What Causes Shin Splints, and How Do You Stop Them Coming Back?
Shin splints are caused by repeated stress on the tibia and the tissues attached to it. They often come back because the underlying cause is never found. This may be poor leg alignment, overpronation or a sudden jump in training load. A standing, weight-bearing check of whole-body alignment can show the structural factors that keep the cycle going.
Key points
- Shin splints (medial tibial stress syndrome) affect the inner edge of the shinbone.
- Training mistakes, footwear, running surface and biomechanical alignment all play a part.
- Scans taken lying down can miss alignment problems that only show when you are standing.
- An EOS standing scan images your legs, ankles and feet under real weight-bearing load.
- Finding the structural cause is the key to stopping shin splints from coming back.
What exactly are shin splints?
Doctors call shin splints medial tibial stress syndrome. It is a bone-stress injury. The pain sits along the inner edge of the tibia, the larger bone in your lower leg. It develops when the periosteum (the thin tissue wrapping the bone) and the muscles attached to it become irritated by repeated loading.
This is not an injury from one single event. It builds up slowly. If the loading carries on without enough recovery, or if the root biomechanical cause is not dealt with, the irritation can get worse and move towards a stress fracture.
How do you know if you have shin splints?
The main sign is a dull, aching pain along the inner edge of your shin. It usually starts during or after running and eases with rest, at least at first. As the condition gets worse, the pain can become constant.
When to get urgent help. If your shin pain is severe at rest, the area is hot or very swollen, or you also have numbness, weakness or loss of feeling in your foot, see your doctor or go to the emergency department. These may point to a stress fracture or another condition that needs to be checked straight away.
Why do shin splints keep coming back?
Shin splints come back when you treat the symptoms but not the cause. Most people rest until the pain fades. Then they go back to the same training, with the same biomechanics, in the same shoes. The overload starts again.
How does alignment affect shin pain when running?
Your body is a connected chain. When one link is out of position, the links above and below make up for it. A slight twist at the hip or a small difference in leg length changes the angle at which your foot hits the ground. That changed loading pattern puts more stress on the inner edge of the tibia, exactly where shin splints develop.
These alignment problems are often impossible to see with the naked eye. Standard scans taken lying down relax the muscles and joints. The skeleton settles into a neutral position that may not reflect what happens when you are standing and moving. That is why many runners have normal-looking scans but still get shin pain that keeps coming back.
How do you stop shin splints from coming back?
Prevention starts with understanding what went wrong in the first place. Some factors you can control yourself. Others need to be looked into.
What you can do now
- Manage your training load. Increase your weekly distance by no more than about 10% at a time. Plan rest days.
- Rotate your shoes. Use more than one pair of running shoes and replace them before the cushioning breaks down.
- Strengthen your calves. Calf raises (both straight-knee and bent-knee) build the capacity of the muscles that support the tibia.
- Raise your running cadence slightly. Shorter, quicker steps can reduce the impact force of each stride.
- Vary your surfaces. Mix softer ground with road running when you can.
What may need a professional assessment
If you have tried the steps above and your shin splints keep coming back, the missing piece is usually structural. Problems such as tibial rotation, a slight leg-length difference, or foot mechanics that cannot be seen from the outside may be driving the overload. Read more about preventing sports injury with 3D skeletal scans.
Shin splints that keep coming back often have a biomechanical cause that standard scans miss. A standing alignment scan can show exactly what is happening under load.
Book a free video consultationHow does a standing EOS scan help with shin splints?
An EOS scan captures your full skeleton while you stand naturally, bearing your own weight. A standard X-ray is taken lying down. The EOS scan instead shows how your bones and joints actually line up under load, the same conditions that trigger shin pain.
For runners whose medial tibial stress syndrome keeps coming back, this can show tibial rotation, ankle alignment, arch position and leg-length differences, all in a single image. The scan uses about 90% less radiation than a standard X-ray, around ten times less.
Standing EOS. You stand in the scanner. Gravity loads your joints just as it does when you run. Alignment problems, rotations and leg-length differences show up as they truly are. A specialist radiographer takes a full image from head to toe in one pass.
Lying-down scans. When you lie flat for a standard X-ray, CT or MRI, your muscles relax and your joints settle. Rotation problems straighten out, leg-length differences compress and arch changes disappear. The image may look normal even though your alignment under load is not.
A note on MRI. EOS shows bones, joints and alignment. If your clinician suspects a soft-tissue problem, a stress fracture that needs to be looked at in detail, or nerve involvement, MRI is usually the better tool. The two scans answer different questions and often work well together.
At ScanAlign, a specialist radiographer reviews your images and maps your alignment from the ground up. The report gives you and your clinician clear, practical information to guide treatment decisions.
Before you start treatment, or change the one you are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in the pelvis, the legs or the spine changes what will actually help.
Frequently asked questions about shin splints
Running through the pain usually makes things worse and can lead to a stress fracture. Cut down your running distance or switch to low-impact exercise until the pain settles. Then deal with the underlying cause before building back up.
Most people see improvement within a few weeks of reduced activity. Full recovery depends on how severe it is and on whether the structural or training cause is dealt with. Without that, shin splints tend to come back.
Shin splints cause a spread-out ache along a stretch of the inner shin. A stress fracture typically causes a sharper pain in one small spot, often noticeable even at rest. If you think you may have a stress fracture, get medical help promptly.
They can, especially if overpronation is adding to the problem. The key is knowing whether your foot mechanics are actually part of the cause. A standing alignment assessment can confirm this before you spend money on orthotics.
Calf raises (both with a straight knee and a bent knee) strengthen the soleus and gastrocnemius muscles. Toe walks, heel walks and single-leg balance exercises also help. These build tissue tolerance around the tibia.
No. You simply stand still for a few seconds while the scanner takes your image. There is no injection, no enclosed tunnel and no discomfort.
An EOS scan uses about 90% less radiation than a standard X-ray, around ten times less. It is one of the lowest-dose skeletal imaging methods available.
No. ScanAlign is a private self-pay clinic. You can refer yourself. The process starts with a free video consultation to check that the scan is right for you.
The price for patients travelling from abroad is confirmed during the free video consultation.
Yes. Research links lower-limb biomechanics, including tibial rotation, hip alignment and foot pronation, to medial tibial stress syndrome. When the skeleton is not well aligned under load, some tissues take more force than they can manage.
Ready to find out why your shin splints keep coming back?
Start with a free video consultation. We will talk about your symptoms, go through your history and tell you whether a standing alignment scan could help.
Book a free video consultationRelated reading
Written by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- Yates B, White S. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. American Journal of Sports Medicine. 2004;32(3):772-780.
- Winters M et al. Medial tibial stress syndrome can be diagnosed reliably using history and physical examination. British Journal of Sports Medicine. 2018;52(19):1267-1272.
- NHS. Shin splints. nhs.uk. Available at: https://www.nhs.uk/conditions/shin-splints/
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.