Shin splints are pain along the inside edge of the shin bone (tibia) that comes on with running or jumping. The clinical name is medial tibial stress syndrome (MTSS). Evidence suggests it's an early bone stress injury: the tibia is loaded faster than it can adapt. Picked up early, it usually responds well to load management and strength work.1,2
Shin pain is one of the most common injuries in runners and field sport athletes, estimated to affect between 4% and 35% of runners.1 Because it's so common, it's often misunderstood. Many people either rest until the pain settles and then return to the same training, or push through until symptoms worsen. Neither approach addresses why the bone was overloaded in the first place. This guide covers what shin splints are, what causes them, how they're assessed, how they're commonly managed and how runners return to running.
What are shin splints?
Shin splints is the everyday name for medial tibial stress syndrome: diffuse, aching pain along the inner (posteromedial) border of the tibia during or after exercise. It's best understood as an early stage of bone stress injury, where repeated loading has outpaced the bone's ability to remodel and strengthen.2
The tibia is one of the main load-bearing bones of the leg, and every stride, take-off and landing sends force through it. Those forces aren't harmful in themselves. Bone responds to load by breaking down and remodelling, becoming thicker and more resilient over time. This is described by Wolff's Law: bone remodels according to the mechanical loads placed on it. Appropriate loading strengthens bone; excessive loading without adequate recovery has the opposite effect.
During running, the tibia experiences several times body weight with every step, adding up to thousands of loading cycles in a typical run. When these repetitive loads accumulate faster than the bone can remodel, symptoms develop, usually from a combination of factors rather than one.3
The term "shin splints" is sometimes used loosely for any lower leg pain, including tendinopathies and compartment problems. That's one reason an accurate assessment matters: the figure above shows how stress fractures, MTSS and tendinopathies differ by location on the tibia.
What do shin splints feel like?
Shin splints usually feel like a dull, diffuse ache along the inner edge of the lower half of the shin. The sore area is typically longer than 5 cm and tender to touch. Pain often appears early in a run, may ease as you warm up, then returns afterwards or the next morning.2
Common signs include:
- Aching along the inside border of the shin bone during or after running, jumping or hopping.
- Tenderness spread over a length of bone (generally more than 5 cm), rather than a single sore spot.
- Pain that's worse after a sudden jump in training, a return from time off or a change in shoes or surface.
Pain that sits more towards the front of the shin, covers a small area (under 5 cm), hurts at rest or at night, or makes hopping on that leg painful raises suspicion of a tibial stress fracture.2 That needs prompt assessment and, often, an MRI.
What causes shin splints?
Shin splints develop when the load going through the tibia exceeds what the bone can currently adapt to. That rarely comes down to one cause. It's the interaction between your intrinsic characteristics and the external loads you apply, with sudden changes in training load the most common and most modifiable driver.4,5
Intrinsic factors include previous bone stress injuries, reduced calf or lower limb strength, altered running mechanics, limited ankle mobility, low energy availability, vitamin D deficiency and inadequate recovery. Together, these may reduce the bone's ability to tolerate repetitive loading.4
Extrinsic factors relate to the stresses applied to the body. Sudden increases in running volume or intensity, returning to sport after time away, changes in footwear, harder running surfaces and large volumes of sprinting or jumping all increase the mechanical demands on the tibia.
Running mechanics can play a part too. Research suggests a longer duration of pronation during stance, as well as contralateral hip drop, may predispose runners to MTSS. A prospective study of cross-country runners found every 1% increase in pronation duration increased the odds of developing MTSS by 1.38 times.4,7
Ultimately, training load is the most modifiable risk factor. Good management focuses on which factors are relevant to you, rather than assuming every case develops for the same reason.
Are shin splints a stress fracture?
Not usually, but they sit on the same spectrum. MTSS is an early stage on the bone stress continuum, with changes around the periosteum (the bone's outer layer). If loading continues to outpace adaptation, it can progress to deeper bone changes and eventually a stress fracture. That's why worsening shin pain shouldn't be ignored.5
The Fredericson classification helps conceptualise where someone sits on this continuum based on MRI.5 MTSS appears consistent with grades 1–2, where changes are seen around the periosteum and people feel diffuse, aching pain along the tibia. Left unmanaged, this can progress to grades 3–4, where bone breakdown becomes prominent in the deeper layers. Once a breach extends from superficial to deep, it's consistent with a stress fracture.
