Dealing With Shin Splints? Here’s What Physical Therapists Want You to Know

Although shin splints are generally fairly innocuous, they're definitely uncomfortable. More importantly, they can lead to serious problems if you ignore them. Here’s what you need to know if you’re dealing with this injury.

What are shin splints?

Officially called medial tibial stress syndrome, shin splints typically cause “a lot of tenderness along the muscles that sit right next to the shin bone,” says Tricia Ligon, PT, DPT, OCS, a physical therapist and orthopedic clinical specialist at 901 Physical Therapy in Memphis, Tennessee.

It’s not super clear why shin splints happen. “There are some theories that shin splints are created from microtears in the tissue, but that hasn't fully been proven,” Dr. Ligon says. “But we do know that it is an inflammatory reaction in the tissue.”

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Physical therapist Alyson R. Filipa, PT, DPT, CSCS, who often treats shin splints in dancers at Cincinnati Children’s Hospital, explains to her patients that this injury happens when you’re breaking down the bone cells faster than they can regenerate. “We all need time for our bones to recover to manage the workload,” she says.

Dr. Filipa adds that shin splints can be the early stages of what could eventually turn into a stress fracture. “That sounds scary, but it's just a spectrum,” she explains.

“If you increase a lot of mileage quickly or start training for a completely new activity, those [can be] precursors to getting shin splints.” —Tricia Ligon, PT, DPT, OCS

The most common shin splint symptoms

If you’ve got shin splints, you’ll feel pain along a large area of the front inner portion of your shin. The muscles there will feel tender to the touch. They might also hurt during high-impact workouts like running and dancing where your foot’s landing on the ground forcefully.

“Pain within the first few minutes of the activity is really common,” Dr. Ligon says. “And then typically the pain will start to subside, then often will come on again after the activity is over.”

Why shin splints happen

The most common cause of shin splints is a big increase or change in your workouts, particularly something high impact like running. “If you increase a lot of mileage quickly or start training for a completely new activity, those [can be] precursors to getting shin splints,” Dr. Ligon says.

Dr. Filipa adds that dietary deficiencies can also lead to stress reactions (like shin splints), particularly if someone is lacking enough calcium and vitamin D. Or, if you’re eating so little you lose your menstrual cycle, you could end up with bone problems that include shin splints. “It [someone] is not getting a period, they're more likely to have bony shin pain,” Dr. Filipa says.

How shin splints get diagnosed

Dr. Ligon says that shin splints are a “diagnosis of exclusion.” Meaning, if you’ve got all the classic shin splint symptoms, but don’t have signs of something more concerning (like a stress fracture), you most likely have shin splints.

Dr. Filipa adds that if your pain has been going on for more than three weeks, the medical team might order an X-ray to check that it hasn’t progressed to a stress fracture.

How to treat shin splints

The top prescription for shin splints is to back off your training for a while. That might mean working out fewer days per week, or for less time, or just easing the intensity a bit overall, according to Dr. Ligon. Don’t worry: You won’t be totally relegated to the couch until the pain stops—you’ll just want to step off the gas a bit.

A smart way to use your new free time is to do some low-impact cross-training focused on the lower legs. “Work on improving the mobility of the Achilles and the calves so that you can lift your foot up higher,” Dr. Ligon says. Strength work is also essential so you can build up those muscles around the shin to better handle big impacts. “Train the muscles that help lift our foot up and down, and build up the strength in [your] calf muscles as well,” Dr. Ligon adds. That means doing exercises like calf raises and tracing the alphabet with your toes.

Additionally, because research¹ has shown that vitamin D deficiency can lead to shin splints, it can be helpful to amp up your intake if you think you might not be getting enough. Dr. Filipa also recommends paying attention to how much calcium you’re getting, and making sure you’re eating enough overall to have regular periods (if you’re someone who menstruates).

FYI: Although many people will recommend icing for shin splints, Dr. Filipa warns that will only help with the pain coming from any localized inflammation, but it won’t get to the root cause or help you heal any faster. “That more fits into the recovery bucket of, ‘I just need to do this to feel better at the end of my day.’ But it's a Band-Aid,” she says.

How to prevent shin splints in the first place

Strong, mobile lower legs are less prone to shin splints, so it’s a smart idea to keep up your ankle and calf mobility work, and strength train your lower legs regularly.

“A lot of times, there's weakness up the chain, too, so working on hip, core, and glute strength is also important to help prevent shin splints,” Dr. Ligon says. Having strong core and glute muscles will help your body better absorb the impact forces, she explains. “If we're weaker in our core and in our hips, our form starts to get a little lazy, which can put increased load and stress on the lower leg,” she says.

This is particularly true if you’re starting a new workout or training program that’s going to strain the area. Remember: Ramp up any new workouts gradually to give the tissue time to recover, and any time you start to feel niggles, pull back. “Don't escalate something that doesn't have to get worse,” Dr. Filipa says.

Dr. Filipa also underscores the importance of paying attention to your diet. Some research² even shows that supplementing with calcium and vitamin D can decrease your risk of stress fractures. (Here are a few more shin splint prevention tips that may come in handy!)

“A lot of times, there's weakness up the chain, too, so working on hip, core, and glute strength is also important to help prevent shin splints.” —Tricia Ligon, PT, DPT, OCS

When to see a doctor

There are a few red flags that you should get your shin pain checked out by a medical provider, according to Dr. Filipa and Dr. Ligon:

• If the pain lingers for two or three hours after you’ve finished a workout
• If it’s causing you to change how you walk or run
• If you can pinpoint the pain to one small spot
• If it’s very sharp after you land from a jump

That said, you don’t have to wait for those signs—and you shouldn’t avoid the doctor out of fear that they’ll tell you to stop doing what you love. “Go sooner rather than later because normally, sooner means that you're just going to get help on how to do some small tweaks so it doesn't get to the point where it is a stress fracture,” Dr. Filipa says. “The sports med physicians that I work with, they are very much wanting to say ‘yes’ to activity as much as possible.”

FAQ

What can be mistaken for shin splints?

Shin splints symptoms can be somewhat similar to two more serious problems: stress fractures and compartment syndrome. The pain of a stress fracture will be more localized to one specific spot, while shin splints will hurt along a bigger area. And compartment syndrome is pretty rare, but could include numbness, tingling, or a feeling of tightness in the muscle.

Do shin splints heal naturally?

“They won't heal naturally without intervention if there's no change to the training plan,” Dr. Ligon says. But, “they could get better on their own with just rest.” However, she warns that if that’s your only strategy, once you go back to your previous workout routine, your shin splints will most likely return for a repeat visit. “Strengthening is the most effective long-term [strategy],” she says.

Can I still run with shin splints?

Yes, you can run with shin splints—you might just need to pull back on your weekly mileage. “Runners fear being told that they can't run, which is why they often wait until things get really bad before they seek treatment,” Dr. Ligon says. “But usually, it's just a change in load or volume that needs to happen; it's not having to stop the activity altogether.”