Shin Splints (Medial Tibial Stress Syndrome)
Shin splints, or medial tibial stress syndrome (MTSS), is pain along the inner edge of the shin bone, most often caused by overload from running and impact activity. It is one of the most common running injuries and responds well to a combination of load management, strengthening, and addressing contributing factors.
Understanding the Condition
Shin splints develop when the bone and surrounding tissues are loaded faster than they can adapt. It exists on a spectrum — if ignored, ongoing bone overload can progress toward a stress fracture, so early management matters.
Signs and Symptoms
- Aching or sharp pain along the inner shin
- Tenderness along a broad area of the shin bone
- Pain at the start of exercise that may ease then return
- Discomfort that worsens with continued running or impact
- Pain on hopping or impact in more significant cases
Causes and Risk Factors
- Sudden increases in training volume or intensity
- Hard or changed running surfaces
- Inadequate footwear
- Reduced calf and hip strength
- Foot posture and biomechanics
- Returning to running too quickly after a break
Assessment
- Training history: Identifying load spikes and contributing factors
- Examination: Locating tenderness and ruling out stress fracture
- Biomechanical assessment: Running mechanics, foot posture, and strength
- Imaging referral: When stress fracture is suspected
Physiotherapy Treatment
Load Management
- Modifying training to settle symptoms while staying active
- Structured, graded return to running
- Cross-training to maintain fitness
Strength and Biomechanics
- Calf, foot, and hip strengthening
- Running technique retraining
- Addressing foot posture, including footwear or orthotic advice
Recovery Support
- Manual therapy for symptom relief
- Education on safe progression and prevention
Preventing Recurrence
Most shin splints are a “load” problem. Building tissue capacity through strength work and managing training increases sensibly is the key to staying pain-free.
Expected Outcomes
With appropriate management, most runners return to full training without pain and with strategies to prevent recurrence.
