Shin Splints (Medial Tibial Stress Syndrome)
“Shin splints” is a common term used to describe pain along the shin, particularly in runners and athletes involved in repetitive weight-bearing activities such as running and jumping. It occurs when the load placed on the tibia and surrounding tissues exceeds the body’s current capacity to tolerate it.
Shin pain can be frustrating and may significantly affect your ability to run, train and participate in sport. Importantly, not all shin pain is the same. Other conditions, including bone stress injuries and compartment syndrome, can cause similar symptoms. A thorough assessment by a physiotherapist can help determine the likely cause of your pain and guide your rehabilitation.
What are shin splints?
Medial tibial stress syndrome (MTSS) is an exercise-related injury that commonly causes pain along the inner or front-inner aspect of the shin.
It typically develops when repetitive loading of the lower limb exceeds the capacity of the tibia and surrounding muscles and connective tissues to adapt.
MTSS is particularly common in runners and athletes who participate in activities involving repetitive impact, such as running, jumping and court or field sports.
What causes shin splints?
Shin splints are usually associated with an increase or change in training load. This may include increases in:
- Running distance or duration
- Training frequency
- Exercise intensity
- Running speed or hills
- Jumping or other high-impact activities
Other factors that may contribute include:
- Reduced strength or capacity of the calf and lower limb muscles
- Changes in training surfaces, particularly harder surfaces
- Inappropriate or worn footwear
- Changes in running technique or training habits
- A sudden return to sport following a period of reduced activity
Often, there isn’t one single cause. Instead, shin pain develops when the overall load placed on the lower limb exceeds its current capacity.
What does shin splint pain feel like?
Symptoms commonly develop gradually and are often associated with a recent increase or change in training load.
You may experience:
- Pain along the front or inner aspect of the shin
- Pain that is aggravated by running or other weight-bearing exercise
- Pain that may initially improve or “warm up” during exercise
- Increased soreness following exercise or later at rest
- Symptoms that become more persistent as the condition progresses
Early symptoms may settle relatively quickly after exercise, which can make it tempting to continue training. However, continuing to repeatedly overload the area without addressing the underlying problem can lead to worsening symptoms and a longer recovery.
What else could be causing your shin pain?
While MTSS is a common cause of exercise-related shin pain, other conditions can present in a similar way.
These may include:
Bone stress injuries
Bone stress injuries occur when repetitive loading of the bone exceeds its ability to repair and adapt. They exist on a spectrum ranging from a stress reaction through to a stress fracture. Pain that becomes increasingly focal, occurs with less activity, persists after exercise or is present at rest should be assessed by a health professional.
Compartment syndrome
Chronic exertional compartment syndrome (CECS) occurs when pressure builds within a muscle compartment during exercise, causing pain and other symptoms. Symptoms are often predictable, occurring after a particular duration or intensity of exercise and settling after stopping.
Other causes
Less commonly, shin pain can be associated with nerve, vascular or other musculoskeletal conditions. Because symptoms can overlap between different conditions, an assessment of your history, training load and physical presentation is important to determine the most appropriate management.
How are shin splints treated?
Treatment is focused on reducing the irritation while progressively rebuilding your ability to tolerate load.
Your physiotherapist may recommend:
Modifying your training load
Temporarily reducing your:
- Training frequency
- Running volume
- Exercise intensity
- High-impact activities
This doesn’t necessarily mean stopping all exercise. Alternative forms of training can often be used to maintain fitness while symptoms settle.
Addressing contributing factors
Depending on your individual presentation, this may include modifying:
- Training technique or running form
- Training surfaces
- Footwear or equipment
- Training progression
Strength training
A progressive strength training program is a key component of rehabilitation.
Building the capacity of the calf, ankle, knee and hip muscles helps improve the lower limb’s ability to tolerate the demands of running and sport.
Strength training should be progressively increased according to your symptoms and training goals rather than simply performed as a short-term treatment.
Gradual return to running and sport
Once your symptoms have settled and your lower limb capacity has improved, your physiotherapist can help you progressively reintroduce running and impact activities.
The goal is not simply to get your pain under control, but to build your capacity to tolerate your usual training load and reduce the risk of recurrence.
How can physiotherapy help?
At Jubilee Sports Physiotherapy, our physiotherapists can assess your symptoms, training history, strength and movement patterns to help determine the likely cause of your shin pain.
We can then develop an individualised rehabilitation program to help you:
- Settle your symptoms
- Modify your training appropriately
- Improve lower limb strength and capacity
- Gradually return to running and sport
- Reduce the risk of future recurrence
If you have ongoing shin pain or are unsure whether your symptoms are shin splints or something else, an assessment can help determine the most appropriate next step.
Contact Jubilee Sports Physiotherapy at our Caringbah practice on (02) 9540 9400 or our Kareela practice on (02) 9528 2200.
