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Shin Splints (Medial Tibial Stress Syndrome): Causes, Symptoms & Treatment in Active Adults

Shin splints

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What Are Shin Splints? 

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Medial tibial stress syndrome (MTSS)—commonly known as shin splints—is one of the most common causes of exercise-related shin pain in runners, dancers, and military personnel.

It affects approximately 20% of runners and 35% of dancers and military populations. Incidence varies depending on training intensity and the population studied (Reshef et al., 2012; Ashley et al., 2025; Physiopedia, 2026).

MTSS presents as exercise-induced pain along the medial border of the tibia, typically affecting a span of at least 5 cm along the distal two-thirds of the bone, in the absence of a stress fracture (Larson et al., 2025).

Shin splints are best understood as a tibial bone stress injury, where repetitive loading leads to microdamage and a stress reaction within the bone (Ashley et al., 2025).

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Symptoms of Shin Splints

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  • Diffuse aching pain along the inner shin

  • Pain during or after exercise

  • Tenderness over a broad area (>5 cm)

  • Symptoms that improve with rest (early stages)

⚠️ Localised, sharp pain may indicate a stress fracture and should be assessed.

 

What Causes Shin Splints?

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Latest research shows that shin splints are not simply due to inflammation. Histological studies have failed to demonstrate true periostitis, shifting understanding toward a bone stress model.

MTSS is now considered a tibial bone stress reaction, where bone resorption exceeds bone formation, leading to structural weakening (Moen et al., 2009; Tweed et al., 2008).

Additionally, fascial traction mechanisms may contribute. The deep crural fascia and muscle attachments—including:

  • Posterior tibialis

  • Flexor digitorum longus

  • Soleus

apply traction along the medial tibia, potentially contributing to symptom development (Stickley et al., 2009).

 

Biomechanical Risk Factors

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Several biomechanical factors increase tibial loading and injury risk:

  • Overpronation (increased navicular drop)

  • Increased rearfoot eversion

  • Altered plantar pressure distribution

  • Reduced calf strength or endurance

These factors increase tibial bending forces and strain, contributing to the development of MTSS (Becker et al., 2018).

 

Why Are Women More at Risk of Shin Splints?

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Women are approximately twice as likely to develop MTSS (Newman et al., 2013).

While mechanisms are not fully understood, several contributing factors have been identified:

1. Bone Structure

  • Narrower tibia and reduced cross-sectional area

  • Higher peak bone stress during running (Bruce & Edwards, 2023; Meardon et al., 2023)

2. Foot Mechanics & Muscle Factors

  • Greater prevalence of overpronation (increased navicular drop)

  • Increased ligament laxity—particularly at the knee—may contribute to dynamic knee valgus and associated foot overpronation (Hamstra-Wright, 2015; Okunuki et al., 2019; Boguszewski et al., 2015)

  • Differences in soleus muscle activity during the stance phase, which may influence tibial loading (Edama et al., 2017)

Note: The relationship between Q-angle, pregnancy-related changes, and MTSS remains unclear and requires further research.

 

Shin Splints and Hormones (Perimenopause)

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While declining oestrogen levels during perimenopause are known to affect bone density and collagen turnover, direct evidence linking perimenopause to MTSS is currently limited.

Theoretically, reduced bone remodelling efficiency may increase susceptibility to tibial stress injuries. Clinicians should therefore consider bone health optimisation in perimenopausal individuals presenting with recurrent bone stress injuries.

 

How Long Do Shin Splints Take to Heal?

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Recovery times vary and are largely based on clinical experience rather than high-quality prospective data:

  • Mild cases: 2–4 weeks

  • Moderate cases: 4–8 weeks

  • Persistent cases: 8–12+ weeks

Studies show an average of 10 weeks (Mulvad et al., 2018).

Recovery depends on:

  • Load management

  • Biomechanical correction

  • Rehabilitation adherence

A previous history of MTSS is a strong predictor of recurrence (OR ≈ 6.38), highlighting the importance of addressing underlying risk factors (Naderi et al., 2020).

 

Osteopathy and Sports Rehabilitation for Shin Splints

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Because there is no single superior treatment and current evidence is limited (Level 3–4) (Winters et al., 2013), at Fit and Flex we provide a personalised, evidence-informed approach to managing shin splints.

Our treatment combines osteopathy and rehabilitation, focusing on:

  • Identifying the mechanical drivers of tibial overload

  • Improving mobility and movement efficiency

  • Progressive strengthening and load tolerance

  • Structured return-to-running programmes

Our goal is not only to reduce pain but to minimise recurrence and optimise performance.

 

FAQs

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Are shin splints serious?

They are usually not serious but may progress to stress fractures if untreated.

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Can I keep running with shin splints?

Running may continue if symptoms are mild, but pain should guide activity modification.

 

Do orthotics help shin splints?

Yes—orthotics that correct overpronation may help. Cushioning insoles alone are less effective.

 

What’s the difference between orthotics and shock-absorbing insoles?

  • Arch-support orthotics: Address foot mechanics (moderate evidence for MTSS)

  • Shock-absorbing insoles: Provide cushioning only and have not shown significant preventive benefit

 

What is the fastest way to recover?

