Shin Splints: What Are They and What Can You Do About Them?
- Jul 1
- 4 min read
by carien boshoff
Preparing for events such as the Gold Coast Marathon is an exciting goal, however the rapid
increase in running volume, combined with repetitive lower limb loading, places runners at
increased risk of overuse injuries such as shin splints.
Understanding shin splints
Shin splints, more formally known as medial tibial stress syndrome (MTSS) is one of the most
common injuries seen in runners and people who do a lot of repetitive impact activity. They
usually cause a dull, aching pain along the inside of the shin bone, and are most often linked to
doing “too much, too soon” in terms of running or load on the legs.
Pain is often:
• Worse at the beginning of a run
• Improves as the body warms up (early stage)
• Returns after exercise or the following day
Shin splints are part of a group of bone related overuse injuries. This means they sit on a scale
from mild irritation through to more serious bone stress injuries. Because of this, it’s important to
pick them up early and manage them properly to stop them getting worse or developing into a
stress fracture.
Why do shin splints occur?
Shin splints usually don’t have just one cause. They tend to develop from a combination of things
such as how much and how quickly you’ve been training, how your body moves when you run or
walk, and whether your muscles and bones are currently strong enough to handle the load being
placed on them.
Common contributing factors include:
• Sudden increases in running volume or intensity
• Reduced calf muscle strength and endurance
• High impact training surfaces (e.g. roads, concrete)
• Inadequate footwear progression or worn shoes
• Poor load management and recovery
Evidence suggests running injuries are predominantly load related overuse conditions, where
training demand exceeds the tissue’s ability to adapt.
Differentiating shin splints from stress fractures
It’s important to tell the difference between shin splints and more serious bone injuries like a stress
fracture in the shin.
Shin splints usually cause a more spread out ache along the shin, whereas a stress fracture tends
to cause more sharp, localised pain in one specific spot.
Shin Splints (Medial Tibial Stress Syndrome) | Stress Fracture |
Diffuse pain along shin | Localised, focal pain |
Pain improves during run (early) | Pain worsens with activity |
No night pain | May have night/rest pain |
No pinpoint tenderness | Clear bony tenderness |
If symptoms are focal, worsening, or persistent, imaging and medical referral may be required.
How shin splints are managed
Treatment is guided by a full assessment of how you move, your symptoms and evidence based
rehabilitation principles. Management usually includes:
1. Adjusting load (training volume)
• Temporarily reducing running distance or intensity
• Avoiding sudden increases in training load (“doing too much too soon”)
• Keeping you active where possible, rather than complete rest
2. Strengthening exercises (key part of recovery)
Building strength in the lower leg is essential for recovery and prevention of recurrence:
• Calf raises (progressing from double leg to single leg and weighted versions)
• Slow, controlled calf strengthening (eccentric loading)
• Later stage: hopping and impact based exercises
• Strengthening the small muscles in the foot
These exercises help the tissues gradually adapt to running loads again.
3. Gradual return to running
• Starting with short run/walk intervals
• Running on flat, even surfaces
• Monitoring symptoms during and after exercise
• Slowly increasing running volume each week
4. Hands on treatment
Manual therapy may be used to help with symptom relief and movement:
• Soft tissue work to calf muscles
• Joint mobilisation around the ankle/foot if required
• Supportive treatment to help you tolerate exercise better
Hands on treatment is used alongside exercise, not instead of it.
5. Footwear and training review
• Checking if your shoes are suitable and not worn out
• Gradual transition if changing to new shoes
• Reviewing running surfaces (e.g. hills, concrete, downhill running)
• Adjusting training load to match your current capacity
Conclusion
Shin splints are a common but highly manageable running related injury. They typically develop
due to excessive training load relative to tissue capacity rather than a single traumatic event.
With early identification, appropriate load modification and progressive strengthening of the calf
and lower limb system, most runners can return to full training safely. Education, structured
rehabilitation and gradual return to run strategies are key to both recovery and long term injury
prevention.
References
Bertelsen, M. L., Hulme, A., Petersen, J., Brund, R. K., Sørensen, H., & Parner, E. T. (2017). A
framework for the etiology of running-related injuries. Scandinavian Journal of Medicine & Science
in Sports, 27(11), 1170–1180.
Cook, J. L., & Docking, S. I. (2015). Rehab is not a four-letter word: The role of loading in tendon
health. British Journal of Sports Medicine, 49(20), 1355–1356.
Moen, M. H., Tol, J. L., Weir, A., Steunebrink, M., & De Winter, T. C. (2019). Medial tibial stress
syndrome: A critical review. Sports Medicine, 49(12), 1851–1866.
Osteopathy Australia. (2023). Scope of practice statement. https://osteopathy.org.au
Osteopathy Board of Australia. (2024). Code of conduct for registered health practitioners.
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