Shin splints, more precisely called medial tibial stress syndrome (MTSS), are an overuse injury that produce pain along the inner edge of the shin during and after running, marching, and jumping. They account for roughly 13-17% of all running injuries and as much as 35% of all injuries in military recruits during basic training.
Shin splints (ICD-10: M76.811) are clinically labeled medial tibial stress syndrome (MTSS), an exercise-induced overuse injury producing pain along the posteromedial border of the tibia, typically in the lower two-thirds. The Yates and White diagnostic criteria define MTSS as exercise-induced pain along the posteromedial tibial border for 5 cm or more on palpation, in the absence of other discrete causes (stress fracture, exertional compartment syndrome, popliteal artery entrapment, deep venous thrombosis). Pathologically, MTSS reflects a spectrum of bone stress and soft tissue irritation: periosteal traction by the soleus, tibialis posterior, and flexor digitorum longus muscles; bone marrow edema visible on MRI; and microdamage in the cortical bone that, if untreated, can progress to a tibial stress fracture. The condition is best understood as bone overload from cumulative microtrauma exceeding the bone's adaptive capacity, modulated by running biomechanics, footwear, surface, and individual risk factors.
The key symptoms of Shin Splints are: Pain along the inner (medial) edge of the shin bone, typically in the lower two-thirds, during running, marching, jumping, or other repetitive loading., Localized tenderness on palpation along a 5 cm or longer segment of the medial tibial border., Pain that initially appears at the start of activity, fades with warm-up, and returns afterward; with continued training, becomes constant., Mild swelling or thickening along the medial tibia in some patients, sometimes with a palpable bony irregularity., Pain on hopping or single-leg standing in moderate to severe cases., Stiffness in the calf and tibialis posterior on examination., Reduced ability to push off during running stride..
Diagnosis is clinical. The history identifies typical exertional shin pain in a runner, marcher, or jumper with a recent increase in training load. Examination reproduces tenderness over a continuous 5 cm or longer segment of the posteromedial tibial border, fitting the Yates and White criteria. Hop testing, single-leg standing, and tuning fork tests support clinical impression but lack specificity. The most important differential diagnoses are tibial stress fracture (localized over a small spot, focal bone tenderness, severe pain on hopping, possible night pain), chronic exertional compartment syndrome (deep aching pain that builds during exercise, tight compartments, often with paresthesia), popliteal artery entrapment syndrome (claudication-like pain that appears at the same distance and resolves with rest, sometimes with pulse changes on dorsiflexion), deep vein thrombosis (unilateral calf pain and swelling with venous risk factors), and infections (rare but important). MRI is the imaging modality of choice when symptoms are severe, fail standard treatment within 4-6 weeks, or features suggest stress fracture; it shows periosteal edema, bone marrow edema, and cortical fracture lines on Fredericson grading. Plain radiographs are usually normal in early MTSS but may show periosteal thickening in chronic cases and identify some stress fractures. Bone scan and CT are now largely replaced by MRI. Compartment pressure testing diagnoses chronic exertional compartment syndrome when this is suspected.
Most cases of MTSS resolve within 4-8 weeks of conservative management. Grade 1 and 2 disease return to full sport within 6-8 weeks; grade 3 may take 8-12 weeks. Approximately 10-15% of patients develop a tibial stress fracture if loading is not adequately reduced and corrected, with longer recovery (6-12 weeks for posteromedial fractures; 12-24+ weeks for anterior cortex fractures). Recurrence rates approach 30% within one year when underlying causes (rapid load progression, biomechanics, nutrition, footwear) are not addressed. Long-term sequelae are uncommon when MTSS is treated appropriately, and most athletes return to or exceed previous performance levels. Predictors of poor outcome include continued running through pain, advanced grade at presentation, recurrent stress injuries, and unaddressed RED-S. Comprehensive return-to-sport programs incorporating gait retraining, strength training, and load monitoring significantly reduce recurrence.
Sports medicine or musculoskeletal specialist referral is appropriate for shin pain lasting longer than 4 weeks despite training modification, recurrent shin splints, atypical pain features, or any suspicion of stress fracture or compartment syndrome. Female athletes with recurrent stress injuries or features of menstrual irregularity should be evaluated for RED-S.
Find specialists →Grade 1: pain settles within 2-3 weeks; full sport at 4-6 weeks. Grade 2: 4-6 weeks rest from running; return-to-running at 6-8 weeks; full racing by 10-12 weeks. Grade 3: 6-8 weeks of reduced loading; full return at 10-16 weeks. Tibial stress fracture: 6-12 weeks; anterior cortex fractures up to 6+ months.
Acute phase: pain-free cross-training (cycling, swimming, pool running, elliptical). After 2-4 weeks of resolving pain, begin a walk/run progression — alternate walking and running, increasing run time by 10% per week. Add hill or speed work only after 4 weeks of pain-free continuous running. Strength work for calves, tibialis posterior, and hips three times per week, with progressive loading.
Choose a sports medicine physician, foot and ankle specialist, or musculoskeletal radiologist with experience in running biomechanics and stress injury management. Centers offering MRI, running gait analysis, and sports physiotherapy familiar with eccentric loading and gait retraining deliver the most complete care.
Medically reviewed by AIHealz Medical Editorial Board · May 13, 2026
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