The most effective approach is:

  • Load management

  • Progressive strengthening

  • Biomechanical correction

 

 

 

References

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Ashley Larson, A., McClure, C.J., May, T. and Oh, R. (2025) Medial Tibial Stress Syndrome. StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK538479/

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Becker, J., Nakajima, M. and Wu, W.F.W. (2018) ‘Factors contributing to medial tibial stress syndrome in runners: A prospective study’, Medicine & Science in Sports & Exercise, 50(10), pp. 2092–2100. Available at: https://journals.lww.com/acsm-msse/fulltext/2018/10000/factors_contributing_to_medial_tibial_stress.14.aspx

 

Boguszewski, D.V., Cheung, E.C., Joshi, N.B., Markolf, K.L. and McAllister, D.R. (2015) ‘Male–female differences in knee laxity and stiffness: A cadaveric study’, The American Journal of Sports Medicine, 43(12), pp. 2982–2987. Available at: https://pubmed.ncbi.nlm.nih.gov/26464493/

 

Bruce, O.L. and Edwards, W.B. (2023) ‘Sex disparities in tibia-fibula geometry and density are associated with elevated bone strain in females: A cross-validation study’, Bone, 173, p. 116803. Available at: https://pubmed.ncbi.nlm.nih.gov/37201675/

 

Edama, M., Onishi, H., Kubo, M., Takabayashi, T., Yokoyama, E., Inai, T., Watanabe, H., Nashimoto, S., Koga, Y. and Kageyama, I. (2017) ‘Gender differences of muscle and crural fascia origins in relation to the occurrence of medial tibial stress syndrome’, Scandinavian Journal of Medicine & Science in Sports, 27, pp. 203–208. Available at: https://onlinelibrary.wiley.com/doi/10.1111/sms.12639

 

Hamstra-Wright, K.L., Bliven, K.C. and Bay, C. (2015) ‘Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: A systematic review and meta-analysis’, British Journal of Sports Medicine, 49(6), pp. 362–369. Available at: https://pubmed.ncbi.nlm.nih.gov/25185588/

 

Larson, A., McClure, C.J., May, T. and Oh, R. (2025) Medial Tibial Stress Syndrome. StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK538479/

 

Marques, T.B.T., Rangel, R.P.S., Martins, L.V. and Vidal, A.P.C. (2025) Preventive interventions for medial tibial stress syndrome: systematic review and meta-analysis, Gait & Posture, 122, pp. 92–98. Available at: https://pubmed.ncbi.nlm.nih.gov/40633262/

 

Meardon, S.A., Derrick, T.R., Willson, J.D., Baggaley, M., Steinbaker, C.R., Marshall, M. and Willy, R.W. (2021) ‘Peak and per-step tibial bone stress during walking and running in female and male recreational runners’, The American Journal of Sports Medicine, 49(8), pp. 2227–2237. Available at: https://pubmed.ncbi.nlm.nih.gov/34077287/

 

Moen, M.H., Tol, J.L., Weir, A., Steunebrink, M. and De Winter, T.C. (2009) ‘Medial tibial stress syndrome: A critical review’, Sports Medicine, 39(7), pp. 523–546. Available at: https://pubmed.ncbi.nlm.nih.gov/19530750/

 

Mulvad, B., Nielsen, R.O., Lind, M. and Ramskov, D. (2018) ‘Diagnoses and time to recovery among injured recreational runners in the RUN CLEVER trial’, PLoS One, 13(10), e0204742. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC6193581/

 

Naderi, A., Moen, M.H. and Degens, H. (2020) ‘Is high soleus muscle activity during the stance phase of the running cycle a potential risk factor for the development of medial tibial stress syndrome? A prospective study’, Journal of Sports Sciences, 38(20), pp. 2350–2358. Available at: https://pubmed.ncbi.nlm.nih.gov/32615855/

 

Newman, P., Witchalls, J., Waddington, G. and Adams, R. (2013) ‘Risk factors associated with medial tibial stress syndrome in runners: A systematic review and meta-analysis’, Open Access Journal of Sports Medicine, 4, pp. 229–241. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC3873798/

 

Okunuki, T., Koshino, Y., Yamanaka, M., Tsutsumi, K., Igarashi, M., Samukawa, M., Saitoh, H. and Tohyama, H. (2019) ‘Forefoot and hindfoot kinematics in subjects with medial tibial stress syndrome during walking and running’, Journal of Orthopaedic Research, 37(4), pp. 927–932. Available at: https://pubmed.ncbi.nlm.nih.gov/30648281/

 

Physiopedia (2026) Medial Tibial Stress Syndrome. Available at: https://www.physio-pedia.com/Medial_Tibial_Stress_Syndrome

Reshef, N. and Guelich, D.R. (2012) ‘Medial tibial stress syndrome’, Clinical Sports Medicine, 31(2), pp. 273–290. Available at: https://pubmed.ncbi.nlm.nih.gov/22341017/

 

Stickley, C.D., Hetzler, R.K., Kimura, I.F. and Lozanoff, S. (2009) ‘Crural fascia and muscle origins related to medial tibial stress syndrome symptom location’, Medicine & Science in Sports & Exercise, 41(11), pp. 1991–1996. Available at: https://journals.lww.com/acsm-msse/fulltext/2009/11000/crural_fascia_and_muscle_origins_related_to_medial.3.aspx

 

Tweed, J.L., Avil, S.J., Campbell, J.A. and Barnes, M.R. (2008) ‘Biomechanical risk factors in the development of medial tibial stress syndrome in distance runners’, Journal of the American Podiatric Medical Association. Available at: https://pubmed.ncbi.nlm.nih.gov/18347118/

 

Winters, M., Eskes, M., Weir, A., Moen, M.H., Backx, F.J. and Bakker, E.W. (2013) ‘Treatment of medial tibial stress syndrome: A systematic review’, Sports Medicine, 43(12), pp. 1315–1333. Available at: https://pubmed.ncbi.nlm.nih.gov/23979968/

 

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