Where shin pain in runners comes from
The everyday term “shin splints” most often refers to medial tibial stress syndrome. It is thought to be a response of the shin bone and the periosteum to repetitive load that, over several weeks, grew faster than the tissues could adapt to it. The pain is usually felt along the inner edge of the shin bone, in its middle and lower part, and the tenderness to pressure covers a stretch of several centimetres.
The problem mainly affects people who are starting to run, coming back after a break or increasing their mileage quickly – for example while preparing for their first half marathon. It also appears more often after switching to a harder surface and when the calf muscles have poor endurance.
The course of the symptoms is characteristic. At first the shin hurts mainly in the first minutes of a run, then the pain eases and comes back after training. If the load does not change, the symptoms appear earlier and earlier, last longer and eventually make running impossible. The sooner you react, the shorter the road back usually is.
Assessment – what needs to be ruled out
Shin pain does not always mean simple overload. In the assessment we check whether the tenderness is diffuse or clearly localised to one point, how the shin responds to hopping on one leg and exactly when the pain appears. Pain at one point on the bone, also present when walking, at rest or at night, may mean a stress fracture of the tibia – in that case we refer you to a doctor, because imaging is needed.
Chronic exertional compartment syndrome gives a different picture: pain and a feeling of tightness build up during a run, sometimes with numbness in the foot, and ease only once you stop. This also needs a medical assessment. If stress fractures keep recurring, it is worth checking with a doctor whether there is an energy deficit relative to your training load (so-called relative energy deficiency in sport, RED-S), which weakens the bones.
How we run the treatment
The foundation is load modification: we reduce the volume and intensity of running to a level at which the symptoms do not build up, and some sessions can be replaced with cycling or swimming. At the same time we introduce medical training – strengthening the calf with the knee straight and bent, the glutes and the foot muscles and, at a later stage, jumping exercises that prepare the bone and muscles for running.
Massage and soft tissue work can reduce tenderness in the short term, but they will not replace grading the load. The same goes for insoles or new shoes – they can be helpful, but on their own they rarely solve the problem. The time it takes to return depends on how long the symptoms have lasted: with a short history it is usually a few weeks, with pain that has lasted for months – longer.
Back to running without a relapse
We start the return plan with walk-run intervals on a soft surface and increase the volume gradually, assessing how the shin responds the next day. The most important rule: we do not add kilometres, pace and hill runs at the same time. Slight discomfort during a run is acceptable as long as the shin is no more tender the next morning than the day before. It is worth keeping calf strength exercises going after you return to full training as well. The same rules protect against other running overload problems, such as IT band syndrome or Achilles tendon pain.
If your shin has been hurting for several weeks and you see no improvement despite rest, you can arrange an appointment via the Contact page.