Shin Splints or Shin Pain When Running?

Noticing a stubborn ache down the front or inside of your lower leg when you run? Many runners describe this as “shin splints”. In clinic, we often refer to this pattern as Medial Tibial Stress Syndrome (MTSS) — a load-related irritation of the tissues along the shin that commonly follows a spike in running or jumping volume.

What is MTSS (in plain English)?

When your training load rises faster than your body can adapt, the repeated forces of running and jumping can irritate the tibia (shin bone), the periosteum (the tissue covering the bone), and nearby muscle attachments. The result is a diffuse, exercise-related pain along the inner border of the lower third of the shin.

Common signs of MTSS

• Location: tenderness along the inside border of the lower third of the tibia, typically spread over an area greater than ~5 cm.
• Warm-up effect: pain may be noticeable at the start of a run and sometimes eases as you settle into your pace.
• Recent training change: a lift in running or jumping load — distance, intensity, frequency, hills, surfaces — often precedes symptoms.

What counts as a “load increase”?

Load isn’t just kilometres. It can rise through duration, intensity (pace, intervals, hills), frequency (more sessions), terrain (harder surfaces or camber), or footwear changes. Even with the same weekly distance, a faster pace, new shoes, or back-to-back hard days can lift stress through the shin.

Are shin splints the same as a stress fracture?

No — but they can be related. It’s important to differentiate MTSS from a tibial stress fracture. Stress fractures often present with more localised tenderness (typically over an area less than ~5 cm), pain that worsens during a run and doesn’t ease as you continue, and may include night pain or pain with normal walking. Both conditions usually require a reduction in running load, but a stress fracture generally needs a longer period away from running to allow bone healing. If you’re unsure which it is, an assessment is the safest next step.

Managing MTSS — the big picture

The underlying physiology is complex, but in many cases the primary driver is a training error — doing more, faster, or harder than your tissues can currently handle. Management typically involves:

• Short-term load modification so symptoms can settle while you maintain overall fitness.
• Gradual, planned progression back to running volume and intensity that suits you.
• Capacity building (strength and conditioning) for calves and the kinetic chain to better share load.
• Technique and equipment context — footwear, surfaces, and pacing choices that fit your goals.

Exact plans differ from person to person. We aim for the least-disruptive path back to comfortable running, tailored to your timeline.

What a rehab plan often includes

At Crux, we start with a thorough history and physical assessment to confirm what’s driving your shin pain. From there, your plan may include targeted strength work and a staged running progression that suits your calendar (events, team commitments, or simply getting back to enjoyable runs). The goal is simple: increase your capacity so the same training feels easier on your shins.

When to get checked

• Shin pain isn’t improving with sensible load changes.
• Pain is focal, persistent, or present at night or with everyday walking.
• You’re unsure whether it’s MTSS or a stress fracture.

This article provides general information for runners and isn’t a substitute for personalised advice. If you’re worried about a stress fracture or your pain is not settling, seek a professional assessment.

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Patrick Brewer

Patrick Brewer is the founder and Principal Chiropractor at Crux Clinic. With a lifelong passion for sport and health, his journey began at sixteen during work experience in a prosthetics and orthotics clinic — where he witnessed the life-changing power of recovery. Today, Patrick is dedicated to helping people move beyond pain, regain confidence, and get back to doing what they love most.