Runners guide to shin splints and stress fractures
Just started training for your first marathon or joined a run club and now you’re experiencing shin pain while running? Welcome to the club. Shin splints are one of the most common and frustrating running injuries. However, not all shin pain is the same. That “I’ll run it off” discomfort could actually be the early signs of a tibial stress fracture that needs immediate care.
At Hoppers Physiotherapy, we regularly see runners and athletes who wish they’d spotted the difference sooner. This guide cover everything you need to know about shin splints and stress fractures. From their causes, symptoms, treatment options and when to seek professional help to get you back to running pain free as soon as possible.
What are shin splints?
Also known as Medial Tibial Stress Syndrome (MTSS), shin splints are an overuse injury characterised by inflammation and irritation of the muscles, tendons and bone tissue surrounding the shinbone (tibia). They commonly occur when training loads increase faster than your body’s ability to adapt.
Common symptoms of shin splints:
- Pain along the inside border of the shin
- Pain often eases as the runner warms up (early stages) and returns after exercise
- Tenderness spread when you press along the shin (usually more than 5cm)
What is a stress fracture?
A stress fracture is a small crack on the shin bone caused by repetitive stress and repetitive loading that exceeds the bone’s ability to remodel itself.
Some signs of a stress fracture include:
- Localised pain to one spot (typically less than 5cm)
- Pain occurs earlier during activity and may persist after exercise
- Significant pain when hopping on the affected leg
- Pain while walking or at night
Stress fractures are common in runners and athletes participating in high-impact sports such as basketball, tennis, soccer and AFL
How to tell their difference?
The main difference is found in the pain pattern and location.
Shin splints
- Pain typically across a larger area along the shinbone
- The pain may ease during your run
- Associated with recent increase in training load
Tibia stress fractures
- Sharp, localised pain in one specific area
- Pain worsens with activity or exercise
- Often painful with hopping, walking or resting
If you are not sure which injury you’re dealing with, it is important to seek an assessment from a professional early to avoid further bone injury.
What causes shin splints and stress fractures?
The reason it is difficult to tell shin splints and stress fractures apart is because they share similar risk training and individual factors and these include:
Training factors
- Sudden increases in running mileage, speed or hill training
- Inadequate recovery between training sessions
- Poor running techniques
- Wearing inappropriate or worn-out running shoes
Individual factors
- Muscle imbalances
- Weakness in areas of the lower limb
- Poor gait or running technique (including excessive pronation or supination)
- Reduced bone density
- Hormonal factors or medications affecting bone health
How to prevent shin splints and stress fractures
Since both injuries share similar risk factors, prevention strategies may overlap. Begin with addressing persistent pain early rather than “running through it”, along with these practices:
Increase Training Gradually – Follow the 10% rule by increasing weekly running volume by no more than 10%. Include rest days and vary training intensity throughout the week.
Improve mobility – Incorporate 2-4 times weekly bouts of strengthening and stretching your lower limbs to reduce unnecessary stress.
Choose the Right Footwear – Training on softer surfaces can assist to reduce impact and proper fitted running shoes.
How sports physiotherapists can help?
Not all shin pain is the same. An early physiotherapy assessment can help differentiate whether you are dealing with shin splints or a stress fracture, guide you with appropriate rehabilitation, and reduce the risk of prolonged time away from running.
Our clinicians at Hoppers Physio are able to give insight into advanced imaging techniques to distinguish between the conditions and use objective training data like VALD technology to give real-time data to find imbalances and strengths to track progress and better guide recovery.
Our physiotherapists will provide:
- Individualised treatment plans – Progressive loading programs tailored to your specific condition and goals, alongside comprehensive biomechanical assessment and movement correction.
- Evidence-based injury prevention strategies – Including gait analysis, load management education, and advice to reduce the risk of recurrence.
- Structured return to run programs – A staged, evidence-based approach to safely return you to training and competition.
Whilst management focuses on modifying training volume, lower limb strength, biomechanics, and gradual loading are equally important to optimise recovery and reduce the risk of recurrence.
When should you see a Physiotherapist?
If your shin pain has persisted for more than a week, is becoming more localised, or continues after exercise or at rest it is time to book a physiotherapy assessment.
Seeking treatment early can help identify the underlying cause of your symptoms, guide appropriate management, and reduce your recovery time, allowing you to return to training safely and confidently.
Get back to pain free training with Hoppers Physio
Whether you’re dealing with shin splints, concerned about a tibial stress fracture, or simply want to prevent injuries before they happen, our experienced team at Hoppers Physiotherapy can help.
For ongoing rehabilitation, strength development and long-term injury prevention, our accredited exercise physiologists can create an individualised exercise program tailored to your goals. To book a comprehensive assessment, contact us on (03) 9749 5110 or book online.