{"id":484,"date":"2026-11-02T09:00:00","date_gmt":"2026-11-02T09:00:00","guid":{"rendered":"https:\/\/clinicanering.com\/blog\/?p=484"},"modified":"2026-10-29T04:16:03","modified_gmt":"2026-10-29T04:16:03","slug":"shin-splints-why-they-hurt-how-to-run-again","status":"publish","type":"post","link":"https:\/\/clinicanering.com\/blog\/en\/sports-medicine\/shin-splints-why-they-hurt-how-to-run-again\/","title":{"rendered":"Shin Splints: Why They Hurt and How to Get Back to Running"},"content":{"rendered":"<blockquote>\n<p><strong>Main points<\/strong><\/p>\n<ul>\n<li>Shin splints are an overload of the shinbone. The bone takes more impact than it can adapt to, and that is why it hurts.<\/li>\n<li>The pain is spread along the inner edge of the shin. Pain focused on a single spot suggests a stress fracture.<\/li>\n<li>The diagnosis is made by talking with you and examining you. Imaging only comes in when there is doubt.<\/li>\n<li>No passive treatment has strong proof of being better than reducing load and returning gradually. A gradual return to running is the main treatment.<\/li>\n<li>For prevention, the best evidence is for neuromuscular training. Cushioned insoles do not prevent it.<\/li>\n<\/ul>\n<\/blockquote>\n<p>Shin splints are one of the most common pains in people who start running or step up their training too fast. In the post on <a href=\"https:\/\/clinicanering.com\/blog\/en\/sports-medicine\/running-pain-when-to-see-a-doctor\/\">running pain<\/a>, I mentioned them in passing. Here I&#8217;ll take more time to explain why they appear, how to tell them apart from a stress fracture and, above all, how to get back to running without them coming back too.<\/p>\n<h2>What shin splints are<\/h2>\n<p>Shin splints is the popular name for <strong>medial tibial stress syndrome<\/strong>. It is pain on the inner side of the shin, mostly in the lower two thirds, that shows up with running or jumping. At first, it usually hurts at the start of a workout and eases after the warm-up. Over time, it hurts throughout the workout and keeps hurting afterwards.<\/p>\n<p>When you press along the inner edge of the bone, the pain shows up over a <strong>long strip, 5 centimeters or more<\/strong>. That is the feature that helps most with the diagnosis. It is a common injury: a 2009 review pooled studies of athletes and military personnel and found shin splints in 4% to 35% of them, depending on the group and the type of training.<\/p>\n<h2>Why it hurts: overload on the bone<\/h2>\n<p>It is easy to think of shin splints as an inflammation, and for a long time that is what people believed: the calf muscles pulling on the membrane that covers the bone and inflaming it. Studies that looked at the tissue under a microscope did not find that inflammation.<\/p>\n<p>What we understand today is that shin splints are a <strong>bone adaptation problem<\/strong>. Bone is living tissue that renews itself all the time. With every running stride, the tibia, the shinbone, goes through tiny deformations. The body responds by removing tired bone and laying down new, stronger bone in its place. When load increases faster than the bone can rebuild, removal gets ahead of reconstruction, and the bone becomes temporarily weaker and sore.<\/p>\n<p>This is why many specialists see shin splints and stress fractures as different stages of the same bone overload problem. If load stays high, shin splints can progress to a fracture.<\/p>\n<h2>Who is at higher risk<\/h2>\n<p>Risk factors have been studied in several reviews. One from 2017 pooled 22 studies and found five that came up repeatedly:<\/p>\n<ul>\n<li><strong>being female<\/strong>, with about twice the chance;<\/li>\n<li>having a higher body weight;<\/li>\n<li>having an arch that drops more when the foot lands, a foot that pronates more;<\/li>\n<li>having had a running injury before;<\/li>\n<li>having more external rotation at the hip.