and Dr Jordan Metzl?

Despite being one of the most common running injuries, shin splints are among the most misunderstood. The term 'shin splints' is actually more of a catch-all phrase for shin pain than a specific diagnosis.

Shin pain that is related to the bone is more commonly referred to as medial tibial stress syndrome – this is the most common type of pain. It typically presents as pain along the inner shin bone (tibia) during exercise, and afterwards when you touch it.

Muscular shin pain is much less common. This is experienced as a more vague tightening pain in the muscular part of the shin, most commonly down the front.

It is important to make sure you have a proper diagnosis from a physiotherapist or sports doctor to determine if the pain is bone-related or muscular.

Bone-related

Bone-related medial tibial stress syndrome is caused by stress on the inside part of your tibia bone, which causes the bone to swell inside. If irritated for long enough, it can lead to a tibial stress fracture. This is when the bone starts to crack and swell.

Pain can also occur along the front part of the tibia (the tibial spine), which is a more serious type of shin pain. It's where the tibia bone flexes, or bows, upon landing, which causes it to widen, and this can quickly turn into a stress fracture. It is harder to treat than medial tibial stress syndrome, and you have this type of pain you should consult your doctor/physio.

Medial tibial stress syndrome also encompasses periostitis: an inflammation of the bone's outer lining, known as the periosteum. This vital connective tissue encases bones and provides an anchor point for muscles. In the early stages of medial tibial stress syndrome, periostitis frequently flares up, causing tenderness along the inner border of the shin.

While it may initially appear like a bone-stress injury, periostitis typically affects a wider area than a classic stress reaction or stress fracture. This is an important, subtle difference to be aware of, in order to address shin discomfort effectively.

Muscular

Muscular shin pain, which is far less common, is characterised by a tightening in the shin that worsens during exercise – some patients report that their legs feel so tight they might explode. As the muscles expand during exercise, the fascia (which the muscles sit inside) gets squeezed, causing a tightening sensation.

This condition is called chronic exertional compartment syndrome (CECS), and in 80% of cases it's in the front part of the shin. The leg is normally pain-free except during activity. Neurological type symptoms can sometimes occur in these cases – tingling, numbness or weakness in the foot may sometimes present. If you suspect you have any of these symptoms, seek expert medical advise.

This is an easy way to distinguish between shin splints and a stress fracture of the shin bone

This is an easy way to distinguish between shin splints and a stress fracture of the shin bone. If you press your fingertips along your shin and can identify a definite spot of sharp pain, this is a common symptom of a stress fracture.

Stress fractures often feel better in the morning, because the bone has rested all night, whereas shin splints often feel worse in the morning because the soft tissue tightens overnight.

Pain from medial stress syndrome is usually most severe at the start of the run, but often lessens and can even go away completely during a run, once the muscles are loosened up.

This is an easy way to distinguish between shin splints and a stress fracture of the shin bone.

If you suspect you have a stress fracture, you should see a doctor/physio and get an X-ray. Treatment for stress fractures usually involves a four- to six-week break from running, depending on the severity of the fracture.

How to spot and fix IT band syndrome:

• Poor biomechanics, including poor hip rotation, overpronation at a good
• Increasing volume of, or intensity of, running too quickly
• A low bone density, which is more common in women. Softer bones bend more easily, which causes strain and microdamage to the bone
• Poorly cushioned or worn-out running shoes, which don't provide the necessary cushioning and support to absorb impact from the pavement

In most cases, shin splints are an overuse injury. Beginners are more susceptible as their leg muscles haven’t been used or stressed in the same way before. However, runners returning from injury can also be at risk if they increase their mileage too quickly.

Medial tibial stress syndrome presents as pain in the bony part of the shin, while exertional compartment syndrome (ECS) is experienced as a tightening pain in the soft, outside, muscular part of the shin.

As a rule, shin splints present as a persistent, nagging pain typically concentrated along the inner border of your tibia. This is especially true with bone-related shin pain (medial tibial stress syndrome). Runners often experience discomfort in the bony part of the shin during and after runs, especially when pressure is applied. In contrast, muscular-related shin pain manifests as a tightening sensation in the soft tissue on the exterior of the shin, which can feel more elusive but just as bothersome.

