Written and reviewed by the BPR clinical team. Last reviewed: 30 July 2026. This article is for education and is not a substitute for individual assessment, diagnosis or treatment by a qualified healthcare professional.
You've been building up your running, feeling good — and then an ache creeps in along the inside of your shin. At first it's just there at the start of a run; before long it's nagging during and after, and even walking upstairs. “Shin splints” is the common name, and it's one of the most frequent complaints in runners and anyone ramping up their training. The reassuring part is that it usually settles with the right, patient approach; the important part is knowing when it might be something more.
What is it?
Shin splints — properly called medial tibial stress syndrome (MTSS) — is an overload problem of the shin bone (tibia) and the tissues attaching to it along the inner border. It sits on a spectrum of bone stress caused by repetitive impact. It's one of the most common running injuries, making up roughly 14–20% of running-related injuries, and it's also frequent in dancers and military recruits. Despite older descriptions, it's better understood as an overload of bone and tissue than as simple inflammation.
Why does it happen?
The theme, as with most overuse injuries, is too much too soon. A sudden jump in running volume or intensity, hard surfaces, worn or unsuitable footwear, and foot mechanics all raise the load on the shin. Known risk factors include a higher body-mass index, greater foot pronation (navicular drop), female sex and a previous episode (Hamstra-Wright et al., 2015). Often it's a combination — a keen new runner, a rapid mileage increase, and legs that weren't yet conditioned for it.
What does it feel like?
The classic feature is a diffuse ache spread along the inner (posteromedial) border of the shin — over a span of several centimetres rather than one precise point. Early on it eases with rest and warms up during activity, then returns afterwards. As it progresses, it can hurt earlier in a run and linger longer. A pain that becomes sharply focal, point-tender or present at rest and at night is a warning sign that needs checking, as it may indicate a stress fracture.
How it's assessed
We'll ask about your training history and how quickly your load has changed, then palpate along the inner shin — MTSS typically produces tenderness over a diffuse area. Part of the job is ruling out the conditions that can masquerade as shin splints: a tibial stress fracture (focal, point tenderness), and exertional compartment syndrome or nerve entrapment (tightness, numbness with exercise). These need a different plan.
What the evidence says
- Load management is the cornerstone. A systematic review found that relative rest and a graded return to activity are the consistently supported core of treatment, while evidence for most passive add-ons (such as ultrasound) is limited (Winters et al., 2013).
- Risk factors are worth addressing. Higher BMI, greater foot pronation and previous injury increase risk, so training load and mechanics are sensible targets (Hamstra-Wright et al., 2015).
- There's no quick fix. Recovery is driven by graded loading and time, not by a single modality — which is why patience and a sensible plan beat chasing a gadget.
How it's treated
The foundation is relative rest and a graded return to running — not complete, indefinite inactivity, but a temporary reduction in the impact load that's provoking it, while you keep fit with lower-impact options like cycling or swimming (Winters et al., 2013). Alongside that, we address the drivers: your training progression, running surfaces and footwear, and the strength and capacity of the calf, foot and hip.
As symptoms settle, running is reintroduced gradually, guided by your response rather than the calendar. Realistically, MTSS often takes six weeks or more to resolve, and rushing back is the most common reason it recurs.
What you can do yourself
Cut back the running load that provokes your pain and cross-train to stay fit. Strengthen your calves, feet and hips, check that your footwear suits you, and when you return to running, build back gradually — small, steady increases rather than big jumps. Use the 24-hour rule: some discomfort is acceptable if it settles by the next day.
When to seek help
When to seek help. Seek assessment if the pain becomes sharply focal or point-tender, is present at rest or at night, or is getting worse despite rest — these can indicate a stress fracture. Numbness, or a build-up of tightness with exertion, also warrants review. Otherwise, see a clinician if shin pain keeps returning or isn't settling with load management.
Frequently asked questions
Can I keep running with shin splints?
Usually in a reduced form, if symptoms are mild and settle within 24 hours. If pain is worsening or becoming focal, back off and get it assessed to rule out a stress fracture.
How do I know if it's a stress fracture instead?
Stress fractures tend to cause sharp, pinpoint tenderness over a small area, and pain at rest or at night. MTSS pain is more diffuse. If in doubt, get it checked.
How long does it take to get better?
Often six weeks or more, depending on how long it's been going on and how well you manage your load. Graded return is key.
Do compression sleeves or insoles help?
They may ease symptoms for some people, but the evidence is limited. They're best seen as comfort aids alongside load management, not a cure.
How do I stop it coming back?
Build your training gradually, keep up calf and hip strength, avoid sudden mileage spikes, and address footwear and surfaces.
How BPR can help
At BPR we'll confirm it's shin splints rather than a stress fracture, work out what tipped your shins over the edge, and build you a graded return-to-running plan with the strength work to keep it from coming back. You can book an assessment at bpr.rehab.
References
- Winters, M., Eskes, M., Weir, A., Moen, M.H., Backx, F.J.G. and Bakker, E.W.P. (2013) 'Treatment of medial tibial stress syndrome: a systematic review', Sports Medicine, 43(12), pp. 1315–1333. doi:10.1007/s40279-013-0087-0.
- Hamstra-Wright, K.L., Bliven, K.C.H. and Bay, C. (2015) 'Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis', British Journal of Sports Medicine, 49(6), pp. 362–369. doi:10.1136/bjsports-2014-093462.