<\/li>\n<\/ul>\n<p>Another review, from 2015, confirmed weight, arch drop and greater hip mobility, and added a greater range for pointing the foot down at the ankle. The studies measure the runner&#8217;s body, but what usually triggers the pain is training. Shin splints tend to show up in beginners and in people who increased volume or intensity all at once.<\/p>\n<p>There is another cause of weak bone, more common in women: eating too little for the amount you train. I wrote about this in the post on <a href=\"https:\/\/clinicanering.com\/blog\/en\/sports-medicine\/red-s-relative-energy-deficiency-in-sport\/\">RED-S<\/a>, which can make bones more fragile and disrupt menstruation. <strong>Low vitamin D<\/strong> also plays a part: a 2026 review linked low levels to more stress fractures, more clearly in military personnel than in athletes, and I explained when it makes sense to test and supplement in the post on <a href=\"https:\/\/clinicanering.com\/blog\/en\/supplements\/vitamin-d-when-to-supplement\/\">vitamin D<\/a>.<\/p>\n<h2>How to tell if it is shin splints<\/h2>\n<p>The <strong>diagnosis is clinical<\/strong>, made through conversation and examination. A Dutch study put this to the test: two examiners assessed 46 athletes with leg pain, each without knowing what the other had concluded. They reached the same conclusion, shin splints or not, in 96% of the athletes.<\/p>\n<p>The same study found that one in three athletes with shin splints had another leg injury at the same time. So the exam needs to cover the whole leg rather than stopping at the shin.<\/p>\n<p>X-rays, MRI and bone scans are not needed at first. MRI helps when there is doubt, mainly to see whether there is already a fracture. But imaging in runners has to be read carefully, because bone changes also show up in people who feel nothing.<\/p>\n<h2>Shin splints or stress fracture?<\/h2>\n<p>This is the distinction that matters most, because a fracture calls for more time off and more care on the way back. With shin splints, the pain spreads along a strip of the bone, and with a fracture it stays in one spot.<\/p>\n<figure>\n<img src=\"\/blog\/wp-content\/uploads\/canelite-onde-doi-v2-en.svg\" alt=\"Drawing comparing where it hurts: with shin splints, the pain is spread over 5 centimeters or more along the inner edge of the shin, in the lower two thirds; with a stress fracture, the pain is focused on one spot.\" width=\"640\" height=\"600\" loading=\"lazy\" decoding=\"async\"><figcaption>\nWith shin splints, the pain is spread out. With a stress fracture, it stays in one spot.<br \/>\n<\/figcaption><\/figure>\n<table>\n<colgroup>\n<col style=\"width: 25%\" \/>\n<col style=\"width: 25%\" \/>\n<col style=\"width: 25%\" \/>\n<col style=\"width: 25%\" \/>\n<\/colgroup>\n<thead>\n<tr>\n<th><\/th>\n<th>Shin splints<\/th>\n<th>Stress fracture<\/th>\n<th>Compartment syndrome<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Where it hurts<\/td>\n<td>A long strip along the inner edge of the shin<\/td>\n<td>One well-defined spot on the bone<\/td>\n<td>The leg muscles, like a tightness<\/td>\n<\/tr>\n<tr>\n<td>When it hurts<\/td>\n<td>During training, and afterwards<\/td>\n<td>Also when walking, sometimes at rest or at night<\/td>\n<td>Starts after running for a while and goes away with rest<\/td>\n<\/tr>\n<tr>\n<td>Other signs<\/td>\n<td>Pain when pressing the bone along a strip<\/td>\n<td>Swelling at the spot, sharp pain in one spot when hopping on one leg<\/td>\n<td>Tingling, numbness or weakness in the foot during exercise<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Pain that also appears when walking, pain at night or <strong>pain very localized to one spot on the bone<\/strong> needs to be checked soon, without waiting for the shin splints to go away on their own. In these cases, MRI helps confirm or rule out a fracture.