Shin Splints: The Two Types, and Why Treating the Wrong One Doesn't Work

Sharp pain in the shins that won't let you run, jump, or cut is one of the most common complaints I see. Most people treat all shin pain the same way. That's why it keeps coming back.

There are two types of shin splints, they involve different muscles, and they need different work.

Step one: where exactly does it hurt?

• Anterior shin splints — pain along the front and outside of the shin.

• Posterior shin splints (medial tibial stress syndrome) — pain along the inner edge of the shin or behind the ankle.

Before anything else: rule out a stress fracture

Stop and get assessed by a sports physical therapist or orthopedist if you have any of these:

• Pain directly on the bone

• Pain at night

• Pain with no activity at all

• Pain with three single-leg hops

Those are red flags. Exercises are not the answer for a stress fracture, and training through one turns a six-week problem into a six-month one.

Anterior shin splints

Pain along the front of the shin, driven by overuse of the tibialis anterior, the muscle that controls your foot as it lands. It gets overworked by sudden jumps in training volume, hard surfaces, or worn-out footwear. It hurts more the more you do.

Test: painful to press on, and painful when you lift your foot up toward your face.

What helps:

• Heel walking — loads the anterior tibialis isometrically in full weight bearing. Use it as a warm-up before running or jumping. 4 x 10 steps.

• Bosu ball dorsiflexion — active dorsiflexion in a lunge position, through full range. 3 x 12.

• Dorsiflexion ball up-and-overs — heels behind a ball, lift the front of the foot and rotate up and over it. Works tibial rotation too. 3 x 12.

The order matters: settle the symptoms first, then fix the root cause, which is almost always that volume went up too fast. Then rebuild the muscle.

Posterior shin splints

Pain along the inner edge of the shin, from irritation of the tibialis posterior muscle or tendon. Common in runners who ramp volume or intensity too quickly, or who have poor foot mechanics.

Test: pain with a single-leg heel raise.

What helps — 3 sets of 12, every other day or before a run:

• Ball posterior tibialis raises — ball between the heels, squeeze to pinch it, then calf raise. This is my first line of defense for posterior shin splints.

• Midfoot banded sidesteps — loop band around the midfoot, hold a heel raise, then side step. Activates the peroneals and stabilizes the arch.

• Heel raise twists — heel raise, then twist the hips side to side under control. Loads the posterior tibialis in a weight-bearing position.

One more thing: don't ice it

Icing numbs the symptom and does nothing for the cause. These are load-tolerance problems. The fix is managing training volume and progressively loading the tissue that's failing, not shutting everything down.

Want this handled properly?

If your shins have been talking to you for more than a few weeks, or you're mid-training-block and can't afford to guess, come get it assessed properly. One hour, one-on-one, and you leave knowing exactly which type you have and what to do about it.

Dr. Mike Blanco, PT, DPT, Cert. DN — USAT Level 1 Certified Coach. Rival Physical Therapy, 681 Lawlins Road, Unit 110, Wyckoff, NJ. Call or text 201-220-9049.

This article is general education, not a diagnosis or individual medical advice. If pain is severe, worsening, or present at rest, get assessed in person.