Why My Shins Hurt When I Run

13 May 2021

Medial Tibial Stress Syndrome

What is it?

Medial tibial stress syndrome, often referred to as shin splints, affects a large portion of the athletic population. The exact cause of this injury is unknown; however, it is currently believed to be caused by muscular traction and inflammation of the periosteal lining of the tibia and a stress reaction to the bone itself.

Athletes often experience widespread pain on the distal aspect of the medial border of the tibia. However, it can also affect the anterior border of the tibial shaft. This shin pain is usually described as a sharp pain or a dull ache, which is worse at the beginning of an activity and reduces in severity with exercise as the muscles warm up. This pain will often return after finishing the training session and may even be present the morning after strenuous exercise.

Although this condition is very treatable and symptoms are often mild to moderate, it is important to look out for warning signs which may indicate a more serious injury. If pain increases during exercise and/or has a specific point of tenderness on the shin, this may indicate that you have a stress fracture, which requires immediate attention.

Why do I have it?

There are several intrinsic and extrinsic factors that cause people to get shin pain.  Training/load errors contribute to a large number of these cases. This is why we see this injury effect beginner athletes, or experienced athletes who have recently increased their training load or training type. In addition to training errors, other common risk factors include:

  • Pronated (flat) foot type
  • Rigid cavus (high arch) foot type
  • Improper footwear
  • Muscle weakness
  • Improper running technique


Initially, treatment for medial tibial stress syndrome is targeted towards load management. This aims to reduce the force going through muscles and bony structures of the lower limb. This is why it is important to wear proper footwear when you’re training. However, in many cases, supportive footwear alone isn’t enough and you may require custom orthotics to offload the effected structures. Another important part of the load management process is rest. This doesn’t necessarily mean stopping training all together but could involve adopting a different type of training for a few weeks. For example, cycling or swimming instead of running.

After steps have been taken to target load management, it is important to follow a rehabilitation program to strengthen the muscles in the legs. Strengthening specific lower leg muscles will increase your soft tissue capacity and reduce the risk of this injury reoccurring in the future.