Shin Splints: Causes, Symptoms, and How Physiotherapy Can Help

Reviewed by the Physiotherapy Team at Waterloo Sports Medicine Centre 

Experiencing pain along the front or inside of your shin during running, sports, or exercise? You may be dealing with shin splints, also known as medial tibial stress syndrome (MTSS). This common overuse injury affects runners, athletes, military recruits, and individuals who suddenly increase their physical activity levels (Lee et al., 2025; Menéndez et al., 2020). 

What Are Shin Splints? 

Shin splints refer to pain that develops along the inner border of the tibia (shin bone) due to repetitive stress placed on the bone, muscles, and surrounding tissues. Symptoms often begin gradually and may worsen during or after physical activity (Deshmukh & Phansopkar, 2022). 

Common symptoms include: 

• Pain or tenderness along the inside of the shin 

• Discomfort during running, jumping, or sports 

• Mild swelling in the lower leg 

• Pain that improves with rest but returns with activity 

  
  

What Causes Shin Splints? 

Shin splints typically develop when the lower leg is exposed to repetitive loading without adequate recovery time. Common contributing factors include: 

• Sudden increases in running distance, intensity, or training frequency 

• Poor footwear or worn-out running shoes 

• Running on hard or uneven surfaces 

• Flat feet or excessive foot pronation 

• Reduced lower limb strength or flexibility 

• Biomechanical factors affecting running and walking patterns (Lee et al., 2025; Menéndez et al., 2020) 

  
  

Who Is at Risk? 

Several factors can increase the likelihood of developing shin splints, including: 

• Participation in running or jumping sports 

• Rapid changes in training volume (Being new to running, or returning to it after time off) 

• Foot pronation or increased navicular drop 

• Higher body mass index (BMI) 

• Limited lower limb strength and conditioning 

• Hard running surfaces, and worn-out or unsupportive footwear  

• Previous history of shin splints (Lee et al., 2025; Deshmukh & Phansopkar, 2022) 

  
  

How Can Physiotherapy Help? 

Physiotherapy is often one of the most effective conservative treatments for shin splints. A physiotherapist can identify the underlying causes of your symptoms and create an individualized treatment plan. 

Treatment may include: 

• Gait and running assessment 

• Progressive strengthening exercises for the calves, hips, and lower leg muscles 

• Mobility and flexibility exercises 

• Activity modification to reduce irritation while maintaining fitness 

• Education on training progression and recovery strategies 

• Footwear recommendations and orthotic considerations when appropriate 

• Return-to-sport planning (Menéndez et al., 2020; Deshmukh & Phansopkar, 2022) 

At Waterloo Sports Medicine Centre, physiotherapists work with athletes and active individuals to address both symptoms and contributing factors, helping reduce the risk of recurrence. 

How Long Does Recovery Take? 

Recovery timelines vary depending on symptom severity, training demands, and how early treatment begins. Mild cases may improve within a few weeks, while more persistent cases can require several months of rehabilitation. 

Continuing to train through significant pain can delay recovery and, in some cases, increase the risk of developing a stress fracture. Early assessment and treatment can help promote a safer return to activity (Deshmukh & Phansopkar, 2022). 

When Should You See a Physiotherapist? 

Early intervention can help identify the cause of your shin pain and get you back to the activities you enjoy.  Consider booking an assessment if: 

• Shin pain persists for more than a few days 

• Symptoms return whenever you exercise 

• Pain is affecting your running, sport, or daily activities 

• Rest is no longer improving your symptoms 

Looking for shin splint treatment in Waterloo or Kitchener? The physiotherapy team at Waterloo Sports Medicine Centre can assess your symptoms, develop a personalized rehabilitation plan, and help you safely return to sport and activity.