How to Heal Shin Splints, according to a PT

One of the most common injuries runners face are shin splints. Indeed, shin splints were the first injury I dealt with a young runner in high school. And, today, as a running coach, I have had several athletes come to me asking how to heal shin splints.

If you’ve suffered from shin splints aka medial tibial stress syndrome, you know the pain. It runs along the shin bone aka your tibia in the front of your lower leg. It’s sore to the touch and hurts most when you start out running, warms up, and then often returns when you stop running.

woman holding her shin — Shin splints are a common running injury.

A lot of beginner runners get shin splints as their body adjusts to the stress of running or they increase their training too fast too soon (which is a common beginner running error). This stress overworks your muscles, connective tissues, and bone tissue causing microtears, tiny cracks, irritation, and/or inflammation of the muscles and tissues.

The good news is, it can be easy to heal shin splints once you diagnose them and take certain steps to treat them.

I got with runner and Doctor of Physical Therapy Joe Norton to cover:

What triggers shin splints?
Do shin splints ever go away?
How to treat shin splints
How to prevent shin splints (including exercises for shin splints)
The best shoes for shin splints, and
Is it okay to run with shin splints (& how to tell if you’re ready to run)

Note: I am not a doctor, so if you have concerns—you should see one or a physical therapist.

Let’s get going, shall we?

What are shin splints?

Shin splints are a common running injury that occur along the side and front of the shin bone (tibia), the long bone in the front of your lower leg.

There are two theories for how shin splints develop:

First, the muscles attaching on the inner aspect of the shin, namely the soleus, tibialis posterior and flexor digitorum longus, pull on the bone. The rate or intensity of muscles contracting leads to excessive stretching of the periosteum on the bone surface resulting in pain.
Second, the impact of running causes more breakdown down of the bone than the body can tolerate leading to microcracks which then cause pain.

What do shin splints feel like?

The pain of shin splints is along the front and side of your shin.

The most common symptoms of shin splints are:

Your shins feel tender to the touch on the front and inner part of the lower leg.
You’ll have a dull ache or soreness when you start running.
In more severe cases, your shins will hurt throughout your run.
You may also notice some swelling in your lower leg.
The pain is not constant and shouldn’t interfere with daily activities.

There is a risk of shin splints turning into a stress fracture if they aren’t given a chance to rest and recover.

How do you know if you have shin splints and not a fracture?

The biggest difference in symptoms between having shin splints and having a tibial stress fracture is that the pain of a stress fracture won’t go away after warming up.

Norton says lower leg pain from a stress fracture will get progressively worse as you run, and they hurt with daily activities such as walking and standing.

Clinically, a stress fracture is very locally tender, he says. There may even be a lump/nodule on the bone at the site of tenderness. Conversely, shin splints are typically sore over a larger area usually described as the middle or lower third of the shin bone.

The other condition to rule out is compartment syndrome, which is characterized by cramping or burning pain in the back of the leg. It may also cause numbness or tingling in the leg or foot.

If you suspect a stress fracture, an X-ray, bone scan, or MRI can show you what’s going on.

What triggers shin splints?

Running is the most common cause of shin splints, says Norton. But let’s peel back the onion on the causes of shin splints a bit more.

Common Causes of Shin Pain

Structural Issues

A high BMI, being female, certain foot characteristics, and a medical history of shin splints are all risk factors for this injury.

Having a higher BMI can lead to more stress impact when you run which is compounded by the repetitive action of running.
Also, the shape of your foot can lead to shin injures: A dropped navicular (big toe bone) can cause pronation of the foot which puts more torsion on the tibial bone.
Runners who have high amounts of hip external rotation tend to be prone to shin splints.
Flat feet may also lead to shin splints.

Your Demographics

Females and new runners are more at risk to develop shin splints, as well as people who have a history of shin splints as they likely have structural, behavioral, or biomechanical factors that predispose them to more shin stress.

Newer runners are more likely to get shin splints as they haven’t developed stronger tibial bones.

A Sudden Increase in Training

A training program that doesn’t incorporate enough recovery can lead to shin splints and other injuries. This includes too much running volume, intensity, and frequency.

Remember this equation: STRESS + REST=SUCCESS

Recovery plays a crucial role in adaptation. When we run, we cause repetitive stress that breaks down the tissue which then builds back stronger, shares Norton.

“When the training is too much or the recovery is not enough, the body continues to break down the bone without building it back causing sustained and progressive microfractures in the bone,” he says.

Review your training to ensure you didn’t have any sudden changes that could have overstressed your shins.

Weak Calves

If the calf muscles have limited endurance or strength, this lowers a runner’s resiliency, leading to overuse, says Norton.

Also, if calf muscles will are misused and overused this can lead to excessive pronation, pelvic drop, or knee collapse, for example, which can cause injury.

Poor Nutrition

Bone is a complex tissue that responds heavily to energy availability through food, says Norton.

shin splints pin 2 — Pin these tips for how to heal shin splints pin for later!

“If there is a lack of food or limitations in certain foods (including those with calcium and Vitamin D3), then this may predispose a runner to a bone stress injury,” he notes.

Do not limit food intake if you are a runner looking to improve performance. If you are not sure if nutrition is a source of your shin splint, consult with a sports dietitian. (I can recommend some good ones!)

Additionally, bone is also very influenced by hormones. If you are a female runner who has amenorrhea (loss of your period), then you should talk to your PCP or OB/GyN OR consult with a dietitian who works with female athletes to talk through your case.

(For strong bones, consider Previnex’s Joint Health Supplement. Save 15 percent with code TMR15 with a money back guarantee.)

