Shin Splints: Diagnosis and Treatment is an umbrella term for exercise-induced pain at the front of the lower leg. It’s a frustrating condition that can bring your training to a halt. So what causes shin splints, and what can you do about them?

What are shin splints?

The pain of shin splints – or ‘medial tibial stress syndrome’ (MTSS) – is an early sign of overworked tissues at the front of the lower leg. If untreated, it can progress to a stress fracture in the shin bone (tibia).

While there’s no consensus on exactly what happens during a bout of shin splints, theories include micro-tears of the muscles at the front of the shin, the muscle becoming partially pulled away from the bone, and tearing of the bone’s connective tissue covering. Or it might be a combination of these, which all result in inflammation – and therefore pain.

Who gets shin splints?

MTSS is an overload syndrome, often resulting from a sudden increase in activity, without allowing proper recovery.

High-impact activities, such as running, jumping and dancing increase the risk of developing MTSS.

In addition, uneven loading during exercise can trigger this painful condition. We naturally tend to be dominant on one side, and it’s often the dominant leg that suffers.

For example, repeatedly running on a cambered road loads one leg more than the other, and shin splints can be the outcome. Adding hills to your route can also cause overload.

And there are also ‘built-in’ biomechanical factors. Overpronation, flat or rigid foot arches, or poor mobility at the hip, ankle or even the mid-back have all been linked to the development of shin splints.

What does it feel like?

You’ll have pain along the shin bone that worsens with exercise. There’s also tenderness when you press the affected area.

The pain can be either along the inside or outside edge of the bone, typically in the middle or lower section of the shin.

As it progresses, the pain may become more constant, feeling sore after rest as well as exercise. This is a sign of the inflammation that’s occurring.

Is my pain definitely shin splints?

No – while MTSS is common (affecting up to 20% of runners), there are other conditions that cause pain in the same area.

Compartment syndrome also causes pain along the outside edge of the shin bone. This happens when the muscle, which is contained in a pocket of connective tissue, swells, causing an increase in pressure.

The pain of compartment syndrome can be accompanied by tingling and numbness, and eventually by muscle weakness. If diagnosed, it can be treated by a surgical incision to release the pressure.

Alternatively, and further along the continuum of overuse injuries, the pain may be a stress fracture of the shin bone. A stress fracture is incomplete – a crack in the bone. When new, stress fractures don’t always show up on X-ray; MRI is a better diagnostic tool.

It can be difficult to tell these conditions apart. But a stress fracture tends to have sharp and localised tenderness, whereas shin splint pain is generally more diffuse. And, where shin splints can be sore in the morning, the pain of a stress fracture eases with inactivity.

What should I do if I have shin splints?

Since MTSS is an overuse injury, rest is key to recovery. Depending on the severity of your symptoms, you may be able to reduce your activity, or you may need to stop altogether until you’ve healed. Cross-train with a low-impact exercise such as swimming or cycling, or use an elliptical trainer.

The next step is to ice the shin. Apply an ice pack several times a day for maximum benefit, especially after exercise.

A topical anti-inflammatory cream can also help to bring down the inflammation.

Get a boost of vitamin D. The sunshine vitamin is vital for bone health, and low levels can put you at risk of overload conditions, including MTSS and stress fractures.

Check your footwear. Make sure you have good support, particularly if you roll onto the inner part of your foot when walking or running (overpronation). This gait pattern means extra stress for the leg muscles as they try to balance the foot, with ensuing microtears, trauma and inflammation. There are plenty of running shoes available that counteract overpronation – seek a biomechanical assessment from a running store with video analysis, or from a qualified therapist. Take your current running shoes with you to demonstrate your gait.

And when you return to exercise, do so gradually. If you’re a runner, stick to trails rather than tarmac. But if you are on roads, change directions on a camber to even out the loading.


However, underlying mechanical problems may still need addressing if you’re going to avoid a repetition of the pain.

Runners can have their gait analysed at most good running stores to ensure they have the right trainers for their type.

If you participate in a sport that involves a lot of heavy landing, such as tennis, basketball or gymnastics, you’ll need a carefully planned programme of conditioning so your muscles can adapt to the demands of the sport. Seek the help of an exercise specialist to help you develop a plan based around your specific strengths and weaknesses.

Check in with a qualified osteopath who can look at the way you function biomechanically. Here at OCHK, we evaluate our patients’ movement patterns to determine whether limitations in one area are impacting elsewhere. Problems with joint mobility and muscle balance have been implicated in the onset of MTSS, so have a check to prevent your shin splints recurring.

Shin splints? We can help!

If you think you might have shin splints, our team of expert therapists can guide you back to health. From osteopathy to yoga therapy to corrective exercise, we can put together a plan to get you back on your feet. Book today!

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