Shin Splints (Medial Tibial Stress Syndrome)

Symptoms

• Aching along the inner edge of the lower half of the shin
• Pain at the start of a run that may ease, then return after
• Tenderness spread over several inches of bone
• Pain that improves with rest

Causes and who gets it

A rapid increase in running or jumping, hard surfaces, worn shoes, and low energy availability are common contributors. It is frequent in new runners, military recruits, and athletes early in the season.

How it is diagnosed

Diagnosis is clinical. The key question is whether the pain is a stress fracture instead. A small, very tender spot on the bone, pain with hopping, or pain at rest or at night raises concern for a stress fracture, and MRI may be used.

Treatment

• Reduce running volume and impact; cross-train with cycling, swimming, or pool running
• Gradual return to running with slow increases in distance
• Calf and hip strengthening
• Check footwear, training surface, and running form
• Make sure you are eating enough to support your training

Recovery time

With load modification, shin splints often settle over 2 to 6 weeks, though they can linger if training is not adjusted. A stress fracture takes longer and is managed differently.

When to see a doctor

• Pain in one small spot on the bone that hurts to press
• Pain with hopping on that leg
• Pain at rest or at night
• Missed periods, low weight, or repeated bone stress injuries (possible low energy availability)
• Calf tightness, numbness, or pain that comes on at a set point in exercise and goes away with rest (possible exertional compartment syndrome)

Clinical pearls

• Diffuse posteromedial tibial tenderness spanning at least about 5 cm favors MTSS; focal tenderness favors a tibial stress fracture
• Single-leg hop test pain raises concern for a bone stress injury
• MRI is the preferred imaging when a bone stress injury is suspected
• Anterior tibial cortex stress fractures are high-risk and need more conservative management
• Screen for low energy availability (REDs) in athletes with bone stress injuries