Shin Splints in Runners: Why They Happen and What You Can Do About Them
Shin pain is one of the most common complaints among runners, particularly when increasing training for a race, returning to running after some time off, or simply trying to run more consistently.
It's often labelled as "shin splints", but what does that actually mean? And perhaps more importantly, why does it happen?
What Are Shin Splints?
"Shin splints" is a broad term commonly used to describe pain along the inside of the shin bone during or after running.
One of the most common causes is medial tibial stress syndrome (MTSS). This typically presents as a more diffuse area of tenderness along the inner border of the tibia rather than one very specific painful spot.
Symptoms may include:
Pain or tenderness along the inside of the shin
Pain at the beginning of a run
Symptoms that increase as running volume increases
Tenderness when pressing along the tibia
Shin pain after running or the following morning
Although shin splints are common, persistent shin pain shouldn't automatically be assumed to be MTSS. Other conditions, particularly bone stress injuries, can produce similar symptoms and may require different management.
Are Shin Splints Really an "Overuse" Injury?
Shin splints are often described as an overuse injury, but I think this can sometimes be misleading.
Running itself isn't necessarily the problem.
A more useful way to think about it is as a mismatch between the amount of load you're exposing your body to and the amount of load your tissues are currently prepared to tolerate.
Your bones, muscles and tendons adapt to the stresses you repeatedly place on them. Running provides a stimulus for these tissues to become stronger, but adaptation takes time.
If training demand increases faster than your capacity to tolerate it, symptoms can develop.
Rather than simply asking:
"Am I running too much?"
A better question may be:
"Am I currently prepared for the amount of running I'm doing?"
Why Do Runners Develop Shin Pain?
There usually isn't one single cause.
Shin pain can appear following changes such as:
Increasing weekly running distance
Adding more running days
Introducing faster sessions or intervals
Increasing the length of long runs
Returning to running after a break
Suddenly adding hills
Changing running surfaces
Combining increased running with additional sport or gym training
Not allowing enough recovery between harder sessions
It's also important to consider time on your feet.
Two runners could both complete 40 kilometres per week, but if one completes those kilometres significantly slower, they may spend considerably more total time loading their legs.
This doesn't mean slower running is bad. It simply means kilometres alone don't tell us everything about training load.
It's Not Always About Your Running Technique
When runners develop shin pain, there's often an immediate temptation to blame their shoes, foot position, cadence or running technique.
These factors can sometimes be relevant, but there isn't one universally "correct" way to run.
Before trying to completely change someone's running style, I generally want to understand what changed around the time their symptoms started.
Did their mileage suddenly increase?
Did they introduce intervals?
Did their long run jump from 12 km to 18 km?
Did they start running five times per week instead of three?
Did they increase their overall time on feet?
Sometimes the answer is less about how somebody runs and more about whether their current training demands have exceeded their current capacity.
Shin Splints vs a Bone Stress Injury
This is an important distinction.
Medial tibial stress syndrome commonly causes a relatively diffuse area of tenderness along the inner shin.
A bone stress injury may be more concerning when pain becomes increasingly localised or is associated with symptoms such as:
A very specific point of tenderness over the bone
Pain that progressively worsens with running
Pain with hopping or impact
Pain during normal walking
Symptoms occurring at rest or at night
These findings don't automatically mean someone has a stress fracture, but they are reasons to have the injury properly assessed rather than simply continuing to run through it.
Should You Stop Running?
Not necessarily.
For many cases of shin splints, completely stopping all activity isn't automatically required. Instead, the goal is to find a level of running and exercise that symptoms can tolerate while allowing the irritated tissues to recover.
Depending on the individual, this might involve temporarily:
Reducing weekly running volume
Shortening individual runs
Removing higher-intensity sessions
Reducing hills
Increasing recovery between runs
Using cycling, swimming or other forms of cross-training to maintain fitness
The important word here is temporarily.
The long-term goal isn't simply to avoid load. It's to gradually rebuild the capacity to tolerate it.
Strength Training for Shin Splints
Rehabilitation should also look at the physical demands of running.
Depending on the runner, exercises may target the calf complex, soleus, foot and ankle muscles, and the wider lower limb.
Examples might include:
Straight-knee calf raises
Bent-knee calf raises
Tibialis anterior strengthening
Single-leg strengthening
Hopping and progressive plyometric exercises
As symptoms improve, rehabilitation should progressively become more representative of running.
Eventually, your body needs to tolerate repeated impact again. This is why rehabilitation shouldn't stop at a few basic strengthening exercises if your goal is to return to regular running.
How Do You Prevent Shin Splints From Coming Back?
There's no perfect formula that guarantees injury prevention, but sensible training progression can reduce unnecessary spikes in load.
Pay attention to more than just your weekly kilometres.
Consider your:
Running frequency + duration + intensity + terrain + other exercise + recovery
If several of these increase simultaneously, your overall training demand can rise very quickly.
For example, adding another running day at the same time as introducing intervals and increasing your long run may be a much larger change than the weekly mileage suggests.
Building running capacity is a process. Give your body enough exposure to adapt without repeatedly asking it to tolerate significantly more than it has recently experienced.
Struggling With Shin Pain When Running?
If your shin pain keeps returning, is getting progressively worse, or you're unsure whether you're dealing with shin splints or something more significant, an assessment can help establish what's contributing to your symptoms.
At Dunmore Osteopathy in Chatswood, I work with runners experiencing shin pain and other running-related injuries. Assessment can include looking at your symptoms, training history, strength and physical capacity before developing an individualised rehabilitation and return-to-running plan.
The aim isn't simply to get you out of pain.
It's to help you build the capacity to get back to running and tolerate the training you want to do.
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