Shin Splints: Causes, Treatment and How Long They Last

What are shin splints?

Shin splints are pain in the lower leg caused by repeated stress on the shin bone, the tibia. The medical name is medial tibial stress syndrome.¹

They are one of the most common causes of lower leg pain from exercise, and they mostly affect runners, dancers and people in military training.^1,3 Reviews put the share of runners affected at somewhere between 5 and 35 per cent.⁴ Across eight studies of runners, between 13.6 and 20 per cent developed them.⁷ In one study that followed 839 recreational runners for 24 weeks, shin splints were the most common injury of all.⁸

What shin splints feel like

• A dull, aching pain along the inner edge of the shin bone. Less often it is along the front.¹
• Pain that gets worse with activity and improves with rest.¹
• Tenderness when you press along the bone. Typically the sore strip is at least 5 centimetres long, not one small spot.³

Left alone and trained through, shin splints tend to get worse over time.¹

What causes them?

For years shin splints were blamed on muscles tugging at the lining of the bone. The better evidence now points to the bone itself. Repeated impact breaks bone down slightly faster than the body can rebuild it, and the overloaded bone becomes painful.^2,3

That fits how they usually start. Common triggers are:^1,2

• A sudden increase in how far, how often or how hard you train
• Running on hard or uneven surfaces
• Worn-out or unsupportive shoes
• Flat feet, or feet that roll inwards

A pooled analysis of 10 studies in runners found a higher risk in women, in people with fewer years of running behind them, in people with a higher body mass index and in people whose arch drops more when they stand. Having had shin splints before raised the risk more than threefold.⁴

Shin splints or a stress fracture?

Untreated shin splints can get worse and may lead to a stress fracture, a small crack in the bone.¹ The two are points on the same spectrum. Stress fractures come from repeated loading on normal bone and are most common in runners, and shin splints cover a range of bone stress injury from swelling inside the bone through to a crack.⁹

Telling them apart matters, because a stress fracture needs a longer break from impact. With shin splints the tender strip along the bone is usually at least 5 centimetres long, and the diagnosis is made by examining the leg.³ If your doctor is worried about a stress fracture, they may order an X-ray, a bone scan or an MRI.¹

Other conditions can cause shin pain as well, including pressure building up in the muscle compartments of the leg and pain referred from the back.²

What helps?

The honest summary of the research is that nothing has been shown to work better than rest followed by a gradual return. A systematic review of 11 treatment trials found none was reliable enough to recommend any particular treatment.⁵ In the three earlier randomised trials, rest did as well as any intervention.³

Ease off, but keep moving

• Cut back or stop the activity that brings on the pain.¹
• Swap to low-impact activity, such as swimming or cycling, while you recover.²
• Ice the sore area for 15 to 20 minutes, several times a day.¹
• Anti-inflammatory medicines are sometimes used for a short time.²

Build back gradually

Once walking and day-to-day activity are pain free, return to running in small steps. In a trial of 74 athletes with shin splints, a graded running program worked just as well alone as it did with added calf exercises or a compression stocking.⁶

Get the load and the mechanics checked

A physiotherapist or exercise physiologist can guide strengthening and look at your running form. A podiatrist can assess your feet. Shoe inserts are sometimes prescribed for flat feet.^1,2

How long do shin splints last?

Longer than most people expect. In the study of recreational runners, the median time from the first pain to being pain free was 70 days for shin splints, the slowest recovery of the common running injuries.⁸

Preventing them

• Increase your training gradually, and warm up properly.¹
• Wear well-fitting running shoes and replace them before they wear out.^1,2
• Where you can, run on flatter, softer surfaces such as grass or a track.²
• Shock-absorbing insoles may help. Two large studies found they helped prevent shin splints.³

When to see a doctor

• The pain is severe, or has not started to ease after a few days of rest²
• It hurts in one small spot, or at rest or at night
• Your shin is swollen, or your foot feels numb or weak
• It keeps coming back whenever you return to running

See also our guides to knee pain, plantar fasciitis and ankle pain.

References

1. healthdirect. Shin splints.
2. Better Health Channel. Shin splints.
3. Moen MH, Tol JL, Weir A, et al. Medial tibial stress syndrome: a critical review. Sports Med. 2009;39(7):523-46.
4. Newman P, Witchalls J, Waddington G, et al. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access J Sports Med. 2013;4:229-41.
5. Winters M, Eskes M, Weir A, et al. Treatment of medial tibial stress syndrome: a systematic review. Sports Med. 2013;43(12):1315-33.
6. Moen MH, Holtslag L, Bakker E, et al. The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial. Sports Med Arthrosc Rehabil Ther Technol. 2012;4:12.
7. Lopes AD, Hespanhol Júnior LC, Yeung SS, et al. What are the main running-related musculoskeletal injuries? A Systematic Review. Sports Med. 2012;42(10):891-905.
8. Mulvad B, Nielsen RO, Lind M, et al. Diagnoses and time to recovery among injured recreational runners in the RUN CLEVER trial. PLoS One. 2018;13(10):e0204742.
9. Matcuk GR Jr, Mahanty SR, Skalski MR, et al. Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options. Emerg Radiol. 2016;23(4):365-75.