Conditions We Treat
Shin Splints
At a glance
Shin splints, known clinically as medial tibial stress syndrome, is an overuse injury that causes a diffuse ache along the inner border of the shinbone, usually in runners and people whose sport involves a lot of running or jumping. It is one of the most common running injuries and can be diagnosed reliably from your history and a physical examination. Treatment centres on adjusting your training load and graded rehabilitation, with shockwave therapy as a supported addition to exercise. The main thing to rule out is a tibial stress fracture.
It starts as a dull ache along the inside of your shin a few kilometres into a run. A couple of weeks later it is there from the first stride, and the next morning the inner edge of the bone feels bruised when you run your fingers down it. Looking back, you may have added mileage, started a race programme or come back to running after a break.
Shin splints is the everyday name for medial tibial stress syndrome. It develops when the tibia is loaded repeatedly without enough recovery between sessions (Najim et al., 2026), and it shows up as pain spread along the lower two-thirds of the inner border of the shinbone, with tenderness over a broad area rather than one spot (Bosnina et al., 2023). In a systematic review of running injuries, it was the second most common new injury in runners after Achilles tendinopathy (Kakouris et al., 2021).
Some people are more prone to it than others. A meta-analysis of risk factors found five that held up across studies: female sex, higher body weight, a foot arch that drops more under load (measured as navicular drop), a previous running injury and greater outward rotation at the hip (Reinking et al., 2017). None of these means you should stop running. They tell us where to look and what a programme needs to address, alongside your training history and footwear. If you run regularly, our 60-second running injury risk screen is a useful place to start.
The main thing to rule out is a tibial stress fracture. Both are bone stress injuries from repetitive loading, but they are managed differently, so telling them apart matters (Najim et al., 2026). Shin splints is a diffuse ache with tenderness spread over several centimetres. A stress fracture usually causes pain localised to one spot, typically less than 5 cm across, with focal tenderness, pain on hopping and in some cases pain at rest and at night (Bosnina et al., 2023). If your history or examination points that way, we refer you directly for imaging. MRI is the definitive scan for a tibial stress fracture (Najim et al., 2026).
In most cases, though, shin splints is a clinical diagnosis. In a multi-site study, two clinicians examining the same athletes independently agreed on the diagnosis 96% of the time using history and examination alone. The same study found that 32% of athletes with shin splints had another lower leg injury at the same time (Winters et al., 2018), so we check the calf, Achilles, ankle and foot as part of the assessment.
Management is primarily non-operative, built on activity modification followed by graded rehabilitation (Najim et al., 2026). In practice that means adjusting how much and how fast you run so the shin can settle, keeping your fitness up with cross-training and then building back with calf and lower leg strengthening, hopping progressions and a structured return to running. Our hands-on care includes soft tissue work through the calf and mobilisation of a stiff ankle or foot, and we look at your running mechanics and training plan for what tipped things over. Our article on chiropractic care for runners covers how this fits together.
Shockwave therapy is something we add when shin pain is persistent. A 2024 systematic review in the British Journal of Sports Medicine concluded from the highest-level trials that shockwave may be effective as an addition to exercise treatment for medial tibial stress syndrome, and that in most studies athletes kept training during treatment with minimal side effects (Rhim et al., 2024). For athletes in season, that matters. It sits alongside the rehab programme, not in place of it.
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Book OnlineCommon symptoms of shin splints
- A dull ache along the inner border of the shinbone
- Pain spread over several centimetres rather than one spot
- Tenderness when you press along the lower inner shin
- Pain that builds during a run and lingers for hours or days afterwards
- Pain that started after increasing mileage, speed or hill work
- Pain that returns each time you try to build back up
- Tightness through the calf on the same side
- Soreness along the shin the morning after a hard session
- Symptoms in one or both legs
If shin pain is building with each run or has started to linger between sessions, getting assessed early helps rule out a stress fracture and start the right plan sooner.
Located on Rivonia Road in Morningside, we treat patients from Sandton, Bryanston, Rivonia, Fourways and across Johannesburg.
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Frequently Asked Questions
Shin splints comes from repeated loading of the shinbone without enough recovery between sessions. It is worth looking at any recent change in your training, such as more mileage, more speed work or a return to running after time off, because each adds load to the shin. Some people are more prone to it: female sex, higher body weight, a foot arch that drops more under load, a previous running injury and greater hip rotation have all been identified as risk factors.
The pattern of pain is the main clue. Shin splints is a diffuse ache along the lower inner border of the shinbone, tender over a broad area rather than one spot. A tibial stress fracture tends to cause pain localised to one small area, focal tenderness when pressed, pain on hopping and sometimes pain at rest or at night. If your symptoms point towards a stress fracture, we refer you directly for imaging.
It depends on how irritable the shin is and what is behind it. Shin splints is managed with activity modification followed by graded rehabilitation, so the answer is usually to change what you are doing rather than carry on as normal. That might mean less volume, flatter routes or cross-training for a period, then a structured build back to full running. If a stress fracture is suspected, imaging comes first.
It can, as an addition to exercise. A 2024 systematic review in the British Journal of Sports Medicine concluded from the highest-level trials that shockwave may be effective as an adjunct to exercise treatment for medial tibial stress syndrome, and that athletes in most studies kept training during treatment with minimal side effects. We use it alongside a rehab programme rather than in place of one.
Usually not. Shin splints can be diagnosed reliably from your history and a physical examination, and two clinicians examining the same athletes independently agreed on the diagnosis 96% of the time. A scan becomes useful when a stress fracture or another cause is suspected, and MRI is the definitive scan for a tibial stress fracture.
A previous running injury is itself a risk factor, and so are factors like a foot arch that drops more under load and higher body weight. We treat recurring shin splints as a sign that the load on the shin needs a closer look. Assessment looks at your training pattern, lower leg strength and running mechanics, then builds a plan around what we find.
References
- Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. Journal of Sport and Health Science. 2021;10(5):513-522.
- Reinking MF, Austin TM, Richter RR, Krieger MM. Medial tibial stress syndrome in active individuals: a systematic review and meta-analysis of risk factors. Sports Health. 2017;9(3):252-261.
- Bosnina F, Padhiar N, Miller S, et al. Developing a diagnostic framework for patients presenting with Exercise Induced Leg Pain (EILP): a scoping review. Journal of Foot and Ankle Research. 2023;16(1):82.
- Winters M, Bakker EWP, Moen MH, et al. Medial tibial stress syndrome can be diagnosed reliably using history and physical examination. British Journal of Sports Medicine. 2018;52(19):1267-1272.
- Najim O, Padhiar C, Aweid B, et al. Tibial bone stress injury: a common cause of leg pain in sports. British Medical Bulletin. 2026;160(1):ldag043.
- Rhim HC, Shin J, Kang J, et al. Use of extracorporeal shockwave therapies for athletes and physically active individuals: a systematic review. British Journal of Sports Medicine. 2024;58(3):154-163.