Periosteal oedema on MRI doesn't diagnose MTSS on its own; some people have oedema on MRI and no pain at all.6 Clinical findings need to line up with imaging to determine the diagnosis.
How are shin splints diagnosed?
Shin splints are diagnosed clinically, through your history and a physical examination. A physio will look at where it's sore, how far the tenderness spreads and how well you tolerate loading tasks such as calf raises, hopping and jumping. An MRI is mainly used to rule out a stress fracture or grade the injury.2
Clinical assessment generally combines functional testing (your ability to load through the calf, tolerance to jumping and hopping) with palpation of the sensitive area. MTSS is generally felt on the posteromedial aspect of the tibia over a length greater than 5 cm. If the sensitive area sits more anteriorly with a smaller radius (under 5 cm), a tibial stress fracture may be suspected and an MRI is warranted.2
Looking through a broader lens, assessment also considers running mechanics and local and proximal strength and endurance. A running gait analysis can help identify mechanical contributors, such as pronation duration and hip drop, that may be worth addressing.
How do you treat shin splints?
Shin splints treatment aims to stop the bone progressing along the stress continuum while gradually rebuilding its capacity. That usually means reducing running load to a tolerable level rather than stopping completely, cross-training to maintain fitness, progressive strength work for the calf and lower limb, then a staged return to impact and running.
Bone adapts positively to progressive mechanical stress, provided the loading is appropriate. A systematic review of MTSS treatments found no single intervention clearly superior,8 which is why management focuses on load and capacity rather than any one passive treatment.
Manage training load
The first step is reducing stress on the tibia to a level it can tolerate. Complete rest is rarely necessary. Modifying running volume, frequency or intensity often allows symptoms to settle while keeping enough stimulus for ongoing bone adaptation. Cross-training, such as cycling, swimming or anti-gravity treadmill running, can preserve cardiovascular fitness while temporarily reducing repetitive tibial loading.
Build capacity
As symptoms improve, attention shifts to the factors that contributed to the injury. Progressive strength training for the calf complex, lower limb and trunk improves the body's ability to absorb force. Commonly used exercises include calf raises (straight and bent knee), single-leg strength work and, later, hopping and plyometrics, which gradually reintroduce impact to stimulate bone remodelling.
How do you get rid of shin splints quickly?
There's no reliable shortcut, because bone adapts over weeks, not days. The approaches most likely to help are reducing the load that provoked the pain early, staying active with lower-impact training and building strength. Ice and rest may ease pain short term, but don't change the bone's capacity on their own.
Returning to the same training as soon as the pain fades is a common reason symptoms come back. Pain is rarely the problem in itself; it's a signal that current training load exceeds the bone's present capacity. Management therefore focuses on increasing capacity, not just making pain go away.
How long do shin splints take to heal?
Recovery times vary widely and there's no set timeline. The outlook for MTSS is generally good when it's identified early and load is adjusted. Cases that progress towards a tibial stress fracture take considerably longer, and a stress fracture on the front of the tibia can mean several months away from running.5,9
Many athletes can continue running during recovery with modifications, as long as pain stays stable and doesn't worsen over 24 hours. If it's worsening, that's a sign you're pushing beyond what the bone can cope with, and continuing to train that way significantly increases the risk of progressing to a stress fracture. For context, a stress fracture on the anterior (front) cortex of the tibia is considered high risk because it has a poorer blood supply and heals slowly.9
Returning to running after shin splints
Return to running after shin splints is usually gradual and guided by symptoms rather than the calendar. It commonly starts with walk-run intervals on flat, forgiving surfaces, progressing to continuous running, then longer durations and finally faster speeds, hills or sport-specific training, changing one variable at a time.
- Pain rule: pain during and after running should stay mild (generally 3/10 or less) and return to baseline within 24 hours.
- One change at a time: increase volume, frequency or intensity separately so a flare-up can be traced to its cause.
- Keep strength work going: calf, lower limb and trunk strength remain part of the plan after you're back running.
- Review the drivers: footwear changes, surfaces, training spikes, energy availability and running mechanics are all worth checking before you build back up.
Our physio for runners service and the RunLab running assessment, which includes running gait analysis, are designed to look at these factors together and build an individual return-to-running plan.
