# Shin splints Shin splints are pain along the inner edge of the shin bone (medial tibial stress syndrome). They come on when running load climbs faster than the bone and the muscles that pull on it can keep up. We work out what changed, settle the pain, build up the calf and foot, and plan a step-by-step return to running. ## Symptoms - Aching or tenderness along the inner edge of the shin - Soreness when you press along the inside of the shin bone - Pain that spreads over a hand's width of bone rather than one spot - Pain early in a run that eases as you warm up, then returns afterward - Shins that ache the morning after a hard run or a long shift - Pain that arrives sooner in each run as training goes on - Mild puffiness over the lower shin ## Assessment Shin splints nearly always follow a change in load, so we ask what changed. A new season, more hills, a move from the Valley Trail onto rocky trail, new shoes, or long days hiking or boot-packing are the usual ones. We also ask how much you run and how the pain behaves during and after a run. Then we examine the shin, calf and foot. We press along the shin bone to see how much of it is tender, and check calf flexibility, ankle movement and foot strength. We watch you hop, squat and step down to test control through the hips, knees and ankles; a knee that drops inward loads the shin more. Shin splints spread over a hand's width of bone or more. Pain in one small spot, sore to press and worse with every run, can be a small crack in the bone from repeated load (a stress fracture). If so, running stops, and a doctor or nurse practitioner arranges imaging. ## Treatment The first job is working out how much running, and how much of your work, study and sport, the shin can take. Often that means less running, flat routes only, and cycling or swimming in place of some runs. Hands-on treatment can ease a tight calf, but the main work is loading, so the bone and the muscles pulling on it get stronger: - **Calf and foot strength:** calf raises built up in stages, and work for the small muscles that hold up the arch. - **Footwear:** what you run and work in, what to change and how gradually. - **Orthotics:** for a foot whose shape or landing adds load to the inner shin, [custom casted orthotics](https://backinactionphysiotherapy.com/services/custom-casted-orthotics) can spread it. We cast your feet and Paris Orthotics makes the pair to that cast. - **Running form:** small changes to cadence and stride cut the load each step puts through the shin. A [running assessment](https://backinactionphysiotherapy.com/services/running-assessment) is where we work those changes out: 55 minutes, one-on-one, with physiotherapists certified by The Running Clinic. Slow-motion video of you on the treadmill shows what each stride does to the shin, and the plan follows. Bring shorts and the shoes you run in now. ## Getting back to sport The way back is walk-run intervals on flat ground, then more running and less walking, then longer runs, then pace. Hills and rocky descents go last, because they load the shin most. Each stage holds until it leaves the shin no more than a little worse and settled by the next morning. In Whistler the Valley Trail dries out long before the alpine trails do, so build distance on the flat before the climbs. Before each run, do the [Run RAD](https://backinactionphysiotherapy.com/resources/run-rad) warm-up, a sheet from our physiotherapists to print and keep. Keep the strength work going after the pain settles. A calf that tires late in a run passes its load to the bone. ## When to come in Book an assessment if shin pain lasts into the next day, spreads along more of the bone, or is cutting your runs short. If your shins flare every spring, book before the season starts, not after the first sore week. Go to the emergency department right away, or call 911, if any of these happen: - you cannot put weight on the leg, even for a few steps - one calf is swollen, warm and painful - your foot is numb, cold or pale - pain, tightness and numbness in the lower leg that keep getting worse after hard exercise ## Who treats it - [Therese Leigh, Physiotherapist, BSc Physiotherapy, MHA, Dip Sport Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/therese-leigh) - [Mike Conway, Physiotherapist, M. PT Sports, M. PT Manips, M. PT Studies, BSc Kin, CHT, GunnIMS, FCAMPT, CSCS](https://backinactionphysiotherapy.com/team/mike-conway) - [Bianca Matheson, Physiotherapist, BSc PT, Grad Dip PT Manips, Dip Sports Physio, FCAMPT, GunnIMS](https://backinactionphysiotherapy.com/team/bianca-matheson) - [Jian Soares, Physiotherapist, M ClinPhys, BSc PT, FCAMPT](https://backinactionphysiotherapy.com/team/jian-soares) - [Dana Elliott, Physiotherapist, MScPT, BSc](https://backinactionphysiotherapy.com/team/dana-elliot) - [Julie Charette, Physiotherapist, BSc PT, Cert. MDT](https://backinactionphysiotherapy.com/team/julie-charette) - [Emilie Noble, Physiotherapist, MSc PT, BSc Kines, AN-IMS](https://backinactionphysiotherapy.com/team/emilie-noble) - [Cameron Gant, Physiotherapist, BSc Physiotherapy, PG Cert Sports Physio](https://backinactionphysiotherapy.com/team/cameron-gant) - [Nicole Klopfer, Physiotherapist, B Physiotherapy (Hons) (UMelb), M Physiotherapy (Manips) (UWA), PGrad Cert Cont & PF Rehab (UMelb), GunnIMS](https://backinactionphysiotherapy.com/team/nicole-klopfer) - [Michael Pearce, Physiotherapist, BSc PT](https://backinactionphysiotherapy.com/team/michael-pearce) - [Kelsey Rey, Physiotherapist, MPT, BHK](https://backinactionphysiotherapy.com/team/kelsey-rey) - [Keeley Wentzel, Physiotherapist, BSc Physiotherapy (Hons)](https://backinactionphysiotherapy.com/team/keeley-wentzel) ## Services - [Physiotherapy](https://backinactionphysiotherapy.com/services/physiotherapy) - [Running Assessment](https://backinactionphysiotherapy.com/services/running-assessment) - [Custom Casted Orthotics](https://backinactionphysiotherapy.com/services/custom-casted-orthotics) - [Registered Massage Therapy (RMT)](https://backinactionphysiotherapy.com/services/massage-therapy) ## Programs - [Run RAD](https://backinactionphysiotherapy.com/resources/run-rad) ## Frequently asked questions ### Should I stop running with shin splints? Not always. Mild shin splints usually tolerate a smaller dose of running, shorter and on flat ground, with cycling or swimming on the days between. Keep each run to a level where the pain is no more than a little worse and has settled by the next morning. If the pain sharpens the further you go, or the shin is sore to press afterward, stop and book an assessment. ### Do I need new shoes for shin splints? Maybe. No single shoe suits everyone, and comfort is a fair guide. Shoes that have lost their cushioning, or a sudden switch to a lighter or flatter pair, can both add load to the shins. How gradually you change shoes matters more than the brand. In a running assessment we look at how your shoes and your stride work together, so bring the pair you run in now. ### Do runners need orthotics? Only some. Many runners do well without them. An orthotic earns its place when the shape or movement of your foot adds strain to a sore area, such as the inner shin. It is one part of a plan with calf strength and training changes. Ours are cast from your own feet after a physiotherapist's assessment, and made to that cast. We do not bill orthotics to your insurer: you pay at the clinic and claim them with our receipt. ### Can I keep hiking or working on my feet with shin splints? Mostly, yes. Walking loads the shin far less than running, so most people keep working and hiking while they recover. Long days on hard floors, steep descents with a heavy pack and boot-packing are the exceptions, because each loads a shin that is already struggling. If the shins ache more each day instead of settling overnight, cut those days back for a while and tell us at your assessment. ## Massage for recovery Massage therapists do not diagnose, so start with a physiotherapist. Once you have a diagnosis and a plan, our registered massage therapists can help with the recovery. [About massage therapy](https://backinactionphysiotherapy.com/services/massage-therapy) *This page is general information, not a diagnosis or a substitute for an assessment. If you are unsure, see a health professional.*