Shin Splints: Causes, Symptoms, and How We Can Help
- staystrongtherapy
- Jun 30
- 6 min read
All information in this blog is supported by peer-reviewed research. There is currently no dedicated NICE guideline for this condition, so current evidence is used throughout. Reference numbers appear throughout, with the full list at the bottom of the page.
What Are Shin Splints?
Shin splints, medically known as medial tibial stress syndrome (MTSS), is a common overuse injury of the lower leg, frequently seen in athletes, runners, dancers, and military personnel. ¹ It involves exercise-induced pain along the inner edge of the shin bone (tibia), arising from repetitive stress to the muscles, tendons, and bone tissue in this area. ²
Genuinely importantly, this condition isn't simply benign inflammation. It's considered an early stress injury in the continuum of tibial stress fractures, meaning it represents an early warning sign of bone overload that can progress to a genuine stress fracture if left unmanaged. ³
What's Actually Happening? A Genuinely Interesting Mechanism Update
For years, the standard explanation for shin splints centred on periosteal inflammation, irritation of the membrane covering the bone, but more recent research has refined this picture considerably. Recent investigations in athletes with persistent symptoms have demonstrated that this is primarily a bone-related condition, related to an imbalance of local bone remodelling with a subsequent failure to repair load-induced microdamage, rather than simple inflammation alone. ⁴ ⁵ This is reinforced by bone scan findings showing a distinctive pattern of increased activity along the affected area of the shin. ⁴
There's also a genuinely interesting and relatively newer theory about which specific muscle is implicated. Anatomical studies have found that the soleus muscle, the toe flexor muscles, and the deep fascia of the lower leg all attach at the typical site of shin splint symptoms, while the tibialis posterior muscle, long assumed to be the primary culprit, does not actually attach at this same site. This suggests the tibialis posterior may contribute to shin splints through a traction (pulling) mechanism on nearby tissue, rather than direct attachment-related strain as previously thought. ⁶
Common Signs and Symptoms
Pain along the inner edge of the shin bone, typically over a broader area rather than one specific point
Pain that initially comes on during exercise and eases with rest, but can progress to pain during daily activity if unaddressed
Tenderness when pressing along the affected area of the shin
Mild swelling occasionally present along the shin
Risk Factors
Research has consistently identified the following risk factors: ⁷ ⁸
Female sex
Previous history of shin splints
High body mass index (BMI)
Reduced hip external rotation range of motion
Navicular drop, a measure related to how much the arch of the foot flattens under load
Muscle imbalance and inflexibility of the calf muscles (triceps surae)
Calf muscle weakness, which can lead to fatigue and altered running mechanics, placing additional strain on the tibia
Running on hard or uneven surfaces, including concrete, which increases impact forces through the lower limb ⁹
Inappropriate or worn footwear
Large, sudden increases in training load, volume, or high-impact exercise
In military populations specifically, where shin splints are genuinely common, affecting 35 to 56% of recruits, additional risk factors identified include low aerobic fitness and smoking. ¹⁰
What to Look Out For
Please seek medical assessment if you experience:
Pain that becomes constant, present even at rest, rather than only during activity (possible progression toward a stress fracture)
A specific, focal point of tenderness rather than pain spread along a broader area
Significant swelling or visible deformity
Numbness or tingling spreading into the foot
How Is It Diagnosed?
Shin splints can most often be diagnosed clinically, based on history and physical examination alone. ¹¹ Diagnosis is primarily based on clinical evaluation, with imaging reserved for symptoms that persist or worsen, helping to rule out the possibility of a developing stress fracture. ³
Myths vs Facts
"It's just inflammation, so anti-inflammatories will fix it." More recent research suggests the underlying process is more accurately understood as an imbalance in bone remodelling and microdamage repair, rather than simple inflammation, which is part of why addressing load and biomechanics matters more than relying on medication alone.
"I just need to push through it." This risks progression along the continuum toward an actual tibial stress fracture, a considerably more serious injury requiring a much longer recovery.
"Taping will sort this out." The evidence here is genuinely unclear. A review of kinesiology taping for shin splints found that while some studies reported positive results, the overall quality of evidence was poor to moderate, and the true efficacy of taping for this condition remains uncertain. ¹²
How We Can Help
Management genuinely emphasises modification of aggravating activities, correction of contributing biomechanical factors, structured physical therapy, and a gradual, monitored return to activity to prevent both recurrence and the more serious complication of stress fracture. ³
Osteopathic manual techniques and manual therapy: addressing restriction in the hip, ankle, and lower limb, given the recognised link between reduced hip external rotation and shin splint risk, alongside calf and foot mechanics more broadly.
