Shin splints are a common source of pain for runners, athletes and people returning to high-impact exercise. We commonly see shin pain in runners, netballers, adolescents, recreational exercisers and athletes returning to sport through our Sports Physiotherapy and Exercise Physiology teams. While females make up the majority of people we see with this presentation, males can also experience shin splints.
The good news is that shin splints don’t always mean you need to stop exercising completely. The key is understanding why the pain has developed, how severe it is, and how much load your body can currently tolerate.
What Are Shin Splints?
Shin splints are commonly referred to as medial tibial stress syndrome (MTSS) and typically present as pain along the inner border of the shin. According to healthdirect Australia, MTSS is the most common type of shin splints and causes pain along the inner edge of the shinbone, and it’s one of the most common causes of lower leg pain caused by exercise.
A typical presentation may include:
- Pain along the medial shin
- Pain spread over a relatively large area rather than one specific point
- A recent increase in running or high-impact activity
- Pain with running or jumping
However, not all shin pain is shin splints. More localised pain, particularly towards the upper or lateral shin, may indicate another condition such as a tibial stress injury or compartment-related problem and should be appropriately assessed.
Common Misconceptions About Shin Splints
We regularly hear patients say:
“I just need to stretch.” Stretching may help address mobility restrictions, but it isn’t necessarily the solution. Shin splints are often related to how much load the lower leg is being exposed to.
“I need to stop running completely.” Not always. Depending on the severity, running may be reduced or temporarily modified rather than stopped completely.
“My calves are tight, so that’s causing my shin splints.” Calf tightness can contribute, but it is only one potential factor. Strength, mobility, running mechanics and training load can all play a role.
“If it hurts, I’ve damaged something.” Pain doesn’t always mean that further damage is occurring. However, pain needs to be monitored carefully and the rehabilitation program should be adjusted if symptoms are progressively worsening.
What Causes Shin Splints?
There is rarely one single cause. Better Health Channel, a Victorian Government resource, confirms that shin splints are usually caused by a number of factors working in combination rather than a single trigger. Common contributing factors include:
- Sudden increases in running volume
- Poor load management
- Calf weakness
- Reduced ankle mobility
- Poor running mechanics
- Changes in footwear
- Changes in training surface
- Hip or lower-limb weakness
- Returning to sport too quickly
Often, it is the combination of these factors that causes someone to exceed their current capacity.
Best Exercises for Shin Splints
The right exercises depend on the severity and stage of rehabilitation. Some exercises we commonly use include:
1. Tibialis Anterior Stretch
This can help address restrictions around the front of the lower leg where appropriate.
2. Tibialis Anterior Foam Rolling
Foam rolling can be incorporated into a mobility routine where muscular tightness is contributing to altered movement.
3. Seated or Standing Toe Raises
Toe raises strengthen the muscles at the front of the shin and can be progressed from seated to standing variations.
4. Seated or Standing Calf Raises
Calf raises are an important part of rebuilding lower-limb strength and preparing the calf complex for the demands of running and jumping.
5. Heel Ball Raises
These can help develop strength through the calf and foot and can be progressed as tolerance improves.
6. Banded Ankle Inversion and Eversion
Resistance-band exercises can strengthen the muscles controlling the foot and ankle and help address strength asymmetries. If ankle stability is a recurring issue for you, our earlier blog on treating a sprained ankle covers this in more detail.
7. Pogos and Trampoline Exercises
Once the earlier exercises can be completed comfortably, low-level impact exercises such as pogos and trampoline work can be introduced.
These exercises help the body gradually relearn how to absorb and produce force before returning to higher-impact running and sport.
How We Approach Shin Splints Rehabilitation
Before prescribing exercises, we first determine the severity of the shin pain and what is currently aggravating it.
We consider:
- Pain at rest
- Pain during loading
- What movements reproduce symptoms
- Strength deficits
- Left-to-right asymmetries
- Running and jumping tolerance
From there, we determine whether running or another high-impact activity needs to be temporarily reduced.
Generally, rehabilitation progresses through mobility and isometrics, then strengthening, then hopping and running drills, then return to sport and higher-impact activities, with the exact progression depending on the individual.
How We Assess Shin Pain
At our clinic, assessment can include:
- Bilateral and single-leg heel raises
- Ankle range-of-motion testing
- Hopping assessments
- Running assessment
- Balance testing
- Functional movement testing
- Strength and asymmetry testing using VALD force plates
We use the same objective, technology-backed approach as our Musculoskeletal Screening service, and can use our fully equipped gym and running track to assess movement in a practical environment and progressively expose clients to the demands of their sport. If foot mechanics are part of the picture, our blog on exercising with plantar fasciitis may also be useful.
Case Study: Representative Netballer
A 23-year-old female representative netballer presented with increasing shin pain.
Her weekly training included:
- One netball training session
- One competitive game
- 8 to 10 km runs at approximately 4:30 min/km, 2 to 3 times per week
- Occasional Pilates
- No regular strength training
Her shin pain initially appeared during a netball game and occasionally towards the end of longer runs. Over two weeks, her symptoms progressively worsened.
Rather than stopping all exercise, we deloaded her training.
We reduced her running distance and speed and temporarily kept her running to grass surfaces. We also introduced a targeted mobility and strengthening program to address her strength deficits and reduced range of motion through the hips, hamstrings and calves.
Her netball minutes were also reduced for approximately two weeks.
As her symptoms settled, we gradually increased her running and netball exposure while progressing her strength and plyometric program, using the same structured return-to-sport approach behind our Sports Specific Rehabilitation and Strength and Conditioning program.
This allowed her to rebuild her capacity rather than simply waiting for the pain to disappear.
What Can You Do to Prevent Shin Splints?
Managing your overall training load is one of the most important factors. Better Health Channel also notes that around 3 out of every 4 running-related injuries occur in the lower leg, which makes prevention especially worthwhile for runners.
Consider:
- Increasing running volume gradually
- Including appropriate rest days
- Maintaining lower-limb strength
- Reviewing footwear when appropriate
- Avoiding sudden changes in training surfaces
- Completing an appropriate warm-up
- Prioritising recovery and sleep
- Using cycling or swimming as lower-impact cross-training when required
- Gradually rebuilding impact exposure after time away from sport
If you’re an adolescent athlete managing shin pain, our Adolescent Injuries service is specifically set up for growing bodies and changing training loads.
Do You Have to Stop Running?
Not necessarily.
One of the most important things we tell clients with shin pain is:
You don’t necessarily need to stop running, you need to manage the load your body is being exposed to and progressively build capacity.
The best approach depends on the severity of your symptoms and what is causing them.
If shin pain is persistent, worsening, present at rest, or becomes very localised to one specific area, it is important to seek appropriate assessment rather than simply continuing to push through it.
With the right assessment, load management and progressive strengthening program, you can work towards safely returning to running, sport and the activities you enjoy. You can book online with our Central Coast team to get started.
