Shin splints is a term you cannot avoid if you have been involved in running or a running-based sport, whether as an athlete, a coach, or a physiotherapist. Despite how common it is, it remains widely misunderstood, and it is often used as a catch-all diagnosis when something more serious, like a bone stress injury, is actually happening.
This guide explains what shin splints really are, how to tell them from a serious bone injury, and when shin pain warrants a proper assessment.
What Are Shin Splints?
Shin splints, known medically as medial tibial stress syndrome (MTSS), is a condition characterised by pain running along the medial border of the tibia, which is exactly what the name describes.
Shin splints can occur for a range of reasons, and some athletes and sports are more prone to the condition than others. The defining feature in most people dealing with MTSS is one of two things:
- A sudden sharp increase in the physical workload of the lower limb
- Chronic overloading of the lower limb with inadequate recovery
In other words, it usually comes down to load management.
Key Features of Shin Splints
Alongside pain at the medial border of the tibia, the features that usually point a practitioner toward MTSS include:
- Dull, aching pain
- Pain that worsens with activity
- Tenderness along the shinbone
- Mild swelling at the shinbone
- Pain that improves with rest
When Shin Pain Is Not MTSS
Because it is so common, most people, athletes, coaches, parents, and even some health practitioners, assume any shin pain is shin splints or MTSS.
This is a significant mistake, and one that can have real consequences for an athlete’s future participation if the pain is not properly assessed. In some cases the pain presents similarly to MTSS but is actually a different condition, which means it can be misdiagnosed and mistreated, leading to poorer outcomes.
Other conditions that can mimic shin splints include:
- Tibialis posterior dysfunction
- Deep vein thrombosis (DVT) or other vascular problems
- Sural nerve entrapment
- Low back radiculopathy
- Bone stress injury or bone stress fracture
Bone Stress Injury of the Tibia
Perhaps the most important condition to distinguish from shin splints is a bone stress injury of the tibia. This occurs when bone is exposed to very high demands without adequate rest, so it breaks down faster than the body can rebuild it. At first this shows up as a bone stress reaction. If it continues, it can progress to a stress fracture.
Managing a bone stress injury depends heavily on early and accurate diagnosis, because a delay or a misdiagnosis can significantly lengthen recovery. This is a major reason a shin splints presentation should never simply be assumed to be MTSS. A thorough assessment should rule out a bone stress injury or stress fracture of the tibia first.
How to Tell the Difference
You cannot reliably diagnose the difference yourself, but some signs make a bone stress injury more likely and are worth taking seriously. Pain that is more focal, meaning you can point to a specific spot rather than a diffuse area along the shin, night pain, pain that persists after you stop and does not settle quickly with rest, and pain that keeps worsening despite backing off your training all warrant assessment rather than pushing on.
If any of those apply, it is worth having the shin properly assessed before continuing to train.
When to See a Physiotherapist
Shin splints are extremely common, and in most cases they come down to MTSS, which is usually a load management issue. But it is important to consult a physiotherapist to rule out more serious conditions, including a bone stress injury or fracture of the tibia, because a misdiagnosis or a delay in diagnosis can have a real impact on your outcome.
Our general physiotherapy team can assess your shin pain and identify what is actually driving it. For runners and running-based athletes, our sports physiotherapy team manages these presentations regularly, and you can see the full range of our physiotherapy and rehabilitation services too.
Frequently Asked Questions
What are shin splints?
Shin splints, or medial tibial stress syndrome (MTSS), is pain along the inner border of the shinbone, usually caused by a sudden increase in training load or chronic overloading without enough recovery. It is common in runners and running-based sports.
How do I know if my shin pain is a bone stress injury rather than shin splints?
A bone stress injury tends to cause more focal pain that you can pinpoint, may hurt at night, and often does not settle quickly with rest. Because the two can look similar early on, a physiotherapy assessment is the reliable way to tell them apart.
Can I keep running with shin splints?
Sometimes, with adjusted load, but not if a bone stress injury has been missed. Because pushing on through a bone stress injury can lead to a stress fracture, it is worth getting shin pain assessed before deciding to continue training.
How long do shin splints take to settle?
It varies with severity and how well load is managed. MTSS often settles over a few weeks with appropriate load adjustment and rehab, whereas a bone stress injury takes considerably longer, which is another reason getting the diagnosis right early matters.
Book an Appointment
Book an appointment at BeFit Training Physiotherapy. No referral needed.
BeFit Training Physiotherapy Edgecliff
Ground Floor, 287-289 New South Head Road, Edgecliff NSW 2027
Phone: (02) 9327 7749
BeFit Training Physiotherapy Coogee
Shop 1/2 Byron Street, Coogee NSW 2034
Phone: (02) 7205 2805
