Shin splints: prevent and recover from shin pain when running

General information, not medical advice. If shin pain does not go away, have it checked by your GP, a sports physician or a physiotherapist.

You run well for a few weeks, and then the inside of your shin starts to ache. At first only at the start, later throughout the run. Chances are it is shin splints. The medical name is medial tibial stress syndrome, or MTSS: an overload of the bone and tissue along the inner edge of the shinbone (the tibia). It is one of the most common running injuries, and the good news is that you can do a lot about it yourself.

Why your shin protests

An Australian meta-analysis from 2013 (a study that pools the results of several studies) looked for risk factors in runners. A higher weight relative to height (BMI), a foot that rolls strongly inward on landing (navicular drop), more outward hip rotation and previous shin splints stood out. Women were also at higher risk.

The main culprit is usually simpler: too much, too soon. Bone adapts to load, but that takes weeks. Suddenly running more kilometres, more days or more hills gives it no time to do so.

Dosing the load wisely

A Dutch review of treatment studies from 2013 found no treatment that clearly worked better than rest followed by a gradual build-up. Shock-absorbing insoles, laser therapy and compression stockings had no convincing effect. Dosing the load well remains the foundation.

Pain up to 3 out of 10 while running, gone by the next morning, is usually acceptable.
Pain that increases during the run, makes you limp or lingers at night: stop and add rest days.
Cycling, swimming or brisk walking keep you fit while running is still too much.

A gradual return to running

If you can walk briskly for half an hour without pain and hop 20 times on one leg without pain, a careful restart is usually possible. Start by alternating: 1 minute running, 1 minute walking, ten times, every other day. If that goes well twice, lengthen the running blocks. Each week increase either the duration or the number of sessions, never both at once. Our plan to start running gently follows the same principle.

Strengthening calves, shin muscle and hips

A Danish meta-analysis from 2014 of 25 randomised trials (studies in which chance decides who gets which approach) found that strength training cut sports injuries by about two thirds. Stretching alone did not. Muscles absorb part of the impact that would otherwise go to the bone. Three exercises, two to three times a week:

Calf raises: on the edge of a step, slowly up and down. Start with 3 sets of 15 on two legs and progress to one leg. With a bent knee you also train the deeper calf muscle.
Shin muscle: stand with your back against a wall, heels a foot away, and lift your toes 15 to 20 times. This trains the tibialis anterior, the muscle at the front of your shin.
Hip and glutes: side-lying leg raises, or side steps with a band around your knees. A strong hip keeps the knee and lower leg better aligned.

How to build such a programme at home is explained in strength alongside running and strength training for beginners who walk or run. Your tendons need the same gradual build-up, see tendons after 50.

Shoes and surface

There is no strong evidence that one particular type of shoe prevents shin splints. Choose a shoe that feels comfortable and replace it when the cushioning is visibly worn. Alternate forest paths, grass and asphalt, and build up extra carefully when you change surface or shoes, because that is a new load too.

When to see a doctor

Shin splints usually cause diffuse pain along a strip of a few centimetres. A stress fracture (a hairline crack in the bone) tends to cause pain at one precise spot you can point to with a finger, pain with ordinary walking or at night, or swelling. A 2005 Cochrane review of such fractures in young athletes and military recruits found little strong evidence for special treatments, so rest from running remains the basis. With those signs, or if the complaints do not improve after a few weeks of adjusted load, get it examined.