<\/p>\n<h2>How to treat shin splints<\/h2>\n<p><strong>No passive treatment<\/strong> has good proof for shin splints. A 2013 review analyzed 11 studies on treating shin splints, and all of them had quality problems. None was good enough to recommend a specific treatment.<\/p>\n<p>Some things had no proven effect: compression socks, a leg brace or orthosis, low-level laser, and a stretching and strengthening program alone as treatment. An earlier review noted that, in studies with a comparison group, rest worked as well as any other treatment tested.<\/p>\n<p>Shockwave therapy was the most promising, but the quality of the evidence is still low. Insoles that support the arch also reduced pain in low-quality studies of beginner and recreational runners. Ice can relieve pain after training, but it does not treat the cause. What is left is a treatment with three parts:<\/p>\n<ol type=\"1\">\n<li>Reduce load until the pain improves. Complete rest is not needed. Cycling, swimming and pool running keep up your fitness without impact.<\/li>\n<li>Strengthen the calf, foot and hip. In the studies, this did not speed up the return, but strength and balance training is the foundation of prevention, as I show further down.<\/li>\n<li>Return to running gradually, which was the basis of treatment in the studies.<\/li>\n<\/ol>\n<p>Avoid taking <strong>anti-inflammatories so you can train through pain<\/strong>. They hide the signal that the bone is overloaded.<\/p>\n<h2>How to get back to running<\/h2>\n<p>There is no fixed timeline, and <strong>pain is what guides the return<\/strong>. In practice, you can go back when pressing on the shin no longer hurts and you can walk briskly and hop on one leg without pain.<\/p>\n<p>In a Dutch trial of 74 athletes with shin splints, a gradual return-to-running program gave the same result with or without calf exercises and with or without compression socks. One way to do the return:<\/p>\n<ol type=\"1\">\n<li>Start by alternating walking and easy running, for example 1 minute running and 1 minute walking, on an even surface.<\/li>\n<li>Run on alternate days at first, so the bone has time to rebuild between sessions.<\/li>\n<li>Increase running time first. Only once you are back to your previous volume, go back to hard sessions, hills or intervals.<\/li>\n<li>Don&#8217;t increase volume and intensity in the same week.<\/li>\n<li>If the pain comes back during a run or the next day, go back one step and wait a few days before trying again.<\/li>\n<\/ol>\n<p>Recovery usually takes from a few weeks to a few months. It takes longer in people who kept training through pain, because the bone spent more time unable to rebuild.<\/p>\n<h2>How to prevent it<\/h2>\n<p>Prevention has been studied more than treatment. A 2025 review pooled 12 trials with more than 8,000 participants and reached four conclusions:<\/p>\n<ul>\n<li><strong>Neuromuscular training<\/strong>, with balance, strength and movement-control exercises, lowered the chance of shin splints, with high-quality evidence.<\/li>\n<li>Insoles for people with very pronated feet also helped, with moderate-quality evidence.<\/li>\n<li>Cushioned insoles did not prevent it, with high-quality evidence.<\/li>\n<li>Static stretching and special socks showed no proven benefit.<\/li>\n<\/ul>\n<p>The neuromuscular training varied from study to study, but it usually combines balance, strength and jumps. Some examples of this kind of exercise:<\/p>\n<ul>\n<li>single-leg balance, first on firm ground and then on an unstable surface;<\/li>\n<li>calf raises, on both legs and then on one;<\/li>\n<li>single-leg squats and glute bridges;<\/li>\n<li>light jumps, such as skipping rope, building up gradually and only once the shin no longer hurts.<\/li>\n<\/ul>\n<p>Two or three short sessions a week fit into your routine without taking time away from running. Putting this together with what we know about bone adaptation, prevention looks like this:<\/p>\n<ul>\n<li><strong>Increase your running volume gradually<\/strong>, especially if you are just starting.