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Shin pain when running? The what, why and how to treat [2021]

Shin pain when running, better known as shin splints, is one of the most common injuries amongst runners. It is most often triggered by a sudden increase in training intensity without the appropriate build-up.

It is associated mainly with people getting into running for the first time, but shin pain when running can impact anyone of any ability.

Shin pain can usually be broken into four categories;

  1. muscle
  2. bone
  3. neural (nerves)
  4. vascular (circulation)

Differentiating between the four different causes can be difficult, this is because you will most likely have some involvement from one of the others alongside the primary cause.

I will try my best to give an explanation of what may be causing your shin pain.

Muscular shin pain

This is the most common cause of shin pain when running and is caused by excessive loading or overuse of the muscles which will make them tight. The two main muscles that are most affected are the tibialis anterior or posterior and the soleus.

Tibialis anterior is the muscle that runs down the front of the shin towards the outside. If you put your fingers on the muscle and raise your toes off the ground you will feel it go firm. Pain in this muscle will occur when it is overused or fatigued.

Tibialis posterior and soleus. These are involved in the flexing of the toes so you can see why an increase in training speed, duration or the introduction of hills will trigger this pain. If these muscles re involved you will most likely experience pain and tightness to the bottom third of the shin.  

Muscular shin pain you will experience pain it at the start of your run, it will ease as the muscles warm then will generally stiffen and feel tight towards the end.

Read about how to treat shin pain

Bony shin pain

The main fear for any runner when you experience bony shin pain is “stress fracture” or “stress reaction”. This is because shin splints and early-stage stress fractures can present the same. There is also evidence to show that untreated shin splints or “pushing through the pain” can develop into a stress fracture.

Our bones get stronger and adapt to the loads that we put on them. A good example of this is the practices involved after breaking your leg and, in most cases, people are placed in a large protective “moon boot” that enables them to walk around.

But too much stress, normally abnormal loading from things like inadequate footwear or flat feet, can stimulate a stress reaction in the bone. If the level of stress on the bone is greater than the speed at which the bone can adapt it will become weakened over time.

If it is not addressed that weakness can start to cause microfractures in the bone, and that is when it develops into a stress fracture. Which is really painful.

A stress reaction will commonly be in the lower third of the leg. What makes is different from muscle pain, is that you will most likely be able to pinpoint the exact area on the bone where it hurts.

A stress reaction will get gradually build and get worse as you run. It will be most painful after you stop and you will experience a deep ache or throbbing sensation at night.

Understand how to treat shin pain

‘Medial Tibial Stress Syndrome’ (MTSS)

MTSS is a medical term that more accurately describes ‘shin splints’. It is used in reference to the dense layer of tissue that surrounds the shin bone called the periosteum.


This layer of tissue has a very good nerve supply which makes it extremely tender to touch. The edge of your shin bone will also feel ‘bumpy’ due to the areas that are inflamed.


To differentiate between MTSS and a stress reaction when trying to determine the cause of your shin pain will be in the location. MTSS will cover a larger area whereas a stress reaction will be a 1-2cm focal point.


MTSS will present as a bit of a mixed bag. Most likely because you will have bony and/or muscular involvement also. The main identifier is the edge of the tibia feeling ‘lumpy’ and tender to touch. It will gradually worsen as you run and be painful for some time after, depending on the severity.

What causes shin pain when running?

About the author

About the Author

Cameron is a former professional rugby player who broke his back in 2007. He is a qualified physiotherapist with two degrees in Sports Science and Physiotherapy. Before Riixo he worked for the UK national health service (NHS), in professional sport and the British army. Read about his story.

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