with a hopping test is not recommended. Being able to hop does not reliably rule out a bone injury, while repeatedly hopping on a sore leg may make it more painful.

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Will you need a scan?

Shin splints can usually be diagnosed from your history and a physical examination. A physiotherapist may ask about recent training changes and assess the tender area, ankle movement, calf capacity and the way you walk or run. Imaging is not routinely needed for straightforward shin splints. If a bone stress injury is suspected, further medical assessment may be recommended. Early bone stress injuries may not show on an X-ray, so an MRI is sometimes needed.

Sudden sharp pain, marked swelling, numbness, weakness or a very tight-feeling lower leg requires urgent medical assessment, as this may indicate a different and potentially serious condition.

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What actually helps shin splints?

Adjust the aggravating activity

The first step is usually to reduce the activity that is aggravating the area. This does not necessarily mean stopping all exercise. A mild case may settle after temporarily reducing running distance, speed, hills or frequency. You may also be able to maintain fitness through pain-free cycling, swimming or strength training.

The amount of rest required depends on how irritable the pain is. Continuing with exactly the same training despite worsening symptoms gives the area little opportunity to recover. On the other hand, avoiding all activity for too long can reduce your capacity and make returning more difficult. The aim is to find a manageable level of activity, allow symptoms to settle and then rebuild gradually.

Rebuild strength and capacity

Strengthening is an important part of recovery. Depending on your assessment, rehabilitation may include:

• straight- and bent-knee calf raises
• calf and soleus endurance work
• foot, ankle, knee or hip strengthening where relevant
• balance and landing exercises
• graded hopping, jumping and running drills.

The most useful exercises depend on the person, what contributed to the overload and the demands of the activity they want to return to.

Use symptom-relieving treatments for the right reason

Ice, massage, taping or hands-on treatment may reduce pain in the short term. Insoles or a change in footwear may help some people, particularly when their shoes are uncomfortable or a recent change contributed to the problem. These treatments can support recovery, but gradual loading and strengthening are still needed to prepare the leg for running.

Give your body the chance to recover

What happens between training sessions matters as well. Eating enough, sleeping well and allowing time to recover after harder sessions help bone and muscle adapt. Concerns about nutrition, menstrual changes or bone health should also be addressed during treatment.

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Returning to running and preventing another flare-up

Signs you may be ready to begin

You do not always have to wait until you feel absolutely nothing before returning to running. Everyday walking should be comfortable, tenderness should be improving and your leg should be able to manage appropriate strength and impact exercises.

Build back gradually

A return to running often begins with short, easy running intervals separated by walking, with a recovery day between sessions. Distance is usually rebuilt before adding speed and hills. How the shin feels later that day and the following morning can be just as important as how it feels during the run.

The popular “10% rule” does not suit every runner. Progress depends on the severity of the problem, your previous training and how your symptoms respond. It is usually easier to judge your response if you change one or two things at a time instead of adding distance, speed, hills and extra training days together.

The same principle helps prevent future problems. Build new activities gradually, maintain calf and lower-limb strength, recover properly between harder sessions and respond early if shin pain begins to persist. Comfortable footwear matters, but there is no perfect shoe that can protect against every training error.

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Final thoughts: It is about load and capacity

Shin splints are not caused by one thing alone, such as tight calves, hard surfaces or worn out shoes. They usually develop when repeated running load exceeds the current capacity of the bone and surrounding muscles to recover and adapt.

The aim of treatment is not to avoid loading forever. It is to settle the injury, identify why the leg’s capacity was exceeded and gradually rebuild the runner’s ability to tolerate running.

Most people recover well with the right changes to training and a gradual strengthening program. Focal or worsening pain, pain during walking or rest, and repeated episodes should still be assessed to rule out a bone stress injury.

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This article provides general information and does not replace individual medical advice. Seek assessment from a physiotherapist, sports physician or GP if you are concerned about persistent or worsening shin pain.

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Clinical sources

• American Academy of Orthopaedic Surgeons (AAOS), Shin Splints.
• George ERM, Sheerin KR and Reid D (2024), Criteria and Guidelines for Returning to Running Following a Tibial Bone Stress Injury: A Scoping Review.
• Hoenig T et al. (2025), International Delphi Consensus on Bone Stress Injuries in Athletes.

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If you or someone you know is struggling with shin splints, you can boon an appointment with us by calling 0298753760, or you can book online.

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