“Shin splints” isn’t a diagnosis
It’s a catch-all for shin pain, and the label matters, because a few different things cause it and they’re managed differently. The two you most need to separate are medial tibial stress syndrome (MTSS) and a tibial stress fracture.
How to tell MTSS from a stress fracture
- MTSS: tenderness spread diffusely along the inner shin, pain that warms up during a run and settles within hours, no night pain, and hopping is uncomfortable but not sharp.
- Stress fracture: tenderness at one pinpoint spot, pain that builds during activity and lingers at rest, often some night pain, and a single-leg hop that’s sharp and focal.
If it looks like a stress fracture, or you’ve got point tenderness, rest pain, night pain or a sharp hop test, stop running and get assessed. Those are red flags.
Rest alone isn’t enough
Resting settles the symptoms but doesn’t fix the capacity problem underneath. The tibia and calf need rebuilding, and you need a graded return to running, not just time off.
The rough protocol
- Reduce load (weeks 1-2): back off running, keep fit with cross-training, and rule out a stress fracture.
- Build tolerance (weeks 2-6): heavy calf raises, hopping progressions once symptoms settle, plus foot, hip and glute work.
- Return to running (weeks 4-10): structured walk-run intervals with rest days between, never adding more than about 10% a week.
- Prevention: keep the calf strength going, progress load sensibly, and don’t run every session on dead shoes.
MTSS managed well is usually 4-6 weeks symptom-free and 8-10 weeks back to full training. A tibial stress fracture is a longer, more protected timeline. If shin pain isn’t improving after 2-3 weeks, get it looked at rather than running through it.