<\/li>\n<li>Include strengthening and balance exercises in your week.<\/li>\n<li>Eat enough for the amount you train; in the post on <a href=\"https:\/\/clinicanering.com\/blog\/en\/body-composition\/metabolism-calories-burned-at-rest\/\">metabolism<\/a> I show how to estimate how much your body burns.<\/li>\n<li>If your foot pronates a lot, a supportive insole is worth considering.<\/li>\n<li>Don&#8217;t spend money on cushioned insoles hoping to prevent shin splints.<\/li>\n<\/ul>\n<h2>When to see a doctor<\/h2>\n<p>Most cases of shin splints get better with less load, but some signs call for an assessment. See a doctor if:<\/p>\n<ul>\n<li>the pain <strong>does not improve after two weeks<\/strong> of reduced load;<\/li>\n<li>the pain appears when walking, at rest or at night;<\/li>\n<li>the pain is focused on one spot on the bone;<\/li>\n<li>there is swelling at the site;<\/li>\n<li>you feel tingling, numbness or weakness in your foot while running;<\/li>\n<li>it is the second or third time shin splints have come back.<\/li>\n<\/ul>\n<h2>Conclusion<\/h2>\n<p>Shin splints are an overload of the shinbone. They appear when training increases faster than the bone can adapt, and the risk is higher in women, in people who have been injured before and in beginners. The diagnosis is made on examination, and spread-out pain sets it apart from a stress fracture, which hurts in one spot. What treats it is reducing load and returning gradually, and what prevents it is neuromuscular training combined with an unhurried progression.<\/p>\n<p>Happy running, and until next time!<\/p>\n<hr \/>\n<p><strong>Responsible physician:<\/strong> <a href=\"https:\/\/clinicanering.com\/sobre\/\">Dr. Gilberto Nering Junior<\/a>, <a href=\"https:\/\/clinicanering.com\/medicina-do-esporte\/\">sports medicine physician<\/a>, CRM-SP 160822, RQE 142486 (Sports Medicine, Brazil).<\/p>\n<p><small>This text was not sponsored, is for information only and does not replace an individual assessment. Questions about the content: <a href=\"https:\/\/clinicanering.com\/contato\/\">contact the clinic<\/a>.<\/small><\/p>\n<p>Cover photo: <a href=\"https:\/\/unsplash.com\/photos\/a-blurry-photo-of-a-person-running-_QvszySFByg\">James Lee<\/a> on Unsplash.<\/p>\n<div class=\"nering-faq\">\n<h2>Quick questions about shin splints<\/h2>\n<h3>Are shin splints an inflammation?<\/h3>\n<p>No. Studies that looked at the tissue did not find inflammation. Shin splints are an overload of the shinbone, which takes more impact than it can adapt to.<\/p>\n<h3>Can I run with shin splints?<\/h3>\n<p>Running through strong pain can make shin splints progress to a stress fracture. The best approach is to reduce load until the pain improves, keep up your fitness with cycling or swimming and return to running gradually.<\/p>\n<h3>How can I tell shin splints from a stress fracture?<\/h3>\n<p>With shin splints, the pain is spread over a strip of 5 centimeters or more along the inner edge of the shin. With a stress fracture, the pain is focused on one spot and often also appears when walking or at night.<\/p>\n<h3>Do insoles prevent shin splints?<\/h3>\n<p>Cushioned insoles do not, and arch-support insoles may help people with very pronated feet. The best-proven prevention is balance, strength and jump training.<\/p>\n<h3>How long does it take to get back to running after shin splints?<\/h3>\n<p>There is no fixed timeline: it usually takes from a few weeks to a few months, and longer for people who trained through pain for a long time. The return is guided by pain and done gradually.<\/p>\n<\/div>\n<h2>References<\/h2>\n<ol type=\"1\">\n<li>Hamstra-Wright KL, Bliven KC, Bay C. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. <em>Br J Sports Med<\/em>. 