To accurately diagnose issues like stress reactions, stress fractures or periosteal inflammation, imaging techniques such as MRI can be useful. However, it’s crucial that the findings from these scans are interpreted in light of your specific symptoms. Symptoms should guide the diagnosis, ensuring that you're not just looking at pictures but understanding the underlying mechanics of pain. This comprehensive approach can lead to more effective treatment strategies and a quicker return to your running.

Medial tibial stress syndrome (or shin splints) tends to not respond well to continuing to run. Whereas with tendon injuries, we tend to allow running with some soreness and awareness in the area (3/10 level of pain), typically running with this level of discomfort for medial tibial stress syndrome prolongs the issue. The unfortunate news is that rest is the first course of action. This does not mean going out for a ‘test run’ every few days. Rest means rest. Give it an initial two weeks to let things settle.

If your shin pain is acute, you shouldn’t run through it – you need to give the bone or muscle time to heal.

While recovering from shin splints, you can try non-impact exercises such as swimming, Knee pain after running: How to spot and fix it cross-trainer. You can also try walking and cycling What is overpronation.

If you have persistent shin splints, try the following:

1. Ice the inflamed area for 15 minutes, three times a day, and ice the shin area immediately after running.
2. Take anti-inflammatories like ibuprofen (though always consult a doctor first if you have existing health conditions) but do not take in order to run pain-free, as this will make the problem worse.
3. What is the best way to treat plantar fasciitis/overpronation running shoes, Is ultra-running bad for the heart orthotic insoles to unload the inside part of your foot's arch.
4. If you have been diagnosed with exertional compartment syndrome (ECS), loosening up the muscles in your leg will help. As mentioned, part of the problem is a tight fascia, the tough material that wraps our muscles. Run your shins and calves over a foam roller to help loosen the fascia. Massage can help too.

If the injury doesn’t respond to self-treatment and rest, see your GP or physio to rule out other causes. A physio can also help you work on any weaknesses that have caused the problem so that it doesn’t reoccur.

Strength train your kinetic chain

Your kinetic chain is your whole body from your neck to your toes – one big interconnected chain of muscles, ligaments, tendons, bones and so on. Each part of the body is a link, and each link depends on the others around it for performance – so whole-body conditioning is key to reducing your injury risk.

However, one area to particularly focus on is your hips and core, as weakness here is linked with shin splints, as well as many other common injuries. If your core (which includes your hips) is weak, your pelvis is unstable, and other muscles have to compensate to keep your hips level. This can put excess strain on the shins and knees.

Strength train twice a week, including exercises like clamshells, glute bridges, side planks, reverse crunches and single-leg squats in your routine.

Change your shoes

It’s also important to check your shoes, as incorrect footwear can itself be an underlying cause. If you can, it’s worth having your gait analysed at a good running store, or to try orthotics that offer similar support shoe that helps control your pronation Injured? Read our complete guide to cross training.

Follow the 10% rule

Never up your weekly mileage by more than 10%, whether you're building up or returning from injury. Give your body time to adjust to the workload.

Up your calcium and vitamin D intake

This will help increase your bone density. Try taking 1,300 milligrams of calcium and 400 micrograms of vitamin D per day. Easy ways to get this without taking a supplement are consuming more milk and yoghurt. in a low gear, without standing up on the pedals is recommended by the NHS.

Shorten your running stride

If you tend to overstride, it can place unnecessary forces through your body. So shortening it slightly while increasing your footstrike cadence may help you generate better stride mechanics, because you’ll be putting a lot less load on your feet, shins and knees. Count your footstrikes on one side for a minute – a good number to aim for is 85 to 90 strikes of one foot per minute.

Strengthen your lower limbs

Matt Bergin, chartered physiotherapist at Performance Team and Increasing volume of, or intensity of, running too quickly, Why should runners focus on dorsiflexion:

1/ Ankle inversion with resistance band

You can also try walking and: This drill strengthens the muscles around your ankle. It targets the tibialis posterior, improving foot alignment and reducing strain on your shins.

