Shin pain: splints, or something that needs a scan
Two very different problems feel much the same in the first few weeks. Here is how to tell them apart, and the honest limit of what you can check yourself.
Get the one-page sheetThe two things it usually is
Shin splints, properly called medial tibial stress syndrome, is a bone stress reaction along the inner border of the shin. The name makes it sound like a muscle problem. It is not one.
A tibial stress fracture sits further along the same road. Same cause, more damage, and a completely different plan. Both come from load going up faster than the bone can keep up with.
Both hurt in roughly the same place. Telling them apart early is the thing that saves you a season.
Pain spread over five centimetres or more, easing when warm, with nothing at rest, is the shin splints pattern. Worth getting assessed, not worth panicking about. One spot you could cover with a fingertip, pain that builds through a run, or pain at rest or at night means stop running and get it looked at this week.
Pain on the front of the shin bone rather than the inner edge, in one spot, is the one to take most seriously. The front of the bone is the side under tension, and those take far longer to settle.
What makes it more likely
Having had it before is the strongest single thing, carrying something like four times the risk. Being female roughly doubles it. A foot that rolls in a long way and carrying more weight both show up consistently.
The one worth naming separately is low energy availability. Eating too little for the training you are doing, periods stopping or going irregular, repeated stress injuries. That changes the whole picture and it needs dealing with first.
The part nobody tells you
The hop test misses four out of five. In a study that scanned every shin, hopping without pain ruled nothing out. Tapping the heel and the tuning fork trick are the same. All of them can raise suspicion. None of them can lower it.
So the check in the guide tells you when to worry. It cannot tell you when not to.
An X-ray will not settle it either. Across the studies, plain X-ray picked up somewhere between one in eight and one in two stress fractures, and a shin can be injured and never show on film. MRI is what gives the answer.
What helps, and what does not
Load is the cause and load is the treatment. Taking it to zero is not the answer and neither is running through it.
Cushioned insoles do not prevent this. That one is settled, with good quality evidence behind it. Static stretching programmes do not either.
What has shown something is neuromuscular work and loading the calf and foot properly, alongside sorting out the training week that caused it.
Give it longer than you want to. On a structured return to running programme the average was around thirteen weeks to get back to eighteen minutes of continuous running without pain. Not two.
Try this first
- Map the pain and note whether it is spread out or in one spot
- Stop the sessions that make it sharper, keep the ones that do not
- Build back by changing one thing at a time, not three
- Keep a note of what your week looked like before it started
Get it looked at if
- Pain in one spot you could cover with a fingertip
- Pain at rest, in bed, or walking on flat ground
- Pain on the front of the shin bone rather than the inner edge
- A tight, bursting ache with numbness or a foot that drops, settling within minutes of stopping
- Periods that have stopped or become irregular, deliberate weight loss, or more than one stress injury
What we would do
We work out which of the two it is, and we tell you plainly when we cannot be sure from the outside, because that is exactly the point where a scan earns its place. Then the return to running plan is built on what we find, with a date to retest.
Want this as a one-page sheet?
The version we hand out in clinic. Print it, stick it on the fridge, work through it.
Related: Gait analysis for runners · All patient guides · Our blog
This guide is general information about a common problem, not a diagnosis of yours. If something is not settling, or it does not match what is written here, come and get it looked at.