Tibial Stress Syndrome (Shin Splints)

Shin splints suck. Been there, done that. In my experience, however, they’re pretty easy to avoid for experienced runners, since they tend to come on when you return to running after an extended period of time off, or when you increase load too quickly. My last bout was in 2002, when I started doing track work in Barton (lots of fast running for the first time in years, with tight turns) and was wearing shoes with too many miles on them. In other words, being stupid. New runners are also prone to shin splints due to their bodies not being accustomed to the stress of running.

Despite the pain at the shin bone (tibia), the problem is usually related to small tears in the muscles around the tibia. Rest is the primary treatment, and then a gradual increase of load. It’s common to see recommendations for ice and ibuprofen, but I’m not a fan of either. Research doesn’t support ice having any beneficial effect other than temporary pain relief, and ibuprofen reduces the body’s inflammatory response, which is necessary to heal the muscle tears and by reducing the pain, makes it more likely that you’ll inadvertently overdo things.

Again, the PainScience guy has a book on this that I’d recommend as a start. But share your experiences and we’ll build up more advice here.

And more from the Running Writings Injury Series from 2012:

Medial tibial stress syndrome can be pretty tough to manage in the short term. It’s part of the spectrum of injuries in the “bone stress injury” area. This goes from short term soreness over a bony area (mild shin splints) to the point of structural failure (stress fracture). The clinical research on MTSS shows that it’s one of the harder injuries to continue running through during rehab; one of the longer studies showed the average range to complete a return to run program was between 100-120 days (Moen et al. 2012) while allowing runners to run up to a 4/10 on the pain scale. Bone stress injuries are also usually managed with the “envelope of function” approach (see ITBS post), but at end-stage they need more compressive loads to improve their tolerance. This is in contrast to our tendon pathologies, which need tension-loads. Compressive load for a bone really means impact, anything on the spectrum of skipping to explosive plyometrics.

Oooh, this is a good one when it comes to medical imaging. As a rad tech at IC I see shin splints and stress fractures fairly often on XC and T&F athletes. It’s interesting how initial x-rays for a stress fracture are negative, but follow-up films 10-14 days after onset of pain will show a healing response if a stress fracture is present. Shin splints, as described above, are not seen on x-rays at all.

My own experience with stress fractures involves having one mid-femoral shaft (aka “thigh bone”), which was early stage and healed fully after 3 weeks of no running. I also had one years ago in my proximal tibia (self-diagnosed) that took about 2 months to heal. In any case the injury sucks, especially during the summer. Dr. Andy Getzin was very helpful getting me back on track with the femoral injury.


@Pete_Kresock Interesting perspective from the imaging standpoint. Do CT scans or MRIs give you any additional info if it’s on the lower end of the bone stress spectrum (shin splints)? I know of some research on osseous homeostasis in the knee after traumatic injury that can identify bone bruising, but not sure about the lower limb.

@JTuori I have no formal training in CT or MRI, but I know that MRI is always more sensitive when imaging soft tissue. An MRI could confirm shin splints vs stress fracture by imaging edema and/or solid bone. CT isn’t very useful in either case. A nuclear medicine bone scan also works well to show a healing response in the case of a stress fracture but shows nothing for shin splints.