Patient information · Physiotherapy and orthopaedics
Shin splints
and how to tell them from a stress fracture
Shin splints — medial tibial stress syndrome — is pain along the inner edge of the shin caused by the bone and its lining being loaded faster than they can adapt. It is the classic injury of doing too much too soon, and the important thing is distinguishing it from a stress fracture, which needs a different approach entirely.
Seek prompt assessment if you have
- pain at a single point you can cover with a fingertip, rather than spread along the shin
- pain at rest or at night, or pain on hopping on that leg
- severe pain, tightness and numbness during exercise that eases on stopping — possible compartment syndrome
- swelling, redness or heat over the shin, or fever
- shin pain with irregular periods or a history of disordered eating
- pain that is worsening despite reducing training
A focal, pinpoint tender spot with night pain suggests a tibial stress fracture, which requires rest from impact rather than modified loading. Shin pain in a female athlete with irregular or absent periods raises the question of relative energy deficiency and low bone density, which needs assessing.
Telling them apart
- Shin splints — diffuse ache along the inner shin over several centimetres, worst at the start of a run, often easing as you warm up, sore afterwards.
- Stress fracture — sharp, pinpoint pain over a small area, worsening through activity rather than easing, often painful at night and on hopping.
- Compartment syndrome — tightness, aching and numbness building predictably at a certain distance, resolving within minutes of stopping.
- Imaging is not usually needed for straightforward shin splints, but MRI is the test of choice where a stress fracture is suspected.
What causes it
- A sudden increase in training — distance, frequency, intensity or hills. The single commonest factor.
- Running on hard or cambered surfaces, and worn-out shoes.
- Weak calf and hip muscles, and poor single-leg control.
- Excessive pronation or a very high arch.
- Low vitamin D, low iron, and inadequate energy intake for training load.
- Returning to running after a break at the level you left off.
Getting better
- Reduce impact load, do not stop entirely. Cut running volume substantially and replace with cycling, swimming, aqua-jogging or cross-trainer to maintain fitness.
- Build calf strength. Heel raises, straight-knee and bent-knee, progressing to single-leg and then added weight. This is the intervention that most changes recurrence.
- Add hip and glute work — single-leg control determines how much load reaches the shin.
- Increase cadence by around 5–10% — shorter, quicker steps reduce impact per stride and are one of the simplest effective changes.
- Return gradually. Walk-run intervals, on soft flat ground, increasing weekly volume by no more than about 10%.
Helps
- Ice after activity, and soft-tissue work to the calf
- Replacing running shoes every 500–800km
- Running on grass, trails or a treadmill rather than pavement
- Checking vitamin D and ferritin, both commonly low in runners
- Strength training twice a week, year-round
Prolongs it
- Complete rest, then returning at the previous volume
- Running through pain that worsens during the session
- Increasing distance and speed in the same week
- Ignoring worn shoes or a change of surface
- Doing only stretching, with no strength work
Why come to us. The important question is whether this is a stress syndrome or a stress fracture, because getting that wrong costs a season. Our physiotherapy and orthopaedic teams assess the shin, check the hip and foot mechanics that caused it, and test vitamin D and ferritin in-house — both frequently low in runners and both affecting bone. MRI is arranged rapidly through our CQC-registered partners where a stress fracture is suspected. Seven days a week, no referral needed.
Stress syndrome or stress fracture? Assessed properly
Physiotherapy on site, bloods in-house, MRI arranged fast.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.