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Shin splints — medically known as medial tibial stress syndrome (MTSS) — is one of the most common running injuries, affecting up to 35% of recreational runners and military recruits. That aching, diffuse pain along the inner shin that starts after a few kilometres of running and lingers for hours after stopping is one of the most frustrating overuse injuries to manage — but physiotherapy gets it right.
What Are Shin Splints?
Shin splints occur when the tibia (shin bone) and the fascial attachments of the lower leg muscles are overloaded, causing localised bone stress and periosteal inflammation along the posteromedial border of the tibia. The condition sits on a continuum from mild soft tissue irritation through to tibial stress fracture if left untreated and overloaded.
Risk Factors
- Rapid increase in training volume or intensity
- Running on hard surfaces (concrete, asphalt)
- Worn or inappropriate footwear
- Foot overpronation (excessive inward rolling)
- Weak hip and calf muscles
- Female sex (higher relative incidence in runners)
- Low bone density
Physiotherapy Treatment
- Load management: Reducing running volume to a pain-free level — typically by 50% initially — then increasing by no more than 10% per week
- Calf and tibialis posterior strengthening: Eccentric and isometric calf exercises progressively load the tibia and periosteum, stimulating bone adaptation
- Hip strengthening: Weak hip abductors increase tibial rotation and tibial stress — a frequently overlooked driver of MTSS
- Running reanalysis: Increasing cadence (steps per minute) by 5–10% reduces tibial loading forces significantly. Avoiding heel striking and increasing forward lean also reduces shin stress.
- Footwear assessment: Appropriate motion control for overpronators; replacing worn footwear
- Bone stress management: Calcium and vitamin D optimisation, particularly in female athletes
Return to Running
Return to running follows a graduated program: walk → walk/run intervals → continuous jogging → progressive distance increase. The key rule: if pain during a run exceeds 3/10 and does not settle within 30 minutes of finishing, the load was too high. Pull back and progress more gradually.
Frequently Asked Questions
What causes shin splints?
Shin splints are caused by excessive loading of the tibia (shin bone) and surrounding muscle fascia — most commonly from a sudden increase in running volume, intensity, or surface. Beginning a new running program, returning after a break, or switching to harder surfaces are classic triggers.
Does stretching help shin splints?
Stretching alone has limited evidence for shin splints. Load management — reducing the training stimulus that is overloading the tibia — is the most important intervention. Progressive calf and tibialis posterior strengthening, and addressing running technique, produce better long-term results than stretching.
Do I need orthotics for shin splints?
Sometimes. Foot overpronation can contribute to MTSS by increasing tibial rotation. A temporary orthotic may reduce symptoms, but addressing the underlying weakness and running mechanics is more effective long-term. Your physiotherapist can advise whether orthotics are appropriate.
Can shin splints turn into a stress fracture?
Yes. MTSS exists on a continuum — from bone marrow oedema (stress reaction) to a frank stress fracture. Continuing to run on symptomatic shins, or rapidly increasing load, risks progression. Physiotherapy early prevents this outcome.
Ashley Haleel
Physiotherapist & Owner — Better Physiotherapy Bundoora