Shin splints are a common condition that causes pain along the inner edge of the shinbone (tibia), especially during or after exercise. People often notice aching, sharp, or throbbing pain in the lower leg, and sometimes mild swelling.

Shin splints are most likely to appear after high-impact exercises that involve running or jumping. In the United States, the condition affects up to one in five runners and around one-third of military recruits during basic training. The condition also appears in gymnasts, dancers, and people who start new or more intense exercise programs. Both adults and teenagers can develop shin splints. Women develop them more often than men do. People with flat or rigid arches are also more likely to develop shin splints.

With rest and care, shin splints can be managed and treated. Most people with shin splints recover fully and return to their usual activities and sports.

Shin splints, also known as medial tibial stress syndrome, is a condition that affects the muscles, tendons, and bone tissue along the tibia. The condition causes pain, discomfort, and sometimes swelling in the lower leg.

The muscles and tendons in the lower leg help absorb the shock of walking, running, or jumping. However, under certain circumstances, such as a sudden increase in activity or repeated shocks, too much stress transfers to the tibia, leading to damage to and inflammation of the bone’s outer layer.

Shin splints occur most often during high-impact activities, such as running, basketball, soccer, dance, and military training. The condition can develop at any age but is especially common in teenagers and young adults who are active in sports or who start new exercise routines.

Shin splints develop when the muscles, tendons, and bone tissue around the tibia become overloaded by repetitive activity from activities like running, jumping, or dancing. This overuse leads to inflammation and sometimes small injuries in the bone tissue.

The exact cause of shin splints may vary from person to person and may involve a combination of factors:

• A sudden increase in activity, such as running longer distances or more frequently, can cause the muscles to tire quickly. When muscles fatigue, they cannot absorb shock as well, and the tibia absorbs more force.
• Biomechanical issues, such as flat feet or overpronation (excessive inward rolling of the foot), change the way the leg absorbs impact, increasing stress on the shinbone.
• Tight or imbalanced muscles in the lower leg may also contribute by pulling unevenly on the tibia during movement.
• Running on hard or uneven surfaces and wearing shoes with poor support puts increased stress on the muscles, tendons, and bones and can lead to shin splints.

Some studies have linked vitamin D deficiency to a higher risk of shin splints in military recruits.

Risk factors for shin splints include:

• Starting a new exercise program or increasing activity suddenly
• Running, especially on hills or hard surfaces
• Participating in sports with frequent stops and starts (such as basketball, dance, gymnastics, soccer)
• Having flat feet (low arches) or very rigid arches
• Overpronation (excessive inward rolling of the foot)
• Wearing shoes that do not fit well, are worn out, have poor support, or decreased shock-absorbing ability
• Muscle imbalance or tightness in the lower leg
• Previous history of shin splints or lower leg injury
• Higher body mass index (BMI, a measure of body fat based on height and weight)
• Female sex
• Training errors, such as rapid increase in intensity or duration of exercise
• Running more than 20 miles per week
• Vitamin D deficiency
• Leg length differences
• Poor warm-up before exercise

Symptoms of shin splints may include:

• Pain along the inner edge of the tibia, especially during high-impact activities that involve running or jumping
• Dull, aching, or sharp pain in the front or inner part of the lower leg
• Pain that starts with exercise and improves with rest
• Pain that gets worse with continued activity and becomes constant
• Tenderness when pressing on the shin
• Mild swelling in the area
• Pain with stretching or contracting the lower leg muscles
• Difficulty participating in sports or exercise due to pain

In severe cases, pain may be present during normal walking or even at rest.

Typically, to diagnose shin splints, your doctor will review your medical history, conduct a physical exam, and order one or more diagnostic tests.

Your doctor may ask about your symptoms, exercise routine, recent changes in activity, and any previous leg injuries. During the physical exam, your doctor will press along the inner edge of your tibia to check for tenderness and may look for swelling or other signs of injury.

In some cases, additional tests may be necessary, including:

• X-rays can help rule out stress fractures or other bone problems.
• Magnetic resonance imaging (MRI) helps identify inflammation, bone stress injuries, or other conditions.
• Bone scans can help distinguish shin splints from stress fractures.
• Ultrasound may show thickening of the tissue around the bone or fluid from swelling.
• Compartment pressure measurement assesses pressure inside the muscles, if chronic exertional compartment syndrome is suspected.
• Blood tests may be used to check for vitamin D deficiency or other underlying issues.

