Shin Splints

Shin splints, medically known as medial tibial stress syndrome, describes pain and inflammation affecting the muscles, tendons and tissue that attach along the inner edge of the shin bone (tibia). It’s one of the most common lower leg complaints among runners, and is also frequently seen in dancers, military recruits and anyone who has recently and rapidly increased how much, how hard, or on what surface they’re training.

Shin splints sits on a spectrum of lower leg bone stress injuries — mild cases involve irritation of the soft tissue attaching to the bone, while more advanced or prolonged cases can progress toward a genuine bone stress reaction or, less commonly, a stress fracture. Understanding where your symptoms sit on that spectrum matters, because it changes how aggressively training needs to be adjusted.

What causes shin splints

Shin splints typically develop when the load placed on the shin outpaces the tissue’s ability to adapt to it. This is most commonly triggered by a sudden increase in running volume or intensity, the introduction of hill running or speed work, or a change in training surface — moving from a soft track to concrete footpaths, for example. Worn-out footwear, tightness through the calf muscles, and reduced strength or endurance in the muscles supporting the lower leg can all contribute by changing how forces are absorbed with each step.

Because bone and soft tissue take time to adapt to new demands, the underlying issue is almost always a training load that’s increased faster than the body has been able to strengthen in response — which is why simply resting until pain settles, without addressing the training factors, tends to see the problem return once training resumes.

Symptoms

Shin splints typically cause a dull, aching pain along the inner edge of the shin bone, often affecting a broader area rather than one precise spot. It’s commonly worse at the start of activity, sometimes easing as you warm up, then returning once you stop or the following day. In more advanced cases, pain can be present even at rest, and the shin may feel tender to touch along the affected area.

When to see a physiotherapist

Shin splints generally respond well to load management and a graded return-to-running programme without needing imaging. However, persistent shin pain that isn’t improving with rest, pain that’s become sharp and well-localised to one specific point, or pain that’s present at rest and worsens with any loading, is worth assessing properly — these features can indicate a developing bone stress injury or stress fracture, which needs a different management approach than straightforward shin splints. Andrew’s assessment can distinguish between the two and guide you toward imaging if it’s warranted.

Physiotherapy treatment for shin splints

Once your assessment has confirmed the diagnosis and ruled out a more significant bone stress injury, treatment typically combines:

• Manual therapy and soft tissue release through the calf and shin muscles, to reduce tension and pain, along with taping or strapping for support during the early, more painful stage
• Exercise rehabilitation — a graded strengthening programme for the calf and lower leg muscles that support the shin, alongside a structured return-to-running programme that reintroduces load at a rate the tissue can adapt to
• Training load review, looking at your recent volume, intensity, surface and footwear to identify what triggered the current episode and adjusting these factors going forward

Andrew will also assess your running technique where relevant, since factors like stride pattern and cadence can influence how much load reaches the shin with each step.

In the early, more painful stage, a short period of reduced or modified activity — swapping some running sessions for lower-impact cross-training such as cycling or swimming — can help settle symptoms while maintaining fitness, before gradually reintroducing running volume as the shin’s tolerance improves. This graded approach tends to work better than stopping activity altogether, since it keeps the tissue adapting rather than deconditioning.

What to expect from treatment

Most cases of shin splints improve within a few weeks of appropriate treatment and load management, though this depends on how long symptoms have been present before starting treatment and how closely the graded return-to-running programme is followed. Rather than stopping activity altogether, Andrew typically guides a modified training load that keeps you moving while giving the tissue the chance to adapt and strengthen.

Preventing recurrence

Because shin splints are so closely tied to training load, the same factors that caused the original episode — a sudden jump in volume, intensity, surface or footwear — are what tend to bring it back if training resumes too quickly once symptoms settle. Building future increases in training gradually, maintaining calf and lower leg strength, and replacing worn footwear are the main habits that reduce the chance of shin splints recurring.