How to prevent shin splints
Preventing shin splints comes down to giving your bones time to adapt. Build running volume and intensity gradually, avoid sudden jumps after time off, change shoes and surfaces slowly, keep up calf and lower limb strength work and make sure you're eating enough to support your training and recovery.4,5
healthdirect emphasises gradual increases in training and adequate warm-up.10 If you've had a bone stress injury before, you may be at higher risk, so a structured plan for building load is especially worthwhile. Related reading: calf strains in runners and Achilles tendinitis, two other common lower leg complaints in runners.
FAQs
Can I keep running with shin splints?
Often, yes, with changes. Many runners keep running at a reduced volume, frequency or intensity, provided pain stays mild (generally 3/10 or less) and settles back to baseline within 24 hours. Pain that builds run to run, or is sharp and focused on one spot, is a sign to stop and get assessed.
How long do shin splints take to heal?
There is no set timeline. Recovery depends on how early the problem is picked up, where you sit on the bone stress continuum and how well training load is adjusted. Early, well-managed cases often settle over weeks, while cases that have progressed towards a stress fracture can mean several months away from running.
Are shin splints the same as a stress fracture?
No, but they sit on the same continuum. Medial tibial stress syndrome is an early bone stress injury with diffuse pain along the inner shin. A stress fracture is further along the continuum and usually causes sharp pain over a small, focal spot. An MRI may be used to tell them apart.
Should I ice shin splints?
Ice may help ease pain in the short term, and healthdirect lists rest and ice among self-care options. On its own it doesn't change the bone's capacity to tolerate load, so it's commonly used alongside load management and strength work rather than instead of it.
Do shoes or insoles help shin splints?
They might, for some people. A sudden change in footwear is a known extrinsic risk factor, so keeping changes gradual is sensible. Research on insoles for MTSS is mixed, which is why footwear is usually considered as one part of a broader, individual plan rather than a stand-alone treatment.
When should I see a physio about shin pain?
It's worth getting assessed if shin pain is getting worse from run to run, lingers the next day, hurts when you walk or at rest, or feels sharp over one small spot. These features may point to a higher-grade bone stress injury that needs a different approach.
If you're dealing with shin pain or suspect shin splints, consider a running injury assessment at our West End, Newstead or Woolloongabba clinics for an individualised loading and rehabilitation plan.
Book Now
References
- Winters M. The diagnosis and management of medial tibial stress syndrome. Der Unfallchirurg. 2019;123:15-19. doi:10.1007/s00113-019-0667-z
- Moen M, Tol J, Weir A, Steunebrink M, Winter TC. Medial Tibial Stress Syndrome. Sports Medicine. 2009;39:523-546. doi:10.2165/00007256-200939070-00002
- Matijevich ES, Branscombe L, Scott LR, Zelik K. Ground reaction force metrics are not strongly correlated with tibial bone load when running across speeds and slopes: Implications for science, sport and wearable tech. PLoS ONE. 2019;14. doi:10.1371/journal.pone.0210000
- Becker J, Wu W. Factors Contributing to Medial Tibial Stress Syndrome in Runners: A Prospective Study. Medicine & Science in Sports & Exercise. 2018;50:2092–2100. doi:10.1249/mss.0000000000001674
- Franklyn M, Oakes B. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments. World journal of orthopaedics. 2015;6 8: 577-89 . doi:10.5312/wjo.v6.i8.577
- Craig DI. Current Developments Concerning Medial Tibial Stress Syndrome. The Physician and Sportsmedicine. 2009;37:39 - 44. doi:10.3810/psm.2009.12.1740
- Becker J, James S, Wayner R, Osternig L, Chou L. Biomechanical Factors Associated With Achilles Tendinopathy and Medial Tibial Stress Syndrome in Runners. The American Journal of Sports Medicine. 2017;45:2614 - 2621. doi:10.1177/0363546517708193
- Winters M, Eskes M, Weir A, Moen MH, Backx FJG, Bakker EWP. Treatment of medial tibial stress syndrome: a systematic review. Sports Medicine. 2013;43:1315–1333. doi:10.1007/s40279-013-0087-0
- Warden SJ, Davis IS, Fredericson M. Management and prevention of bone stress injuries in long-distance runners. Journal of Orthopaedic & Sports Physical Therapy. 2014;44(10):749–765. doi:10.2519/jospt.2014.5334
- healthdirect. Shin splints. healthdirect.gov.au/shin-splints (accessed October 2026).