Shin splints

What are shin splints, and how common are they?

Shin splints, also called medial tibial stress syndrome (MTSS), are an overuse injury that causes pain and tenderness along the inner edge of the shinbone¹. They are common, mostly in people who repeatedly load their lower legs, such as runners². They are also often seen in athletes and military personnel who run and jump repeatedly³.

Some people use "shin splints" more loosely for any pain along the shinbone, from knee to ankle⁴. In some cases the pain can get in the way of daily activity and sport¹.

If you have an ache along the inside of your shin that starts with exercise, treat it as a real injury that needs attention. Don't assume it will go away on its own.

What causes shin splints, and who gets them?

Overuse is one of the most common reasons for shin splints, such as doing more than your fitness is ready for⁴. Repeated stress on the shin bone may lead to pain and inflammation⁵. Several internal and external factors play a part¹.

The exact cause isn't certain, and it may be more of a stress reaction in the bone⁴. Compared with softer ground such as grass or sand, hard surfaces such as concrete or asphalt appear to carry a higher risk for those who run on them⁶. Less lean muscle in the lower leg is a likely risk factor². Overall, who is most at risk isn't clear yet⁷.

Build up your running or jumping load gradually, because overuse is one of the most common reasons for the pain⁴. Where you can, vary or soften the surfaces you train on, though this is only a suggestion and isn't proven yet⁶.

What does it feel like, and how is it diagnosed?

Shin splints usually cause a dull ache across a large part of the inner shin (over 5 cm), often in both legs, starting soon after exercise begins and easing with rest⁶⁸⁹. The painful area may be swollen and sore to touch⁹.

Clinicians usually reach a diagnosis by checking the leg and questioning the patient about their symptoms¹⁰. Your history matters most; tests or investigations only confirm the diagnosis and shouldn't be relied on alone¹¹.

Pain in one pinpoint spot can be a stress fracture (a small crack in the bone)⁸. Pain with walking that fades within minutes of rest may have another cause, such as reduced blood supply⁸.

What can I do first for shin splints?

Self-care comes first. Stop or ease off the activity that brings on the pain, then build back up gradually. Don't run through it: shin splints can get worse if ignored⁸, and training on unchanged can lead to a stress fracture³⁸⁹.

Shin splints can usually be treated at home⁸; they may start to get better within a few weeks⁸, though recovery can also take a long time². Care aims to correct what is overloading the leg, such as training load, the way you walk or run, and your footwear or foot mechanics¹¹. A podiatrist or physiotherapist can help you look at these.

It isn't clear yet which treatment works best, and no single approach is proven for everyone¹¹. That's why a sensible, gradual approach is the advice.

What helps if home care isn't enough?

If home care hasn't worked, it's better not to keep repeating it. A stress fracture, compartment syndrome (another cause of leg pain with exercise) or pain referred from your back can feel similar⁴.

It isn't clear yet which extra treatments help. Care that corrects overload factors comes first, and surgery is considered only for stubborn cases¹¹.

Don't leave a suspected stress fracture to settle on its own, as some need aggressive treatment¹²¹³.

How long does it take to get better, and can I stop it coming back?

Recovery varies, and for some people it takes a long time². Carrying on with training unchanged can turn mild, activity-related discomfort into more persistent pain, and in severe or prolonged cases it can raise the risk of a stress fracture³. Build back gradually, and adjust your load if mild pain returns.

Neuromuscular training (exercises that retrain how the muscles control the leg) and insoles for people who overpronate (whose feet roll inwards) help prevent shin splints¹⁴. That applies to stopping them developing in the first place, not to treating them once they're established¹⁴. It isn't clear yet what stops them coming back after recovery. A physiotherapist or podiatrist can advise on both.

What can make it serious?

• You have new numbness, tingling, pins and needles or weakness in your foot that has come on gradually.
• You get aching or cramping in your calf, thigh or foot when you walk that eases when you rest.
• Your pain is getting worse, or doesn't settle with rest, less activity or pain relief.