Shin splints from running: causes and what to do

Doctors call it medial tibial stress syndrome. The pain runs along the inner edge of the shinbone (the tibia), where the lower-leg muscles attach. It usually covers a strip several inches long, aches during and after running, and feels tender when you press along the bone.

The American Academy of Orthopaedic Surgeons (AAOS) describes it as overuse of the muscles and bone tissue in the lower leg. Runners are the group most at risk.

It often appears in the first weeks of a new running habit, or when a runner returns after a long break and picks up where they left off. Your heart and lungs get fitter within weeks. Bone takes months to catch up, and the shins are where that gap shows first. Shin splints usually affect both legs, though one side is often worse.

• A sudden increase in how often, how long or how hard you run. AAOS gives the example of switching from flat routes to hills.
• Lots of running on hard surfaces or downhill.
• Flat feet or rigid arches.
• Worn-out shoes. MedlinePlus notes that running shoes lose over half their shock absorption after about 250 miles (400 km).
• Weak calves and hips, which leaves the shin taking more of the load.

A stress fracture is a small crack in the bone from repeated stress. If shin pain does not respond to rest, a doctor may order imaging to check. The table is a rough guide only. If you are unsure, get it examined before you run again.

1. Stop running. MedlinePlus suggests expecting at least two to four weeks off running, keeping normal daily walking.
2. Keep fit without impact: swimming, cycling or an elliptical, as long as they do not hurt.
3. Ice the shin for up to 20 minutes at a time, several times a day, wrapped in a towel and never directly on skin. NHS advice is up to 20 minutes every two to three hours.
4. Over-the-counter pain relief can help. Follow the label and check with a pharmacist if you take other medicines.
5. Look at your shoes. If they have carried you a few hundred miles, replace them. See running shoes by budget.

AAOS and MedlinePlus both say to be pain-free for at least two weeks before you start running again. Then start below where you were, and build slowly. This is one way to do it on flat, soft ground:

If the pain comes back, stop, rest for a few days, and drop back a week. MedlinePlus notes that shin splints can take three to six months to heal completely, so a setback early on is common.

• Running through it because it eases once you warm up. The pain often returns worse afterward, and the next run starts from a lower point.
• Coming back at your old distance after two weeks off. Start lower than you think you need to.
• Changing everything at once: new shoes, a new route and more runs in the same week. Change one thing at a time.
• Treating it with stretching alone. Rest and a gradual return matter more.
• Ignoring one small, very tender spot on the bone. That pattern needs a doctor, not more ice.
• Doing every run on concrete. Even one run a week on grass or a track spreads the load.

Two or three cross-training sessions a week keep most of your fitness, so the return to running feels easier.

• Build slowly. A common rule of thumb is to add no more than about 10% to your weekly distance.
• Mix in softer surfaces such as trails, grass or a track.
• Strength work twice a week: calf raises, squats, and side-lying leg raises for the hips.
• Replace shoes once the cushioning is worn, and choose a pair that suits your feet.
• Cross-train on one or two days a week with cycling or swimming.

Two strength exercises for the lower leg, two or three times a week once the pain has settled: slow calf raises on both feet, then one foot, 3 sets of 15; and toe raises, standing with your back to a wall and lifting your toes and the front of your feet, 3 sets of 15. They build the muscles that help the shin cope with impact.

Long challenges suit a gradual build. Turtle is 42.3 miles (68 km) over 39 days, about 1.1 miles (1.7 km) a day, easy to split and mix with walking. Walking counts toward your total, so you can keep moving while your shins settle.

• Pain still there after several weeks of rest, ice and pain relief.
• Pain in one small spot on the bone, pain at rest, or pain at night.
• Swelling in the lower leg that is getting worse.
• A shin that is red and hot to the touch.
• You are not sure the pain is shin splints at all.

This is general information, not medical advice. See a doctor or physical therapist if pain lasts, gets worse, comes with swelling, or if you have a health condition.

• Can I run through shin splints? Running on painful shins tends to make them last longer and raises the risk of a stress fracture. Rest first.
• How long do shin splints last? Many improve within a few weeks of rest. Full healing can take months.
• Do compression sleeves help? AAOS lists compression among the measures that may help. They will not replace rest.
• Should I walk instead? Yes, if normal walking is pain-free.

• Shin Splints (OrthoInfo, American Academy of Orthopaedic Surgeons)
• Shin splints (NHS)
• Shin splints: self-care (MedlinePlus)