Blog
Shin splints: what causes them, how long they take and how to tell them from a stress fracture
Shin splints are one of the most common running injuries. What the research says about risk factors, recovery time, graded return to running, shockwave and insoles, and the warning signs of a stress fracture.
Published · 5 min read Leer en español
Shin splints, called medial tibial stress syndrome by clinicians, is pain along the inner edge of the shinbone that comes on with exercise. The typical sign is tenderness you can feel along a stretch of the bone 5 cm (about 2 inches) or longer [1]. Despite the old idea of an inflamed lining of the bone, studies point instead to the bone being loaded faster than it can adapt [2].
Who gets it
It is one of the most common running injuries. In a review of studies covering about 3,500 runners, it was the leading general running injury, with 13.6% to 20% of runners developing it [3]. In a study of 124 naval recruits, 35% developed it during 10 weeks of basic training [4].
Shin splints often follow a sudden change in training, such as running more often, farther or harder, or switching surfaces [7]. The risk factors that hold up best across studies are:
| Risk factor | What a review of 22 studies found |
|---|---|
| Being female | About twice the odds (odds ratio 2.35) |
| A previous running injury | About twice the odds (odds ratio 2.18) |
| More flattening of the arch when standing | Linked to higher risk |
| Higher body weight | Linked to higher risk |
| More hip outward rotation | Linked to higher risk |
Source: Reinking et al., Sports Health, 2017 [5]. These are associations, not proof of cause. Weekly mileage, age and height were likely not risk factors.
An earlier review found that a previous episode of shin splints and fewer years of running were also linked to higher risk [6], though the later review did not confirm those [5].
Shin splints or a stress fracture?
This matters, because a stress fracture needs more protection. Both come from overload, but they feel different:
- Shin splints: pain spread along a longer stretch of the inner shin [1]
- Stress fracture: pain in a specific spot on the bone that, as it gets worse, hurts with walking and daily activities, may cause a limp, and can ache at night in bed. Swelling and bruising are possible [16]
On exam, tenderness at one point on the bone is the most important sign of a stress fracture [17], and a doctor may ask you to hop on the leg to see if it hurts [16]. X-rays can look normal early on, so an MRI may be needed [16] [17]. Without treatment, a stress fracture can progress to a complete break [17].
Not eating enough for the amount you train raises the risk of bone stress injuries, as does sleeping less than 7 hours and low vitamin D [16].
How long does it take?
It depends on how long you have had it. The NHS says shin splints usually get better within a few weeks [8], and MedlinePlus suggests at least 2 to 4 weeks of rest from your sport, adding that full healing can take 3 to 6 months [9].
People with long-standing symptoms take longer. In a trial of 74 athletes who had symptoms for months, it took an average of more than 100 days to complete a graded running program:
- Graded running plus compression stocking102 days
- Graded running alone105 days
- Graded running plus calf exercises118 days
Source: Moen et al., 2012 [11]. 74 athletes; the differences were not significant. The program ended at 18 minutes of continuous, fairly hard running.
What helps
A graded return to running is the backbone of treatment. In that trial, athletes ran 3 times a week with a rest day between sessions, moved up a stage only when their pain stayed below 4 out of 10, and cut back when pain reached that level during or after running or the next day [11]. Adding calf exercises or a compression stocking did not speed things up [11].
Most other treatments are unproven. A review of 11 trials found no treatment clearly better than another, including braces, iontophoresis, laser, stretching and strengthening, and compression stockings, and all the trials had a high risk of bias [10]. An older review concluded that, in three trials, rest was as good as any intervention [2].
Shockwave therapy may help as an add-on. In a study of 42 athletes that was not randomized, adding shockwave to a graded running program shortened recovery to about 60 days, compared with about 92 days [12]. A 2024 review suggests shockwave may be effective as an addition to exercise for shin splints [13]. The evidence is still limited.
Preventing it
- Neuromuscular training (balance, strength and movement control exercises) reduced shin splints in a 2025 review of prevention trials [14].
- Insoles for flat-footed runners may help, with moderate certainty [14]. Shock-absorbing insoles did not [14].
- Stretching did not prevent running injuries in a Cochrane review [15], and the 2025 review found no support for it either [14].
- Avoid sudden jumps in training in how often, how far or how hard you run [7].
What you can do now
- Stop or cut back the activity that causes the pain, and switch to low-impact exercise such as swimming, a stationary bike or an elliptical [7] [8]
- Use an ice pack wrapped in a towel for up to 20 minutes every 2 to 3 hours [8]
- Return gradually, and only after being pain free for at least 2 weeks, starting with less frequency, distance and intensity than before [7] [9]
- Replace worn-out shoes [7]
See a clinician if the pain is getting worse or not improving [8], or if you still have pain after several weeks of rest, ice and pain relievers [9]. Get checked promptly if the pain is severe, you injured your shin [8], or the pain is in one spot, hurts when you walk or at night, or makes you limp, since those suggest a stress fracture [16].
The takeaway
- Shin splints are pain along the inner shin, common in runners and military recruits.
- Being female, a previous injury and flatter arches are linked to higher risk, and sudden training jumps often trigger it.
- A graded return to running is the main treatment. Most add-ons are unproven, though shockwave shows some promise.
- Recovery can take a few weeks, or several months if symptoms have lasted a long time.
- Pain in one spot, pain at night or a limp needs an exam for a stress fracture.
You can start physical therapy in Utah without a referral. If your shins hurt every time you run, an evaluation can rule out a stress fracture, look at your training load and build a step-by-step plan to get you running again.