How to do it: Sit on the floor with your legs straight out in front of you. Bend one leg and, with the other, place a band – securely tied to a stable piece of equipment out to your side – around the inside of your foot. Turn your foot in against the band, using your ankle to perform the movement. Slowly release and return to the starting position. Repeat on both legs, performing 10-12 reps for 3 total sets.

2/ Calf raise

You can also try walking and: By strengthening the calf muscles, calf raises improve ankle stability and support, reducing the strain on your shins during running.

How to do it: Begin by standing with the balls of your feet on the edge of a step, allowing your heels to hang off. Make sure your feet are hip-width apart for stability. Push through the balls of your feet to raise your heels as high as possible, lifting your body up. Hold the position briefly at the top to engage your calf muscles, then slowly lower your heels back down below the level of the step for a full stretch. Repeat for 20-25 reps and 3 sets.

3/ Hop, hop, hold on spot

You can also try walking and: This movement targets the muscles and stability of the foot and ankle while improving overall proprioception. By hopping and landing on your forefoot, it promotes the use of the calf and smaller foot muscles, which are crucial for maintaining proper alignment and stability during running. Strengthening these muscles helps prevent excessive inward collapse of the foot (pronation), which is a common factor contributing to shin splints.

How to do it: Begin standing on one leg. Perform three repeated hops on the spot, landing and holding on the third hop – land on your forefoot. The aim is to stick the landing on tip toes and keep the foot and ankle as stable as possible, while ensuring the foot does not excessively collapse inwards and your heel does not hit the ground. Perform 6-8 reps for 3 sets.

Try these running drills

Running drills are a form of neuromuscular exercise that help to transfer the strength that we've worked on in the above exercises into more specific running type movements. It helps to train and develop the individual components required for a given part of the running cycle. With foot and ankle drills, the focus is foot placement, stability and control, as well as trying to be snappy and quick off the ground. Try the below twice weekly, or as part of your pre-run drills.

1/ Active plant walk

You can also try walking and: This drill promotes mobility and flexibility in the ankle and foot, while also engaging the muscles that support the shins. By alternating between raising the toes and planting the foot, you will build up ankle stability, encourage proper biomechanics, and strengthen the tibialis anterior, which can alleviate tension in the lower leg muscles.

How to do it: Begin by raising up onto the balls of both feet. Pull the toes of one foot off the floor and up towards your shin, as the opposite foot stays planted into the ground on tip toes. Then switch – actively planting your foot (remaining on tip toes) into the ground as you then pull the toes of the other foot up towards your shin. Repeat this for 15 reps, for 2-3 sets.

2/ Active plant skip

You can also try walking and: Building on from the active plant walk, this is a more dynamic, high-intensity drill that further improves stability and strength in the lower legs. The skipping motion engages the calves and promotes quick foot placement, which helps improve proprioception and agility. By keeping the movements short and snappy, you also train your muscles to react more efficiently, reducing the risk of injury while reinforcing proper running mechanics.

How to do it: Begin by performing the active plant walk above and then make the movement more of a skipping, bouncing movement from one foot to the next. The aim is to make short, snappy movements, spending as little time in contact with the ground as possible. Repeat this for 15 reps, for 2-3 sets.

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Jenny Bozon

Why it works Runner’s World, overseeing RW’s new membership programme, set to launch later this year. She has been with the brand for close to three years now – previously working as deputy digital editor, where she covered all manner of running topics, spanning training, health, injury, nutrition and gear. Over the years, she’s interviewed an abundance of awe-inspiring athletes, from top-tier ultrarunners and Olympic champions to everyday runners who have accomplished extraordinary things. Jen has been a sports journalist for 10 years; she is the former editor of Women’s Running magazine and has also worked as Sports Editor at Red Bull. She started running a decade ago and likes to dabble in triathlon a little, too. You’ll find she’s happiest plodding down the Thames path or chowing down on a post-run pastry.

Expert consulted:Matt Bergin BSc (Hons) MSc

Chartered Physiotherapist

Matt is an international middle-distance runner with a keen interest in running-related injuries, rehabilitation and prehabilitation.