Shin Splints vs. Stress Fracture: How to Tell the Difference
Is It Shin Splints—or Something More Serious?
Shin pain is extremely common when runners increase their training.
It can happen when:
Starting a running program
Increasing mileage
Adding hills
Changing surfaces
Returning to sports
Increasing running frequency
But not all shin pain is the same.
Two conditions that can look similar are medial tibial stress syndrome (shin splints) and a bone stress injury/stress fracture.
Understanding the differences is important.
What Are Shin Splints?
Medial tibial stress syndrome typically causes pain along the inside portion of the shin.
Symptoms often include:
Diffuse tenderness
Pain along a larger section of the shin
Pain associated with running
Symptoms that improve with rest
Pain following increases in training
Shin splints are often associated with a sudden increase in training load.
What Is a Stress Fracture?
A stress fracture is a bone stress injury that occurs when repetitive loading exceeds the bone's ability to adapt.
Symptoms may include:
More localized pain
Increasing pain with activity
Pain that becomes progressively worse
Pain with walking
Pain at rest in more advanced cases
Significant tenderness over a specific area
A suspected stress fracture should be medically evaluated.
Why Do Runners Develop Shin Pain?
Training load is one of the biggest factors.
For example:
A runner who has been inactive during the summer suddenly begins running five days per week.
They may also add:
Hills
Speed work
Longer distances
Harder surfaces
That's a substantial increase in stress.
Strength and Movement Matter
While training load is important, strength and movement capacity should also be evaluated.
A physical therapist may assess:
Calf Strength
The calf plays a major role in absorbing and producing force during running. This is a powerhouse muscle group that should NEVER be overlooked!
Hip Strength
Hip weakness may affect lower-extremity control. If the hips control everything that happens downstream, its safe to say that this is pretty important for runners and all athletes.
Ankle Mobility
Limited ankle mobility may change how the lower extremity handles loading. We want the muscles and tendons to handle the load and we also want to the attachment of the tendon to the bone to be solid!
Single-Leg Control
Running is essentially a repeated single-leg activity.
We may assess:
Single-leg squats
Step-downs
Balance
Calf raises
Hopping
How DynaMo Testing Can Help
At Carolina Movement Doc, DynaMo testing can objectively quantify strength in areas such as:
Knee extension
Knee flexion
Hip extension
Hip abduction
Calf strength
This helps identify deficits that may be contributing to reduced lower-extremity capacity.
What Can ForceDecks Tell Us?
VALD ForceDecks can be used to assess force production and performance characteristics through tests such as:
Countermovement jump
Squat assessment
Landing
Bilateral force production
Objective data can be particularly helpful when monitoring an athlete's progress during rehabilitation.
When Should You See a Physical Therapist?
Physical therapy may be appropriate when shin pain appears related to training load, strength deficits or movement limitations.
An evaluation can help determine:
What activities aggravate symptoms
Whether training load needs modification
Whether strength deficits exist
Whether mobility is limited
How to safely progress activity
When Should You See a Physician?
Certain symptoms warrant medical evaluation rather than simply attempting to rehab through them.
Seek medical evaluation if you experience:
Highly localized bone pain
Pain with normal walking
Pain at rest
Increasing pain despite reducing activity
Significant swelling
Pain that persists or progressively worsens
A stress fracture may require imaging and a period of activity modification. This is where us, as physical therapists, should be referring to physicians for further diagnostics so we can establish a crystal clear picture of what is happening.
Returning to Running After Shin Pain
Once a serious bone injury has been ruled out and the athlete is appropriate for rehabilitation, the focus should be on rebuilding capacity.
That can include:
Strength → single-leg control → impact → hopping → running → speed
The progression should be based on symptoms, objective capacity and training demands.
Don't Ignore Recurring Shin Pain
If every increase in running results in another episode of shin pain, the answer probably isn't simply "rest until it goes away."
Something about the current training load or physical capacity may need to change.
At Carolina Movement Doc, we use objective strength testing, VALD ForceDecks, DynaMo, movement analysis and performance-based rehabilitation to help runners understand why they are struggling and develop a plan to return to activity.
If shin pain is keeping you from running, don't guess at the cause. Get it evaluated and build a stronger foundation for your next mile.
