Shin Splints: Why They Happen, How to Prevent them and When to Watch for Red Flags

Dr. Michael Blanco PT, DPT
Oct 8, 2025
4 min read

If you’ve ever trained for a race, started running again after time off, or jumped into a new workout routine (including getting back into your sport), you’ve probably felt that burning, tight ache down the front or inside of your lower legs. Those are shin splints. Shin splints are of the most common overuse injuries we see at Rival Physical Therapy.

The good news? Shin splints are highly treatable when managed correctly. But they can also become something more serious, such as a tibial stress fracture if the symptoms are ignored.

Our Shin Splints: Treat Yourself guide was created to help you understand which type of shin splints you have, how to treat them safely, and how to recognize when it’s time to see a professional.

What Are Shin Splints?

“Shin splints” is a general term for pain along the lower leg, usually brought on by repetitive impact activities like running or jumping.

There are two main types:

Anterior Shin Splints

Pain on the front and outer part of the shin
Caused by overuse of the tibialis anterior muscle, which lifts your foot during running and walking
Often triggered by sudden increases in training volume, hill running, or hard surfaces

Research shows anterior shin pain is frequently linked to eccentric overload of the tibialis anterior and poor ankle mobility (Yates & White, 2004, British Journal of Sports Medicine).

Posterior Shin Splints (Medial Tibial Stress Syndrome)

Pain on the inner edge of the shin, often near or behind the ankle
Caused by stress and inflammation along the posterior tibialis muscle and tendon
Common in runners with flat feet, poor arch control, or worn-out footwear. Often a load management issues for runners as well.
Common in jumping and cutting sports (basketball, soccer, football)

Studies have identified weak posterior tibialis activation and poor foot mechanics as key contributors to medial tibial stress (Moen et al., 2012, British Journal of Sports Medicine).

Typical Areas that Shin Splints are Found

Why Shin Splints Happen

Shin splints develop when training load exceeds tissue capacity. This means that your muscles, tendons, and bones most likely aren’t ready for the volume or intensity you’re asking of them.

Common causes include:

Rapid mileage or intensity increases
Running on hard or sloped surfaces
Improper or old shoes
Weak calf, hip, or foot stabilizers
Limited ankle mobility
Poor running mechanics (overstriding, excessive pronation)

Essentially, your body’s braking system is working overtime, and the result is irritation along the muscle bellies, tendons and tibia.

Red Flags: When It’s More Than Shin Splints

Not all shin pain is created equal. While mild shin splints improve with targeted rehab, tibial stress fractures require medical attention with MRI being the gold standard for detecting a stress fracture. Typically, you will not be able to see a stress fracture on X-ray! The only way to see a stress fracture on X-ray is if it has progressed to a full blown fracture! (Not good)

Red flag warning signs:

🚩 Sharp, localized pain directly on the bone

🚩 Pain that persists at rest or wakes you up at night

🚩 Swelling or tenderness that doesn’t improve after 1–2 weeks

🚩 Inability to perform 3 pain-free single-leg hops

If you notice these symptoms, it’s time to stop training and get evaluated by a sports physical therapist or orthopedist. Early intervention can prevent a minor injury from turning into a full stress fracture.

How to Prevent Shin Splints

1️⃣ Gradual Progression

Follow the 10% rule. Don’t increase your weekly running volume or intensity by more than 10% (this is for the general person without proper guidance. I have been known to increase volume up to 30% in some cases, but everyone is DIFFERENT)

2️⃣ Strength Train Regularly

A strong lower body reduces stress on the tibia. Focus on calf raises, hip strengthening, and foot stability exercises at least twice a week. Prehab beats rehab!

3️⃣ Improve Footwear and Surfaces

Replace worn-out shoes every 300–500 miles and alternate running surfaces when possible. If you’re wearing “super” shoes, this number can be cut in half or more.

4️⃣ Address Mobility

Tight calves or limited ankle dorsiflexion can increase shin stress. Incorporate mobility drills and dynamic warm-ups before running.

How to Rehab Shin Splints

Our Shin Splints: Treat Yourself guide walks you through targeted exercises to both identify and fix your type of shin splints.

For Anterior Shin Splints:

Heel Walks
Bosu Ball Dorsiflexion
Dorsiflexion Ball Up & Overs

Goal: Reduce tension on the front of the shin and progressively load the anterior tibialis.

For Posterior Shin Splints:

Midfoot Banded Sidesteps
Heel Raise Twists
Ball Posterior Tibialis Raises

Goal: Improve foot stability, strengthen the posterior tibialis, and restore load tolerance.

Pro tip: Perform these exercises every other day or before running as part of your warm-up. And yes, skip the ice! Tendon and muscle irritation heal better with controlled movement and blood flow, not long-term icing. If you need some sort of relief, try a heat pack OR some Icy-hot.

When to Seek Help

If your shin pain doesn’t improve within two weeks, or if you suspect a stress fracture, schedule a visit at Rival Physical Therapy. As sports physical therapists who work daily with runners, triathletes, and high school/collegiate sports, we can perform gait analysis, assess load tolerance, and design a rehab plan to get you back to training safely.

The Takeaway

Shin splints are your body’s way of saying, “Slow down and rebuild.” By identifying whether you have anterior or posterior shin splints and treating them early you can avoid more serious injury and return to running stronger than before.

Download the full Shin Splints: Treat Yourself guide to identify your type of shin pain and start your recovery today.

Let the team at Rival Physical Therapy help you move, perform, and train pain-free.