Shin splints

Also called Medial tibial stress syndrome

Shin pain from doing too much too soon. The important job is separating it from a stress fracture, which needs rest rather than modification.

What it is

Pain along the inner border of the shin bone, caused by overloading the bone and the soft tissue attached to it. It is a classic overuse injury of runners, dancers, military recruits and anybody who increases activity too quickly.

The usual causes are a sudden increase in training volume, hard surfaces, worn or unsuitable footwear, poor running mechanics, and weak calf and hip muscles.

**The critical distinction is from a tibial stress fracture.** Shin splints cause diffuse pain over several centimetres that typically eases as the person warms up. A stress fracture causes sharply localised pain over one point, pain that worsens through activity, pain at rest and at night, and pain on hopping. A stress fracture needs a period of complete rest from impact, and continuing to run on one can lead to a complete fracture.

Female athletes with irregular or absent periods are at particular risk of stress fractures, as part of relative energy deficiency in sport, and that should be asked about directly rather than treated as a separate matter.

Other causes of shin pain include compartment syndrome of the chronic exertional type, and, in an older person, peripheral arterial disease.

Treatment is load management, strengthening, and correcting footwear and training errors.

Signs you might notice

Aching or sharp pain along the inner edge of the shin, spread over several centimetres.

Worse at the start of exercise, often easing as it warms up, then worse afterwards.

Tenderness along the bone edge.

Mild swelling sometimes.

Suggesting a stress fracture instead, and needing assessment: pain localised to one small point; pain that worsens as exercise continues; pain at rest or at night; and pain on hopping on that leg.

Suggesting chronic exertional compartment syndrome: tightness and pain building predictably at the same distance, with numbness or foot drop, relieved by stopping.

Urgent: severe pain with a tense swollen calf, numbness, or a cold foot.

How it can affect day-to-day life

The training error is usually visible in the story: a new running plan, a return after a break, a change of surface, or old shoes. Fixing that is the treatment; rest alone allows a return to the same mistake.

Complete rest is rarely necessary. Cross-training on a bike or in water maintains fitness while impact is reduced.

The ten per cent rule, increasing weekly volume by no more than about a tenth, is a reasonable rule of thumb for return.

Calf, hip and foot strengthening addresses the underlying mechanics, and is more effective than insoles alone for most people.

For military recruits and new runners, this is extremely common and is a training design problem as much as an individual one.

Persistent shin pain that does not settle over several weeks deserves imaging rather than more rest.

Supporting someone well

Reduce the load rather than stopping altogether: fewer miles, softer surfaces, and cross-training.

Identify and fix the training error: too much, too soon, too hard a surface, or worn shoes.

Get shoes that fit and are not worn out, and replace them regularly.

Strengthen calves, hips and feet; this is where the lasting fix is.

Increase volume gradually when returning.

Ask for assessment if pain is at one point, worse through exercise, or present at night; that may be a stress fracture.

Ask about periods and about eating in a female athlete with a stress fracture; low energy availability is a common underlying cause.

Ask for physiotherapy for persistent pain.

Where to get help

A pharmacist for pain relief; a GP practice or self-referral to physiotherapy.

Sports medicine or imaging for suspected stress fracture.

Urgent care for severe pain with a tense swollen calf.

Chartered Society of Physiotherapy publish running injury guidance.