Going on a run can feel amazing – feeling your heart beat with every stride as you take in the scenery around you. That is, until your lower shins start to twinge with pain. You push through and keep running, but your shins start to hurt more and more with every step. Finally, after you wrap up your workout, every inch of your shins radiates with soreness.

If this sounds familiar, you might be experiencing medial tibial stress syndrome, otherwise known as shin splints. It’s painful and it’s common. Fortunately, it’s also very treatable. Keep reading to learn the mechanics behind what’s happening to your shins and what may be causing the pain. And with the help of Lauren Clarkson, one of TRIA’s athletic trainers, we’ll also go over effective at-home treatments, ways to prevent future pain and how to know if you need to see a sports medicine physician.

What are shin splints?

Your tibia, also known as your shin bone, connects your knee to your ankle. It’s surrounded by muscles, tendons and bone tissue. When you walk, run or otherwise exercise your legs, these muscles expand and contract in harmony. And most of the time, everything works well.

However, like any part of your body, these muscles, tendons and tissues can get overworked. This can happen from overuse or when your leg muscles are working under less-than-ideal conditions, like walking in worn shoes or running in different conditions without giving yourself enough time and preparation to adjust. Your leg muscles adapt, but in ways they’re not meant to naturally move.

This abnormal movement causes parts of your shin muscles to overwork, slowly becoming more irritated and painful over time. When you work out and this pain shows up, you have shin splints.

Causes of shin splints

You can develop shin splints several different ways:

• Through any kind of sustained, repetitive or high-impact leg activity that leads to overuse – the kind of leg muscle stress that can come from running, gymnastics, dancing, military exercises or playing sports like tennis and basketball.
• By shocking your leg muscles too quickly with too much new activity or much longer activity instead of ramping up your training over time.
• When you don’t give your leg muscles enough time to rest and recover after intense exercise or activity.
• By often running through sudden surface changes, like quickly switching to a harder surface from softer terrain like grass or a forest trail, or from soft back to hard.
• You exercise with older shoes that are worn out or don’t provide enough support for your feet, or new shoes that are uncomfortable, or don’t support your feet correctly.
• You work out without enough energy or restful sleep, or you’re exercising with mental stress or distractions.

Shin splint symptoms to watch for

Shin splints usually appear gradually as you exercise, in either one or both of your legs. At first, your shin starts to feel sore or begins to ache. As you exercise, the dull ache becomes sharper and more painful. The pain keeps up until you stop using your legs, then it slowly recedes as your muscles relax.

When your shins are hurting, you may notice swelling, and the pain might become more intense when you push down on your shin. More severe cases of shin splints can also cause pain that lasts well after you finish using your legs.

Treatment for shin splints

Shin splints may be painful, but they don’t have to last long. With the right short-term treatments and long-term approaches, your shin muscles will be back in prime condition.

• Cool the pain with ice – When it comes to instant relief, ice is the key to reducing any pain and swelling. Apply a small bag of ice or a cold pack to your shin for 10-20 minutes, three or more times a day. If you want to get creative, use a (literally) cool trick TRIA athletic trainer Lauren recommends. Take a paper cup and fill it 3/4 full of water, freeze, then peel off the top half of the cup for an icy pop that you can apply to your shin. Rub the ice in a circular pattern with gentle pressure until your shin is numb. After about eight minutes, you should have a perfectly chilled (perhaps slightly pink) shin.
• Use over-the-counter (OTC) pain relievers – Using ibuprofen, naproxen and acetaminophen can also help with pain. Ask your doctor if you have any questions and always follow all label instructions.
• Evaluate your footwear – How long have you worn your current pair of shoes? If you’ve run or walked in them for more than 300-500 miles (560-800 kilometers), they’ve already lost over half of their ability to absorb shocks. It might be time to get a new pair of running shoes with supportive insoles. If they’re still new, they might need more breaking in outside of your workout. If they don’t fit well or aren’t protecting your feet, it’s time to replace them with a new pair.
• Rest and rethink your workout – Your shins are going to need some time off to fully recuperate. That usually means taking a few weeks off from high-impact exercise until your shins are 100% pain-free. However, that doesn’t mean time off from working out entirely. In the meantime, you can get your exercise from more low-impact activities like swimming, stationary cycling or using an elliptical machine. If those aren’t an option, try cutting your current high-impact activity in half and run on softer, more level surfaces until your shins are free of pain. In either case, make sure to add some stretching exercises to your workout that keep your lower legs loose.

