Shin Splints

Shin Splints 

‘Shin Splints’ is not an official diagnosis but a term used to describe pain felt on the front or along the inside border of the shin. This pain can be the result of different causes, some more serious than others so it is important to have your pain assessed so that it’s cause can be identified and treated appropriately. 

In runners, the most common and treatable cause of shin splints is ‘Medial Tibial Stress Sydrome’ (MTSS) which is a reaction of the ‘periosteum’ which lines the medial border of the tibia. There are several theories which may explain the cause of the reaction but it is widely considered to be an inflammatory reaction due to excessive traction on the periosteum pulling away from the bone. More serious conditions such as a stress fracture (incomplete crack through the bone) or compartment syndrome (swelling of muscles within a closed compartment of the lower leg) can be the cause of shin pain. 


MTSS usually presents as a dull ache along the inner border of the shin. Often both sides are affected. Pain is normally worst first thing in the morning, it is often at its very worst at the start of a run, it may improve a bit as you warm up only to ache after finishing. There will be a generalised tenderness on palpation along the shin bone, if there is a sharp pain just on one specific point this may be indicative of a stress fracture. It is not uncommon for generalized MTSS to evolve into a focal stress fracture.  

Other signs of a stress fracture include pain confined to a single point, worsening pain with continued activity andreduced pain with rest (these will generally feel better in the morning). Stress fractures will only show up on a plain X ray when they are quite severe. Most will only show up on an MRI or Bone Scan. While a bone scan is the most sensitive test, MRIs have no radiation and are usually preferred in all but the most difficult cases. 

Shin pain caused by compartment syndrome will present on the outside the shin over a more fleshy muscular area. There may be a feeling of ‘increased pressure’ in the lower leg or pins and needles/numbness due to compromise of neural tissue in the compartment. Pain will come on and worsen during a run and continue after stopping. Compartment pressure testing performed by a Specialist Sports Physician can be used to confirm this diagnosis and involves inserting a needle into the compartment and measuring it’s pressure before and after running on a treadmill. 


All forms of shin injury are caused by over loading of the tissues in the lower leg. MTSS is common in new runners who have not yet adjusted to the stress of running or runners who increase their training load too rapidly. An imbalance between the calf and anterior lower leg muscles may also be behind the cause which is usually that the calf muscles are overly tight and the anterior muscles are weak. Other factors which may lead to overload are over pronation of the foot, wearing poorly fitted or worn out footwear, instabilities at the hip and training on hard surfaces. 

Stress fractures can be predisposed by any of the above factors and may also be linked to osteoporosis or hormonal imbalance more commonly in female runners. Compartment syndrome can be associated with overuse, calf muscle tightness and increased calf size. 

Prevention and Treatment  

At the first sign of any shin pain, it is always best to see a Physiotherapist to identify the cause of pain and allow early management to begin before the condition worsens. The Front Runner Physiotherapists are experienced in diagnosis of shin pain and will have your condition treated promptly using a holistic approach to ensure all contributing factors are accounted for. 

Self-management strategies for MTSS including icing the painful area, anti-inflammatory medication, reducing your training load, sticking to running on soft surfaces and regular calf stretching. Physiotherapy treatment techniques including soft tissue release, dry needling and a stretching/strengthening program will help to reduce your recovery time and help to prevent re-injury. 

Not all stress fractures are the same. A low grade stress response in the fibula can mean as little as 4 weeks out from running if you are really lucky. A stress fracture in the tibia can be more serious. The inside and posterior border of the tibia has a great healing capacity but the front border of the tibia can be one of the nastiest spots there is for a stress fracture and can often mean complete rest with crutches and even aggressive surgery.  All stress fractures should be seen by a specialist Sports Physician who will help your physio to manage it correctly but also to investigate for underlying causes. 

So it is important to have these conditions diagnosed as early as possible for your best chance at a full and speedy recovery. 

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