Shin Splints: What Causes Them and How Physical Therapy Can Help You Recover

Whether you're training for your first 5K or just picked up walking as part of a new wellness routine, there's one phrase that can stop your progress in its tracks: shin splints.

That sharp, aching pain along the front of your lower leg can show up quickly — and linger stubbornly if not addressed properly. While shin splints are incredibly common, especially among runners and athletes who engage in repetitive leg activity, the underlying causes are more complex than most people realize.

At RISE Rehab, we go beyond just “rest and ice.” We get to the root of the issue, looking at your biomechanics, muscle imbalances, movement patterns, and training habits to build a custom recovery plan that gets you back on track — stronger than before.

In this guide, we’ll walk through:

• What shin splints actually are (and aren’t)

• The anatomical structures involved

• Common causes (beyond just “too much running”)

• How physical therapy treats shin splints at the source

• What to do right now if you think you have them

Let’s take a step forward — pain-free.

What Are Shin Splints, Really?

The term “shin splints” is a bit of a catch-all — and that's part of the confusion.

The correct medical term is medial tibial stress syndrome (MTSS). It refers to pain that develops along the inner edge of the tibia (shin bone), where the muscles, tendons, and bone tissue become irritated or inflamed due to repetitive stress.

This pain is typically:

• Dull, aching, or throbbing

• Located on the lower two-thirds of the tibia, often on the medial (inner) side

• Worse with running, jumping, or walking long distances

• Present at the start of activity and may fade with warming up, only to return worse later

It’s important to understand that shin splints are a symptom — not a diagnosis. That means we need to look deeper to understand what's really going on under the surface.

Anatomy and Physiology: What’s Actually Happening in the Lower Leg?

The lower leg is more than just your shin bone. It’s a complex structure of muscles, tendons, fascia, nerves, blood vessels, and bones — all working together to absorb shock, generate motion, and stabilize your body as you move.

Key structures involved in shin splints include:

Tibia (Shin Bone)

The tibia bears the majority of your body’s weight during walking and running. Repeated ground reaction forces can cause bone stress responses — early stages of stress fractures that may start as shin splints.

Tibialis Posterior & Anterior

• Tibialis posterior controls pronation and arch stability.

• Tibialis anterior lifts the foot during gait and controls foot drop. Overuse can cause these muscles to pull excessively on the tibial periosteum (the sensitive outer layer of the bone), creating irritation and inflammation.

Calf Complex (Gastrocnemius + Soleus)

Tightness or dysfunction in these muscles can overload the tibialis posterior and anterior or increase joint stress at the ankle and knee.

Fascia and Connective Tissues

The fascia around the anterior compartment and deep posterior compartment can restrict blood flow and muscle expansion, contributing to pain with activity.

Periosteum

The periosteum is rich in nerve endings and vascular supply — when inflamed due to microtrauma from muscle pull or excessive loading, it’s often the key source of pain in shin splints.

What Causes Shin Splints?

Shin splints often arise when loading exceeds the tissue’s ability to recover. At RISE, we identify all contributing factors, not just the obvious ones.

1. Sudden Increase in Training Volume or Intensity

Increasing distance, speed, or frequency too quickly overloads the tibia and associated musculature.

2. Poor Foot Mechanics (Overpronation)

Excessive inward collapse of the foot during weight bearing increases stress on the tibialis posterior, which pulls on the periosteum of the tibia.

3. Muscle Imbalances and Weakness

Weak:

• Glutes

• Core

• Foot intrinsics Leads to overcompensation by smaller, more fatigue-prone muscles in the lower leg.

4. Inappropriate Footwear

Shoes with poor shock absorption or inadequate arch support create abnormal loading through the lower leg.

5. Training Surface

Running on hard surfaces (like concrete) or transitioning suddenly to soft/springy tracks or treadmills alters shock absorption.

6. Tightness or Poor Mobility

Particularly in the calves, hamstrings, and ankles, reducing your ability to dissipate ground reaction forces effectively.

Muscle/Tendon vs. Bone Stress: A Critical Diagnostic Distinction

Differentiating between soft tissue origin (muscle or tendon-related) and bone stress injury is essential, especially for tailoring treatment. However, it’s important to note that the traits outlined below are common indicators of one diagnosis versus the other, but there can still be overlap. For example, while bone stress injuries often present with night pain and focal tenderness on the tibia, muscle-related injuries might initially present with generalized pain but, if untreated, could progress to cause localized tenderness or discomfort similar to a stress fracture. This overlap can complicate diagnosis, which is why a thorough evaluation by a physical therapist or physician is critical for ensuring the right treatment approach.

