The Shin Splint Symptoms That Could Signal a More Serious Injury

Every once in a while, I’ll go for a run and immediately feel some nagging soreness in my lower legs. I always know the culprit for the pain: shin splints.Luckily, my successful formula for relieving those leg aches is pretty simple. With years of running, I’ve discovered that discomfort in my shins typically signals that it’s time for a new pair of trainers or a training week with reduced volume. Once I make some tweaks to my footwear and training plan, my shin splints almost always go away within a few days.But not every instance of shin splints can be quickly treated with a shoe swap or mileage modification. Depending on the severity of your symptoms, your shin splints could require medical attention and a longer recovery period. Your pain may even be due to an injury entirely different from shin splints—something I once learned the hard way. So when should you make a trip to the doctor’s office for a bout of shin splints?“There’s a lot of different risk factors [for shin splints], and this is one condition where it’s very, very difficult to treat every patient the same,” says Alicia Canzanese, DPM, in the Runner’s World Guide to Common Running Injuries: Shin Splints.Shin splints are one of the most common overuse injuries runners face, and differentiating between a mild case and a severe one requires staying in tune with your pain and recognizing red flags.What are shin splints?Shin splints, or medial tibial stress syndrome (MTSS), is an injury characterized by pain in the lower front part of the leg, usually right along the tibia. Usually, shin splint pain occurs while running or walking, but goes away once you stop your activity. “When you're resting, relaxing, and doing nothing, there's no pain in the shin,” Canzanese says in our injury program. “But as you start moving, you'll have pain in the beginning. When you first start going, it's going to fade a bit, maybe go away and then it's going to be worse the more you're doing.”What’s typically to blame for shin splints? It’s classified as an overuse injury—or a condition caused by incorporating too much volume or intensity into your training—but other factors can put you at risk of developing shin splints:Wearing improper footwear (or older shoes, in my case at times)Tight calf muscles, or decreased ankle dorsiflexionHip muscle weakness or imbalance​Weakness in your gluteus medius, or the muscle on the outside of your pelvisBMI, weight, or nutritional considerationsAbnormal navicular dropIf your shin pain lessens as you warm up into your runs, and your symptoms disappear once you complete your miles, you can usually manage your injury with a modified training plan, rehab exercises, stability shoes and arch supports, cross-training, or massaging and foam rolling. And the less severe the shin splints, the shorter the recovery timeline typically is—sometimes as brief as one to two weeks.Whenever I experience mild shin pain, I always pose two questions to myself: How many miles have I completed in my current running shoes, and have I made any significant increases in my training load? If I’ve put nearly 500 miles on my shoes, or have taken note of a recent increase in mileage or intensity in my training, I know that based on my injury history, the lower leg pain is likely a simple case of shin splints. I’ll switch into a fresh pair of training shoes, dial back my volume and workout intensity, and incorporate shin exercises into my strength training to relieve the pain. Within a week or so, my shin splints typically subside.When you should see a doctor?I once thought I had a classic case of shin splints, but noticed that my symptoms felt much more intense. Not only did my shins and calves burn while running, but the pain would worsen over the course of runs, and I even felt numbness, tingling, and complete loss of feeling in my feet during my miles. But instead of seeking medical advice immediately, I spent months stubbornly running through the pain—and hoping some foam rolling and shin exercises would make the symptoms disappear. (Spoiler alert: The pain didn’t go away.)Needless to say, I did not take the smart, recommended route for addressing my injury. If you notice any of the following symptoms with your shin splints, you should visit a medical expert for further diagnosis and treatment:Your shin pain worsens as you run or exerciseYou feel pain while walking, or doing other daily activitiesYour symptoms aren’t relieved by rest or cross-trainingFoam rolling or manual massage doesn’t alleviate the shin painInstead of pain covering a broad area along your tibia, your pain is concentrated in one small area on the bone (which could be a sign of a stress fracture)Pain that gets worse with activity, or significantly affects your day-to-day life, can often signal a stress reaction or fracture, which can sideline you from running for months. Increasingly worse pain and tightness in the shin could also be a sign of another lower-leg condition known as exertional compartment syndrome (ECS). A doctor’s evaluation can rule out other injuries and identify what’s truly causing your lower leg pain—whether it’s shin splints or something else entirely. “When the pain starts progressing, when you get to the point where it maybe hurts in the beginning of the run and it’s fading but not completely going away, or it’s really coming back at the end of a run, that’s really when you want to go see a doctor,” Canzanese says.With a more severe case of shin splints, you may need as long as six to eight weeks to recover properly. If your shin splints turn out to be a more serious condition like compartment syndrome or a stress fracture, you may need months away from running to fully heal, which makes seeing your doctor incredibly important if you notice any red flags with your shin pain.As for those severe shin splints I thought I had? Turns out, it was actually compartment syndrome. I finally took a trip to an orthopedic doctor who made the diagnosis and put me on track with a long recovery plan requiring surgery, physical therapy, and a slow return to running. Visiting a medical expert soon after you notice severe symptoms—and not waiting months like I did—can make recovering from your injury and working back into training much smoother.No matter the extent of your injury, your physician will likely prescribe strengthening exercises to address your lower leg pain. Incorporating moves like heel walks, calf raises, and dorsal foot stretches into your strength routine a few times a week can help relieve your aches while also addressing muscle weaknesses and imbalances. You can see our full list of recommended shin splint exercises in the Runner’s World Guide to Common Running Injuries: Shin Splints.The Bottom LineShin splints can be a frustrating injury to deal with as a runner, and they likely won’t go away overnight. Pinpointing your pain, understanding your symptoms, and knowing when a case of shin splints could be something more serious makes all the difference for staying healthy and on track with your training. A good rule of thumb: If you’re ever in doubt, go see a doc.🏃🏻‍♀️ Recognize symptoms, recover safely, and build strength to prevent setbacks with the Runner’s World Guide to Common Running Injuries.Ashley is Editor of Content Hype at Hearst’s Enthusiast & Wellness Group. She is a former collegiate runner at UNC Asheville where she studied mass communication. Ashley loves all things running; she has raced two marathons, plus has covered some of the sport’s top events in her career, including the Paris Olympics, U.S. Olympic Trials and multiple World Marathon Majors.