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What You Need to Know About Shin Splints

Female runner jogging down the road

Shin splints, also known as medial tibial stress syndrome, present with pain in the inner part of the lower leg and are one of the most common running related injuries. Medial shin pain is most often caused by repetitive contact on hard surfaces, introducing an undue stress on the bones, muscle, and lower extremity joints. Shin splints can be a nagging and ongoing injury; however, they can usually be treated in a conservative way with a few simple changes in your training pattern and strengthening program.


  • Gradual onset of anterior or medial shin pain
  • Tenderness to palpation (inner aspect of lower leg)
  • Mild edema or redness


  • Too much, too soon: Sudden increase in training frequency, duration, or intensity.
    A general rule of thumb to avoid shin splints and any overuse injury is to avoid increasing your training routine more than 10% a week.
  • Old running shoes: A good running shoe typically lasts about 400-600 miles. When your sneakers exceed their life, more force is emitted throughout your joints because the shoes aren’t absorbing the impact that they once were, exposing your body to an increased risk of injury.
  • Training on a hard, declined surface: In particular, descending hills are a source of shin splints, secondary to the positioning of your foot when running downhill and the eccentric demands. When running downhill, your initial impact with the ground is in a plantar-flexed position (forefoot striking) which puts stress on the anterior muscles in your shin rather than distributing forces evenly through the joints and soft tissue.
  • Previous history of shin splints combined with failure to treat your previous bout of shin splints properly before returning to a high level of activity.
  • Faulty running mechanics up the entire kinetic chain. Flat or rigid arches and over-pronation may unevenly distribute pressure on the leg, resulting in shin splints. Also, weakness in the stabilizing muscles of the hip and core may result in an overuse injury such as shin splints.

Treatment Suggestions:

  • Utilize the “RICE” principle when treating shin splints.
    • Rest: Avoid high-impact activities (such as running and jumping). Use this time to cross train (swim, elliptical, bike) and give the legs a period to recover from the repetitive pounding.
    • Ice: Ice for periods of 15-30 minutes for 2-3 times a day.
    • Compression: Sleeves or ace bandages providing a compressive force may help ease your symptoms.
    • Elevate
  • Stretch your calves, hip flexors, quads, and hamstrings
  • Participate in core, hip and lower extremity strengthening exercises
  • Foam roll your anterior tibialis and gastroc/soleus muscles
  • If direct by a doctor take anti-inflammatories to help diffuse any swelling or inflammation
  • Seek medical help if pain persists to rule out a more serious injury, such as a stress fracture or compartment syndrome.
  • Get a running analysis to evaluate any biomechanical faults and receive recommendations on how to alter your running form to avoid excessive stress on your bones, joints, and soft tissue.

How to Avoid Shin Splints:

  • Warm up with dynamic stretching prior to working out that lasts at least 5-10 minutes.
  • Once you begin your run, the first 1-2 miles should also be “warm up” before you get into your training run for the day
  • Don’t increase the intensity, frequency, and duration of your training too quickly
  • Run on softer surfaces like a track or grass when possible
  • Select footwear that is comfortable- do not buy high support shoes just because someone once told you that you pronate. Shoes should be comfortable and do not require a break-in period. Buy what feels good when you run. This will require testing them out so select a store with a policy that allows you to return shoes that have been run in.
  • Avoid over-striding during running. Shorten your stride to increase your cadence
  • Remember to cross train, strength train, and stretch

Reviewed on January 4, 2021

Michelle Cilenti, physical therapist

Michelle Cilenti, PT, DPT, SCS, OCS, CSCS is a double board-Certified Clinical Specialist in both sports and orthopedic physical therapy. She is a certified strength and conditioning specialist and enjoys working with runners and young athletes. She holds coaching certifications in both USA track and field level 1, as well as Road Runners Club of America.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.