Shin Splints or Medial Tibial Stress Syndrome: Causes & Treatment

If you've ever experienced shin splints, you know the panic that comes with it: "my training is ruined", "a new marathon PB? Not happening!". 
 
And if you've battled them for a while, you'll become convinced that only the most radical of solutions will provide relief: 

But hey, take comfort in the fact that you're not alone. Shin splints (or the fancy name, medial tibial stress syndrome) is one of the most common injuries among runners. 
 
But what causes shin splints and how can you treat and prevent them?  

The pathophysiology of shin splints

Shin splints develop when your shin bone (tibia) and the muscles around it are overworked without enough time to recover.
 
This happens when small, repeated stresses cause irritation and micro-damage in the bone’s protective layer (periosteum) and surrounding muscles. 

What's the periosteum got to do with anything?

The periosteum is a thin protective layer that covers your shin bone. This layer contains tiny blood vessels and nerves, so it can easily become sore when irritated.

When you run or jump, your muscles pull on the periosteum where they attach to the shin bone. This constant pulling can cause small areas of damage in the periosteum, causing inflammation. 

The body responds by trying to repair the damage, but if you keep stressing the area without enough rest, your symptoms will continue.

Because the periosteum is full of nerve endings, any swelling or irritation here can feel especially painful, even if the bone itself isn’t injured.

This is why shin splints often feel like a deep ache in the shin, especially at the start of a run or workout when the muscles and bone covering are under stress.

 
How your muscles contribute to shin splints 

The deep muscles of your lower leg—especially the soleus (a calf muscle) and the flexor digitorum longus (which helps move your toes)—are heavily involved in running and jumping. These muscles are connected to your shin bone and help absorb shock when your foot hits the ground.

When these muscles become too tight or too tired, they stop doing their job properly. Instead of absorbing shock, they transfer extra stress to your shin bone and the surrounding tissues.

Because the muscles attach to the periosteum (the bone covering), their constant pulling can make the irritation worse, keeping the area inflamed and painful.

If you increase your activity too quickly, like running longer distances or training on harder surfaces, your muscles may not have enough time to get stronger. This puts too much pressure on your shins all at once.

As the strain continues, tiny micro-tears can develop in both the muscles and the bone covering, leading to persistent pain that worsens with activity.

 What causes shin splints?

Shin splints are usually caused by:

✅ A sudden increase in training load – running longer distances or adding more intensity too quickly
✅ Not enough recovery time – overworking your legs without proper rest between sessions
✅ Worn-out or unsuitable shoes – running in shoes with poor support or cushioning
✅ Biomechanical issues – overpronation (when your foot rolls inward when landing), tight calves, or poor ankle/hip mobility
✅ Hard or uneven training surfaces – running on concrete or uneven ground increases impact forces
 
If any of these sound familiar, it’s likely your body is struggling to adapt to the load, leading to shin pain and inflammation.

How do I treat shin splints?

The first step is to reduce the pain and inflammation. 
 
That often means rest (bugger).

Switch to low impact activities like cycling or swimming for a while. You can use anti-inflammatories (NSAIDs, like ibuprofen) to manage pain. Ice packs for 10-15 minutes can also help. 

Check your shoes and biomechanics

Make sure your running shoes provides the right support for your foot type. Sometimes shin splints can arise because you're using shoes that are past their use-by-date, or simply not the right type for you. 
 
While it's tempting to buy a pair online for a cheep cheep 🐣 price, go to a running store like Shoe Science or Athletes Foot where the shop assistant can watch you running on a treadmill to evaluate how your foot strikes the ground.

Sorting out your shoes could save you taking the expensive route, which may involve seeing a podiatrist and getting custom orthotics made. 
 
Another culprit could be your overall running technique. You can get a gait analysis to identify elements of your technique that may be letting you down. 

Lastly, strengthen key muscles

Shin splints often occur because of weaknesses in key muscle groups, leading to poor shock absorption. Some ideas for areas to work on:
 
🔹 Calf raises – Strengthens the calf muscles, which support the shin and ankle during impact.
🔹 Single-leg hopping – Improves muscle control and shock absorption in the lower leg.
🔹 Core and hip strengthening – A strong core and hips help stabilise your legs and reduce stress on your shins. 

There are loads of videos available on YouTube that you can do with zero equipment and at home. 

Is it shin splints or a stress fracture? 

Shin splints and stress fractures can feel similar, but there are key differences:

⚠️ Shin Splints: Pain gradually builds over time, usually across a larger area of the shin. It tends to ease after warming up but may return after activity.

⚠️ Stress Fracture: Pain is sharp, focused on one specific spot, and often persists even at rest. Stress fractures don’t improve with stretching or massage and require medical evaluation (and usually an MRI).

If you suspect a stress fracture, it’s crucial to see a medical professional to prevent further damage. Don't tough it out!