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Part 1: Step by Step- Navigating the Terrain of Shin Splints

Ah, the dreaded shin splints… if you’re a runner or an athlete in any sport that involves running or jumping,  you’ve probably experienced shin splints at some point. It’s one of those pains that you want to address ASAP before it gets worse. Waiting 3 months or until you’re having pain with daily activities to finally do something about it often makes the comeback a lot slower and more tedious. 

What are Shin Splints?

Here’s the quick and dirty on shin splints: It’s one of the most common running related injuries and it’s hypothesized to be a bone overload + stress injury. Simply put, it’s shin pain during running, jumping, or playing sports.  If you’ve been to Made 2 Move before, you’ve likely heard your PT talk about the equation: 

  • Stress + Recovery = Adaptation

 Shin splints are an example of the stress > recovery, and thus, adaptation is often not achievable. The stresses on the bone (ground reaction forces, repetitive loading, quick jumps in mileage) placed upon the shin bones is greater than the recovery they’re being given. 

Other names you may hear shin splints referred to as:

  •  Medial tibial stress syndrome (MTSS)

  •  Bone stress injury (BSI)

The Continuum of MTSS 

Athletes often ignore shin splints in the early stages because it hurts while they run, but the pain often subsides pretty quickly (if not immediately) after the run is completed. “No biggie, must have just be an off day or a sore calf,” is often the thought running (no pun intended)  through an athlete’s head.

However, we always encourage our runners to listen to these early signs (rather than ignore them), as continuing to run on an aggravated bone only exacerbates the severity. The early, dull, achey pain is simply your body’s initial stress reaction- letting you know “Hey, THIS (whatever the aggravating activity may be) is too much.” Mild, achey pain is common during the early stages of the shin splint continuum. 

The early stress reaction usually subsides relatively quickly with adequate recovery and rehab. However, if these early indicators are continuously ignored, an athlete may progress (not in a positive way) along the continuum into later stages. Later stages of the shin splint continuum can include  stress fracture or even complete bone fracture in which athletes are forced to take time off from their sport. (Warden et al. 2014). 

What causes shin splints?

Activities like running and jumping place stress on the bones through muscle contractions and the impact of landing. This type of loading can be really great, because it causes microdamage which stimulates remodeling, which can lead to stronger, denser bones! Woohoo! 

However, when loading starts to exceed your body’s ability to adapt, you may experience those early stress reaction signs such a mild, dull, achey pain in the shin. This is your body saying, “YO, things are breaking down faster than we can remodel them,” which can lead to a bone stress injury like MTSS. As Physical Therapists, the most common reason we see this happen in runners/jumpers is:


  • Increasing running volume too quickly, or doing too much too soon.

  • Fancy way to put it is “workload error.” This means you’re running more than your tissues can handle - the break DOWN is happening faster than the build UP.

  • Low Energy Availability

  • This is exactly what it sounds like: the nutrients going into the body don’t match the physical demands being placed upon it. This can be due to excess energy expenditure (exercise), low nutrient intake (not eating enough), or a combination of the two. If you aren’t fueling properly, this adds to the unequal equation of workload outweighing the current capacities of your body. This is a common reason we’ll refer athletes to our sports dietitian friend, Reilly Beaty, RD!

How Do I Know if I Have Shin Splints?

Imaging is required to make a definitive diagnosis of MTSS, but many of the early signs can be identified by the athlete, reported to the PT or AT, which can point us in a direction of healing without the additional cost of imaging. 

Early signs to look out for: 

  • Mild, dull ache when running

  • Pain doesn’t subside after the warmup

  • Pain is present at higher speeds, distances, etc., but is gone almost immediately after the run ends. 

  • Pain when touching any of the bony structures around the shin, ankle, or foot.

Later signs to look out for: 

  • Pain with lower impact activities such as walking. 

  • More localized pain (ie- the athlete can point more specifically to the spot that it hurts).

  • Pain when touching any of the bony structures around the shin, ankle, or foot.

The good news about shin splints? They respond well to activity modification and proper load management, so working with a PT often gives athletes a game plan to get back to their sport ASAP.  

Interested in working with a PT who is just as pumped to get you back out on the field, court, or track as you are? Reach out to today to set up an initial evaluation. And stay tuned for next week’s blog on the management and treatment of shin splints! 


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