Do shin splints ever go away?

Yes, shin splints go away once your body has time to heal. This can take anywhere from two to six weeks–with 58 days being the average time and two weeks if you take a tw0-week break from running, according to physical therpist Dr. Nelly Kinedarbois.

It is advisable to meet shin splints head on. If they develop into stress fractures or a stress reaction, you will have to be away from the sport for much longer.

How I get rid of my shin splints?

First make sure you have a diagnosis. Stress fractures, compartment syndrome, posterior tibialis tendonitis, referred pain from the knee or spine all must be excluded.

How to Heal Shin Splints

If you are certain you have shin splints, here is your action plan.

1. Rest.

If your pain is prevalent when running, take a two-week break from running and choose low-impact activities such as swimming, biking, rowing, or the alter-G treadmill instead. If your shins only hurt when running for the first mile or so, you may be able to continue running. But you should reduce both volume and intensity while you address the injury. Also, avoid running on hard surfaces and see a healthcare provider if it persists for more than two weeks!

2. Ice.

Apply ice packs or perform ice massages on your shins 3 times a day for 15 minutes. Do this by freezing a paper cup full or water and peeling back the top of the cup. Rub it on your sore shin bones. If you are still running, ice soon after running. Do NOT ice before running.

3. Massage.

Foam roll your calf muscles at least once a day and gently stretch them.

4. Strengthen.

Address deficiencies. If you have seen a PT, they should be able to tell you what muscle groups need to be strengthened or lengthened in your kinetic chain.

5. Consider new shoes.

Make sure you aren’t due for new shoes. If your shoes aren’t too old, ensure you are wearing the right shoes for you. You may also need more supportive shoes, arch supports, insoles, or a custom orthotic to correct biomechanical issues.

6. Take pain-relievers sparingly.

Nonsteroidal anti-inflammatory drugsare also one of your treatment options. However, taking NSAIDs to relieve pain can inhibit the body’s healing process.

If you need it to run or perform your daily activities without pain, then I think it’s best to go to your doctor. Get a physical examination and ensure you don’t have a stress fracture of the tibia, or something else.

Best Shoes for Shin Splints

shin splints graphic — Here is your action plan for shin splints.

If you suspect your shoes were a contributor to your shin splints, here are some considerations for your next pair of running shoes, according to Norton:

Look for a cushioned shoe that offers premium shock absorption such as the Hoka Bondi or Hoka Mach. It is suspected that overstriding and high ground forces may contribute to MTSS (shin splints).

If a more cushioned shoe does not make the pain noticeably better, try a stiff shoe with rigid arches.
If these options do not work, try a motion-controlled shoe or a stability shoe to reduce the effects of pronation on the lower extremities. In a randomized controlled trial of 260 runners, those who wore a motion controlled shoe were less likely to sustain a “pronation” related injury like shin splints.
It’s best to go to a running store and have them watch you run to know if you are pronating. This way you can try on the shoes before buying them to see how your shins feel.

Is it okay to run through shin splints?

It is not recommended to run through shin splints. Unlike tendon injuries, shin splints aren’t able to heal while continuing to run. In many cases, if you continue to run with shin splints, your pain level and duration will likely increase, says Norton.

Also, unlike most other injuries where running is okay if your pain is at or slightly above a 2/10, for shin splints you need to err more on the side of caution, says Norton.

If pain is above a 1/10, do not run! As the shin bone is sensitive to breakdown in the presence of pain. Also, if you are changing your gait, compensating for pain, then do not run!

The best course of action is to rest for two weeks. Then perform the “hop test” to assess if you may be ready to try running.

How to perform a hop test:

Stand on one leg (the hurt leg if only one shin hurts) and hop for 20 seconds. If you don’t have pain, you may try an easy run/walk.
If you have pain, try walking for 5-10 minutes and repeat. If you don’t have pain, you can try a return to running with an easy run/walk.
If you do have pain, continue to rest, and treat your shin splints.

4 Key Exercises to Treat & Prevent Shin Splints

Key exercises to prevent shin splints and heal shin splints involve strengthening the calf muscles, and strengthening and improving coordination of the lateral hip and glute muscles.

Heel Raise (single leg):

On a step, stand on one foot with your heel off the step
Raise it up so that you are on your tippy toes, hold for a second
Slowly lower to the starting position
Do 25 reps on each side
Add weights if this gets easy
If this is hard, start with both legs

Step Down (single leg):

Stand with one foot on a step, one
single leg step down

foot off the ground.
Slowly lower the leg off the step and lightly touch your heel to the floor
Slowly return to your starting position.
Do 10-15 reps on each side.

Leg Bridge (single leg):

Lie on your beg with your knees bent.
Lift one leg off the floor, extending in front of you.
single leg bridge
Squeeze your glues and engage your core. Raise your hips off the floor. Hold for 1-2 seconds.
Lower hips and repeat. Do 10-15 reps on each side.

Side Plank with Hip Lift:

Lie on your side and prop your upper body up on your elbow so that you are in a straight line making a V with the floor. (Bend your knees and have them touch the floor if this is too hard).
side plank hip lift
Engage your core and glutes and slowly lower your hips to the ground keep everything in line.
Lift up and repeat for 10 reps on each side.

If you are unsure if you have shin splints, go see a sports medicine physician or physical therapist. You don’t want to waste time treating an injury you don’t have. And you don’t want it to get worse by letting it go untreated!

If you want guidance with your running goals, check out my run coaching services. Also, be sure to check out my free training plans:

side plank hip lift