Doctors also consider other conditions that can cause similar symptoms, such as stress fractures, tendinitis, muscle strain, nerve entrapment, or vascular problems.

Most people with shin splints recover with simple, non-surgical treatments. The main goal is to relieve pain and allow the leg to heal.

Main treatments include:

• Rest: Stopping or reducing activities that cause pain for one to two weeks, or longer if needed.
• Ice: Cold packs applied to the shin for 20 minutes at a time, several times a day, can reduce pain and swelling.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Medicines like ibuprofen, aspirin, or naproxen can help decrease pain and swelling.
• Compression: Wearing an elastic bandage may help prevent swelling.
• Elevation: Raising the leg can decrease swelling.
• Stretching and strengthening exercises: Stretches that focus on the lower leg and hip muscles can improve flexibility and strength. Calf strengthening and ankle mobility exercises are also important for building strength and restoring range of motion.
• Supportive shoes: Shoes with good cushioning and support can help absorb shock and reduce stress on the shins.
• Orthotics: Shoe inserts may help people with flat feet or recurring shin splints by supporting the arch and aligning the foot and ankle.
• Physical therapy: Therapists can teach exercises to strengthen and stretch the leg muscles and may use other treatments to reduce pain.
• Cross-training: Low-impact activities like swimming or using an elliptical trainer or stationary bicycle can help maintain fitness.
• Gradual return to exercise: Once pain has resolved, start with low-impact activity and slowly increase duration and intensity. Running on softer surfaces and decreasing running volume can be helpful.
• Surgery: Surgery may be considered if symptoms do not improve after a year of conservative treatment.

Ultrasound, shockwave therapy, or other therapies may be used in some cases, but evidence for their effectiveness is limited.

The following steps can help prevent shin splints:

• Wear proper shoes with good support and cushioning, especially when participating in high-impact sports.
• Replace running shoes every 250 to 350 miles.
• Use shoe inserts or orthotics if needed for foot alignment.
• Warm up and stretch before and after exercise.
• Increase activity level slowly, avoiding sudden changes in intensity or duration.
• Avoid running or exercising on hard or uneven surfaces. Consider changing training surfaces if pain develops.
• Cross-train with low-impact activities such as swimming or biking.
• Strengthen and stretch lower leg muscles regularly.
• Avoid overtraining and allow time for recovery between workouts.
• Ensure adequate intake of vitamin D and calcium.
• Correct biomechanical issues, such as flat feet or overpronation, with physical therapy.
• Maintain a healthy body weight.

If pain develops, stop or change activity.

People with shin splints may be at increased risk for certain complications, especially if they continue to exercise despite pain. These include:

• Stress fractures (small cracks in the bone) from continued overuse and stress on the tibia
• Chronic tendinitis (long-term inflammation of the tendons)
• Decreased ability to participate in sports or exercise
• Time away from training or competition
• Worsening injury from overly aggressive rehabilitation or incorrect diagnosis
• Difficult-to-control pain
• Residual weakness after surgery

The outlook for people with shin splints depends on several factors, including the severity of symptoms, how quickly treatment is started, and whether risk factors are addressed. Most people recover fully with rest, proper treatment, and a gradual return to activity.

In most cases, pain and swelling improve within a few weeks to a few months. People can return to their usual activities once they are pain-free and have regained strength and flexibility in the lower leg. Increasing activity slowly and using proper footwear help prevent future episodes.

Some people may experience recurring pain, especially after periods of inactivity followed by sudden increases in exercise. With proper prevention and care, most people can manage symptoms and continue to participate in sports and exercise. If pain does not improve with treatment, or if symptoms are severe, a doctor should be consulted to rule out other causes and prevent complications.

“The Yale Department of Orthopaedics & Rehabilitation takes a holistic approach to the treatment of shin splints,” says Stephanie Schmidt, MD, a primary care sports medicine physician who focuses on preventing, diagnosing, and treating a wide range of common problems and injuries, including muscle strains, sprains, joint health, arthritis, and tendonitis. “We not only focus on treating the current pain and symptoms but also take a holistic approach in targeting the underlying biomechanics and training factors that led to the development of this condition. Once the patient has recovered from their pain, we take a proactive approach to preventing recurrence with structured physical therapy, evaluation for orthotics, and gradual return to activity.”