2015;49(6):362-369. <a href=\"https:\/\/doi.org\/10.1136\/bjsports-2014-093462\">doi:10.1136\/bjsports-2014-093462<\/a><\/li>\n<li>Marques TBT, Rangel RPS, Martins LV, et al.\u00a0Preventive interventions for medial tibial stress syndrome: Systematic review and meta-analysis. <em>Gait Posture<\/em>. 2025;122:92-98. <a href=\"https:\/\/doi.org\/10.1016\/j.gaitpost.2025.07.312\">doi:10.1016\/j.gaitpost.2025.07.312<\/a><\/li>\n<li>Men\u00e9ndez C, Batalla L, Prieto A, et al.\u00a0Medial Tibial Stress Syndrome in Novice and Recreational Runners: A Systematic Review. <em>Int J Environ Res Public Health<\/em>. 2020;17(20):7457. <a href=\"https:\/\/doi.org\/10.3390\/ijerph17207457\">doi:10.3390\/ijerph17207457<\/a><\/li>\n<li>Moen MH, Holtslag L, Bakker E, et al.\u00a0The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial. <em>Sports Med Arthrosc Rehabil Ther Technol<\/em>. 2012;4:12. <a href=\"https:\/\/doi.org\/10.1186\/1758-2555-4-12\">doi:10.1186\/1758-2555-4-12<\/a><\/li>\n<li>Moen MH, Tol JL, Weir A, et al.\u00a0Medial tibial stress syndrome: a critical review. <em>Sports Med<\/em>. 2009;39(7):523-546. <a href=\"https:\/\/doi.org\/10.2165\/00007256-200939070-00002\">doi:10.2165\/00007256-200939070-00002<\/a><\/li>\n<li>Moraes BF, Leit\u00e3o CVFS, Rodrigues VMS, et al.\u00a0Vitamin D and the risk of stress fractures in athletes and military personnel: a systematic review and meta-analysis. <em>Am J Sports Med<\/em>. 2026;54(11):2854-2863. <a href=\"https:\/\/doi.org\/10.1177\/03635465261441254\">doi:10.1177\/03635465261441254<\/a><\/li>\n<li>Reinking MF, Austin TM, Richter RR, et al.\u00a0Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors. <em>Sports Health<\/em>. 2017;9(3):252-261. <a href=\"https:\/\/doi.org\/10.1177\/1941738116673299\">doi:10.1177\/1941738116673299<\/a><\/li>\n<li>Winters M, Bakker EWP, Moen MH, et al.\u00a0Medial tibial stress syndrome can be diagnosed reliably using history and physical examination. <em>Br J Sports Med<\/em>. 2018;52(19):1267-1272. <a href=\"https:\/\/doi.org\/10.1136\/bjsports-2016-097037\">doi:10.1136\/bjsports-2016-097037<\/a><\/li>\n<li>Winters M, Eskes M, Weir A, et al.\u00a0Treatment of medial tibial stress syndrome: a systematic review. <em>Sports Med<\/em>. 2013;43(12):1315-1333. <a href=\"https:\/\/doi.org\/10.1007\/s40279-013-0087-0\">doi:10.1007\/s40279-013-0087-0<\/a><\/li>\n<li>Winters M. The diagnosis and management of medial tibial stress syndrome: An evidence update. <em>Unfallchirurg<\/em>. 2020;123(Suppl 1):15-19. <a href=\"https:\/\/doi.org\/10.1007\/s00113-019-0667-z\">doi:10.1007\/s00113-019-0667-z<\/a><\/li>\n<\/ol>\n<p><script type=\"application\/ld+json\">{\"@context\": \"https:\/\/schema.org\", \"@type\": \"FAQPage\", \"inLanguage\": \"en\", \"mainEntity\": [{\"@type\": \"Question\", \"name\": \"Are shin splints an inflammation?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"No. Studies that looked at the tissue did not find inflammation. Shin splints are an overload of the shinbone, which takes more impact than it can adapt to.\"}}, {\"@type\": \"Question\", \"name\": \"Can I run with shin splints?\", \"acceptedAnswer\": {\"@type\": \"Answer\", \"text\": \"Running through strong pain can make shin splints progress to a stress fracture. 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See who is at risk, how to tell them from a fracture, what treats them and how to run again.<\/p>\n","protected":false},"author":1,"featured_media":226,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[60],"tags":[],"class_list":["post-484","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-sports-medicine","entry entry-center"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Shin Splints: Cause, Treatment and Return to Running<\/title>\n<meta name=\"description\" content=\"Shin splints are bone overload in the shin, not inflammation. 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