Deep tissue and sports massage: targeted soft tissue work for the calf muscles, particularly the soleus, given its anatomical link to the affected area, alongside the surrounding lower leg muscles.
Medical acupuncture and cupping: used as part of a broader treatment plan to support pain management.
Load and training modification advice: practical guidance on training surfaces, footwear, and managing sudden increases in training volume, all recognised contributing factors.
Exercise and Rehabilitation
Calf strengthening: directly addressing the muscle weakness identified as a contributing risk factor, helping to reduce fatigue-related changes in running mechanics that place additional strain on the tibia.
Calf flexibility work: addressing the muscle inflexibility and imbalance linked to shin splint development.
Hip mobility and external rotation work: given the specific link identified between reduced hip external rotation and increased risk.
Gradual, structured return to load: a progressive approach to training volume and intensity, rather than a sudden return to previous levels, reflecting how sudden increases in load are a key recognised trigger.
Footwear and surface advice: where appropriate, guidance on more shock-absorbing footwear and avoiding excessive training on hard, unforgiving surfaces.
A structured rehabilitation approach, alongside gradually monitored return to activity, is genuinely important to prevent both recurrence and progression to a more serious bone stress injury. ³
What to Expect at Your First Appointment
We will take a thorough history, including your training load, footwear, and running surfaces, and carry out a hands-on assessment of your hip, calf, and ankle mechanics, alongside a thorough examination of the painful area to help distinguish shin splints from a more serious stress fracture. We will explain clearly what we find and build a progressive, evidence-based treatment plan addressing the underlying biomechanical contributors, not just the painful area itself.
Frequently Asked Questions
Do I need a scan? Not usually at first. Diagnosis is generally clinical, with imaging reserved for symptoms that persist, worsen, or raise concern about a developing stress fracture.
How long do I need to rest? A period of around 2 to 6 weeks of relative rest, combined with appropriate treatment, is commonly recommended to allow symptoms to settle before a safe, gradual return to activity.
Will this turn into a stress fracture if I keep running on it? It genuinely can. Shin splints represent an early point on the same continuum as tibial stress fractures, which is exactly why addressing it properly, rather than pushing through, matters.
Will taping help? The evidence is currently unclear, with mixed-quality research, so we wouldn't rely on taping alone as your main treatment, though it may be used alongside other, better-evidenced approaches if you find it helpful.
Recognise these symptoms? Get in touch using the contact form and we will assess and build the right treatment plan for you.
References
Medial Tibial Stress Syndrome (Shin Splint): Prevalence, Causes, Prevention, and Management in Saudi Arabia. Cureus. 2024;16(5):e59441. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11140428/
Medial Tibial Stress Syndrome (Shin Splint): Prevalence, Causes, Prevention, and Management in Saudi Arabia. Cureus. 2024. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11140428/
Medial Tibial Stress Syndrome. StatPearls Publishing. Updated December 2025. Available at: https://www.ncbi.nlm.nih.gov/books/NBK538479/
Saad MA, Jamal JM, Aldhafiri AT, Alkandari SA. Medial Tibial Stress Syndrome: A Scoping Review of Epidemiology, Biomechanics, and Risk Factors. Cureus. 2025;17(3):e81463. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11958822/
Medial Tibial Stress Syndrome: A Scoping Review of Epidemiology, Biomechanics, and Risk Factors. PMC. 2025. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11958822/
Shin Splints, a hidden epidemic among runners and athletes. Discovery Medical Science. 2025;29(160). Available at: https://discoveryjournals.org/medicalscience/current_issue/v29/n160/e79ms3571.pdf
Medial Tibial Stress Syndrome. Physiopedia. Available at: https://www.physio-pedia.com/Medial_Tibial_Stress_Syndrome
Hamstra-Wright KL, Bliven KC, Bay C. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. British Journal of Sports Medicine. 2015;49(6):362-369.
Shin Splints, a hidden epidemic among runners and athletes. Discovery Medical Science. 2025. Available at: https://discoveryjournals.org/medicalscience/current_issue/v29/n160/e79ms3571.pdf
Highlights of Medial Tibial Stress Syndrome in Military Recruits: A Narrative Review. PMC. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629594/
The diagnosis & management of medial tibial stress syndrome (shin splints): an evidence-update. ResearchGate. Available at: https://www.researchgate.net/publication/321077784_The_diagnosis_management_of_medial_tibial_stress_syndrome_shin_splints_an_evidence-update
Efficacy of kinesiology taping for shin splints. Referenced via: https://www.researchgate.net/publication/321077784_The_diagnosis_management_of_medial_tibial_stress_syndrome_shin_splints_an_evidence-update
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