What You Need to Know About Shin Splints

Woman runner jogging down the road at sunset

Shin splints, also known as medial tibial stress syndrome, are classified by pain in the inner part of the lower leg and are one of the most common injuries to develop in runners. Medial shin pain is most often caused by repetitive pounding 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/stretching program.


  • Gradual onset of anterior or medial shin pain
  • Tenderness upon 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 never increase your training routine more than 10% a week.
  • Old and run down shoes: A good running shoe typically lasts about 400-600 miles before breaking down. When your sneakers break down, more force is emitted throughout your joints because the shoes aren’t supporting your arch or absorbing the continuous impact that they once were, exposing your body to an increased risk of injury.
  • Training on a hard, inclined surface: In particular, descending hills are a source of shin splints, secondary to the positioning of your foot when running downhill. When running downhill, your initial impact with the ground is in a plantar-flexed position (forefoot striking) which puts unneeded 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 to loosen the tissue, break up any adhesions, and encourage blood flow to the area
  • Take anti-inflammatories to help diffuse any swelling or inflammation
  • Invest in orthotics or arch supports to help disperse the impact of the ground force more equally and place you in a better alignment
  • 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
  • Don’t increase the intensity, frequency, and duration of your training too quickly
  • Run on softer surfaces
  • Select footwear or get fitted for inserts to accommodate to your specific foot type
  • Avoid over-striding during running
  • Remember to cross train, strength train, and stretch


Tracey Colantonio is a doctor of physical therapy at Hospital for Special Surgery Rehabilitation, currently doing a rotation at the James M. Benson Sports Rehabilitation Center. Tracey did her undergraduate work at Manhattan College and her graduate studies at Hunter College. She played soccer in college and has since found a love for running. She is passionate about sports medicine and specializes in treating orthopedic injuries.

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.

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