Fitness Focus Copy-and-Share: Shin Pain : ACSM's Health & Fitness Journal

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Fitness Focus Copy-and-Share

Shin Pain

Thompson, Dixie L. Ph.D., FACSM

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ACSM's Health & Fitness Journal: November 2009 - Volume 13 - Issue 6 - p 5
doi: 10.1249/FIT.0b013e3181bcd7d6
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In Brief

Shin pain is a common complaint of runners and other athletes for whom running is a major component of their sport (e.g., basketball, soccer). Although shin splints is the common term used to indicate pain in the front part of the lower leg, there are actually several conditions that may be the actual source of the pain. The focus of this article is medial tibial stress syndrome (MTSS), the most common cause of shin pain.


MTSS is characterized by pain in the lower portion of the shin along the inside edge of the bone during running or other high-impact activities. This pain is linked with an irritation/inflammation of the membrane (periosteum) surrounding tibia. Tendons attaching to the tibia also may be irritated. Repeated high-impact running puts strain on the bone and other structures. Although the bone attempts to adapt to the repeated stress, the bone's ability to adapt may be overwhelmed and become inflamed. Commonly, MTSS develops when an athlete suddenly increases the intensity, frequency, and/or duration of workouts. Thus, shin splints are a common complaint during the preseason, especially if athletes have not maintained their workouts during the off-season. The risk for MTSS also is increased by running on hard surfaces and by wearing running shoes without adequate support and cushioning. Although not seen in all sufferers, overpronation at the ankle seems to increase the likelihood of shin splints in some runners.


The typical treatment for overuse injuries applies to MTSS. Common recommendations include:

  • Rest - Avoid high-impact activities for 7 to 10 days. To help maintain conditioning, replace with pool workouts. Gradually return to running and other high-impact activities.
  • Ice - Apply ice for approximately 15 minutes after activity. Compression (light pressure with an elastic wrap) and elevation also may help alleviate swelling.
  • Most people can safely use over-the-counter pain medications for a short period to help with pain. These should not be considered a long-term solution. If you are taking other medications or have other medical conditions, consult your physician before taking any medication.

You should consult your physician if your shin pain is intense, does not go away with rest, is accompanied by a noticeably hot and inflamed area, or is linked to an accident. Only a qualified medical professional can determine the precise cause of your pain and order the appropriate treatments.


Avoiding sudden large increases in intensity, frequency, and/or duration of workouts is one of the best ways to prevent MTSS. The 10% rule suggests that your workout volume or intensity should not increase by more than 10% per week. In addition, it is important to replace shoes when the cushioning is compromised. Because running on hard surfaces, downhill running, and running on slanted surfaces can worsen the problem, choosing one's running route carefully also is important.

If you frequently develop shin pain, consult a podiatrist, orthopedist, or other physician who can accurately diagnose your condition and prescribe treatment.

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