It's also a good opportunity to get an evaluation from a physical therapist that specializes in running. During your visit, a physical therapist performs a physical examination to identify any areas of your body that may benefit from strengthening, stretching or coordination exercises. Your therapist can also analyze your running form and provide treatments that can help you run with less pain, return to your typical running mileage and prevent future injuries.

With ice and rest, your shins should be pain free in about 2-4 weeks, allowing you to slowly get back into your normal workout routine. Don’t dive back in with abandon though – shin splints take about 3-6 months to fully heal, and a workout that’s too intense for your still recovering shins can send you right back to square one. Once the pain of shin splints is gone, there are several steps you can take to avoid them in the future.

• The 10% rule – While it may be tempting to fully jump back into your routine, too much activity too soon can send pain back to your shins. It’s important to ease back into things through slow running, gradually adding more intensity over time. To do this safely and effectively, Lauren guides her patients with the 10% rule. In the 10% rule, increasing your distance or time 10% each week usually gives your body enough time to respond and adapt without pain. Temporarily increasing your step rate (cadence) by 10% can also help your shins heal. Once you start, keep increasing your activity gradually each week until you’re back to pre-pain condition.
• Building lower body strength – Building up your lower leg muscles through stretching and strength exercises can also keep shin splints away. Adding a strengthening program to your routine that focuses on your lower body can help build your gluteal, hamstring and core muscles, helping to take pressure off your shin muscles. You can also introduce smaller exercises to help strengthen and stretch your lower body daily. To build up your calf muscles, Lauren recommends heel lowers: standing on the edge of a step, rise on the balls of your feet as high as you can go, then slowly lower your heels below the step. Repeat until your muscles start to feel tired.
• Warm up before working out – Give your muscles a good stretch and warmup before you start the bulk of your workout. Doing so will help ease your shin muscles into activity rather than shocking them into work.
• Take your recovery lessons further – The good habits you learned recovering from shin splints can also keep them from coming back. That includes making sure your footwear fits well and isn’t too worn from overuse. Same with keeping a healthy balance of high- and low-intensity activities in your workout mix.

What about other times of the year?

As the seasons turn, it’s a good idea to keep track of how and where you’re working out. Changes in terrain and surfaces play a big part in how shin splints develop. If your outside running surface starts to become harder, firmer or slippery as seasons change from fall to winter, adjust your workout location and length appropriately. The same goes for the transition from winter to spring and summer – you may be able to run longer and faster as the ground becomes softer and more forgiving.

When should you see a physical therapist or sports medicine physician?

Symptoms that initially point to shin splints have the potential to develop into something more. If your shin pain lasts for more than two weeks, even with ice, OTC pain relievers and rest, you may want to make an appointment with a physical therapist as soon as possible. You usually don’t need a referral.

It’s also a good idea to visit a sports medicine physician if you experience any of the following:

• You have pain that continues more than a few hours after exercise, or it wakes you up at night and continues into the morning.
• There’s a small spot on your shin bone that is tender to the touch.
• You have swelling in your legs that is getting worse, or your shin is red and feels hot when you touch it.

These can be signs that something other than shin splints is the problem. A sports medicine physician can check out your symptoms and possibly take an X-ray or perform other tests to see if you have other shin problems like a stress fracture, tendonitis or compartment syndrome.

If you’re a runner, TRIA has built an entire program for you, featuring a team of specialists dedicated to the needs and pains of runners, including injury care and training. Check out the TRIA Running Program page for more information.