Clinical Feature	Muscle/Tendon Origin (Soft Tissue)	Bone Stress Response
Pain Onset	Gradual, often associated with activity (i.e., running or jumping)	Sharp, localized; may occur earlier in activity and/or persist at rest
Location	Diffuse tenderness along the muscle or tendon	Focal tenderness localized to the tibial shaft, often at the medial border
Pain Timing	Pain worsens with activity and may improve during or after warm-up	Pain often worsens as activity progresses, and can remain painful during rest or at night
Night Pain	Uncommon, typically resolves with rest	Often reported; a hallmark sign of early stress fractures
Physical Exam	Generalized tenderness in the soft tissue (calf, tibialis anterior/posterior)	Point tenderness over a specific site on the tibia, especially over the bone's medial aspect
Response to Treatment	Symptom relief with manual therapy, stretching, or dry needling	May require rest or protection, and may not improve without modification of loading
Imaging	Soft tissue injuries are often normal on X-ray or MRI	MRI may show bone marrow edema, cortical thickening, or microfractures; stress fractures visible on MRI or bone scan
Complications	Less severe, but can result in chronic pain or overuse injuries	Can progress to full fracture if not managed, resulting in significant setbacks in training and function
Research Considerations	Studies show that myofascial trigger points and muscle imbalances (such as in the tibialis posterior) are common contributors to shin splints (Huang et al., 2020).	According to Martin et al. (2019), bone stress responses typically require a period of rest and rehabilitation to address underlying biomechanics.

⚠️ If a stress fracture is suspected (e.g., sharp pinpoint pain, swelling, night pain), immediate imaging and modification of activity is recommended. At RISE, we work closely with referring physicians to ensure proper diagnosis and safe return-to-activity planning.

How Physical Therapy Helps Shin Splints — The RISE Rehab Approach

Rest alone won’t fix dysfunctional movement patterns. At RISE, we take a comprehensive, full-body approach that targets not just symptoms — but the root cause.

1. Biomechanical Movement Assessment

• Running/walking analysis

• Foot/ankle alignment

• Hip/knee/core coordination

• Leg length discrepancy screening

We identify faulty patterns that increase stress through the shin — and correct them through targeted retraining.

2. Manual Therapy and Soft Tissue Work

Reducing soft tissue tension and restoring mobility is key.

We may use:

• Myofascial release to release fascial restrictions

• Instrument-assisted soft tissue mobilization (IASTM) for scar tissue or fascial adhesions

• Joint mobilization at the foot and ankle

• Dry needling to address deep trigger points in the tibialis posterior, soleus, or peroneals

Dry Needling for Shin Splints

Dry needling targets neuromuscular trigger points and can relieve chronic tension in the lower leg muscles. This can:

• Reduce pain and improve local circulation

• Release muscle knots that pull excessively on the tibia

• Help re-establish normal motor control This is especially effective when combined with mobility work and exercise.

3. Addressing Neural Tension

In some cases, shin pain may involve neural tension in:

• Saphenous nerve

• Tibial nerve Gentle nerve glides, along with addressing fascial entrapment sites, help restore nerve mobility and reduce symptoms not responsive to traditional stretching.

4. Strengthening and Corrective Exercise

We guide you through a progressive loading program targeting:

• Foot intrinsics (short foot exercises, toe yoga)

• Tibialis posterior and anterior

• Glute med/max and core for proximal control

• Calves and soleus for endurance

• Eccentric loading for tendon adaptation

Exercises are individualized based on your specific presentation, sport, and goals.

5. Return to Running/Activity Program

We guide return to sport safely with:

• Gait retraining and cadence adjustments

• Gradual loading protocols

• Surface and footwear recommendations

• Cross-training to maintain fitness while healing

When to See a Physical Therapist

If you’re noticing any of the following, it’s time to schedule a PT evaluation:

• Shin pain that doesn’t improve after 1–2 weeks

• Pain that worsens or appears earlier in activity

• Pain at rest or at night

• Swelling, bruising, or focal tenderness

• Numbness or tingling

Early intervention makes a big difference — and prevents progression to more serious injuries like stress fractures.

Ready to Rise Above Shin Splints?

You don’t have to settle for “waiting it out” or avoiding the activities you love. At RISE Rehab, we specialize in evidence-based, one-on-one care that addresses your unique anatomy, mechanics, and goals.

Whether you're an athlete, runner, or weekend warrior — we’ll help you retrain your body, reduce pain, and prevent future flare-ups.

Book Your Personalized Evaluation Today

Your pain-free future starts now. Whether you're ready to dive into a full recovery plan or just want to talk through your symptoms, we're here to listen. Set up a call with a RISE physical therapist to discuss what you're experiencing, ask questions, and learn how we can help you get back to feeling like yourself again.