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The Ultimate Guide to Shin Splints: Causes, Prevention, and Physical Therapy Treatment

If you’ve ever started a new walking or running routine and suddenly felt a burning or aching pain along the front or inside of your shin, you’re not alone. That nagging pain is often called shin splints, and it can derail your fitness goals, sideline you from sports, and make even simple activities like walking or climbing stairs uncomfortable.

The good news: with the right understanding of what shin splints are, why they happen, and how to manage them, most people can recover fully and return to activity. Physical therapy plays a key role in both treating shin splints and preventing them from coming back.

This comprehensive guide from Cawley Physical Therapy & Rehabilitation—serving runners, walkers, and athletes across Northeast Pennsylvania—covers:

What Are Shin Splints?

“Shin splints” is a common term, not a precise diagnosis. Most of the time, when people talk about shin splints, they’re referring to medial tibial stress syndrome (MTSS): pain along the inner border of the shinbone (tibia) that occurs with exercise. This pain is related to stress on the bone and surrounding tissues from repetitive impact activities like running, brisk walking, or jumping.

Shin splints are considered part of a stress injury continuum. On one end, you have early, reversible overload of the bone and soft tissues. On the more severe end, that overload can progress to a stress reaction or even a stress fracture if not addressed. Catching and managing shin pain early is key to avoiding more serious injury.

If you’re ready to move past chronic shin pain and back into your routine, the team at Cawley PT is here to help. Schedule your appointment today.

Common Symptoms of Shin Splints

While every person is different, shin splints typically feel like:

At first, the pain may only show up at the end of a run or walk. Over time, if ignored, it can start earlier and last longer—even into daily activities.

Because “shin splints” is a broad term, your physical therapist or medical provider will also screen for other conditions that can cause shin pain, such as compartment syndrome, nerve issues, or vascular problems, especially if your symptoms are unusual or severe.

What Causes Shin Splints?

Shin splints are usually the result of too much load, too quickly on tissues that aren’t ready for it. Several contributing factors tend to show up together.

1. Training Errors

One of the biggest causes of shin splints is rapid change in activity level. Common mistakes include:

Your bones and soft tissues need time to adapt to new loads. When stress accumulates faster than your body can rebuild and strengthen, irritation and pain can follow.

2. Foot and Ankle Mechanics

How your foot moves with each step can influence how force is transmitted up your leg:

Physical therapists carefully analyze your gait and foot mechanics, because correcting these patterns is often essential for long-term relief.

3. Muscle Imbalances and Weakness

Weak or tight muscles in the lower leg and beyond can contribute to shin splints:

Because the entire lower body works as a kinetic chain, physical therapy looks beyond just the painful area.

4. Footwear and Surface

Shoes that are worn out, not appropriate for your foot type, or not suited to your activity can contribute to shin splints by reducing shock absorption or failing to provide the right support. Likewise, training almost exclusively on concrete or other very hard surfaces can increase stress.

5. Bone Health and Systemic Factors

In some cases, underlying bone health plays a role. Factors such as low energy availability (not eating enough for your activity level), hormonal issues, or low bone density can make you more vulnerable to stress injuries. This is especially relevant for female athletes and individuals with a history of stress fractures.

When Is Shin Pain More Than Shin Splints?

While shin splints are common and manageable, it’s important to recognize warning signs of more serious problems like stress fractures or compartment syndrome. Seek prompt evaluation if you notice:

A physical therapist or medical provider can help differentiate between standard shin splints and more serious conditions, and can coordinate imaging or referrals when needed.

How to Prevent Shin Splints

Prevention is about managing load, improving mechanics, and building resilience. Even if you’re currently dealing with shin pain, these strategies will be part of your long-term solution.

1. Progress Your Training Gradually

A common rule of thumb is to increase training volume (such as running mileage) by no more than about 10% per week, but even that can be too much for some people. Key principles include:

Your physical therapist can help you build a safe, realistic progression plan tailored to your current fitness and goals.

2. Choose Appropriate Footwear

While no shoe can magically prevent all injuries, a well-fitting, activity-appropriate shoe can help distribute forces more evenly. Consider:

In some cases, your physical therapist or other provider may suggest temporary use of orthotics or inserts to help control excessive pronation or support your arch.

3. Warm Up Before You Exercise

Jumping straight into high-intensity activity can be a shock to your muscles and bones. A good warm-up might include:

Warm muscles and tissues are better able to absorb load and move efficiently.

4. Build Strength and Flexibility

Strengthening and stretching the muscles that support your lower legs and hips can reduce your risk of shin splints. We’ll walk through specific exercises in the next section.

5. Listen to Early Warning Signs

One of the simplest—and hardest—prevention tools is listening to your body. Mild shin discomfort that shows up only at the end of a run may be an early sign that you’re overdoing it. Reducing your training volume briefly, and addressing mechanics and strength, can prevent a minor issue from becoming a major setback.

Physical Therapy for Shin Splints: What to Expect

Physical therapy offers a structured, individualized approach to treating shin splints. Rather than just telling you to “rest,” a PT helps you:

Comprehensive Evaluation

Your first PT visit often includes:

From there, your therapist will confirm whether your pain looks like typical medial tibial stress syndrome or if another diagnosis might be involved.

Manual Therapy

Hands-on techniques may be used to reduce pain and improve tissue mobility, including:

Manual therapy is usually paired with exercise, not used alone.

Activity Modification and Return-to-Running Planning

Instead of stopping all movement, your PT helps you find the right level of activity that doesn’t worsen your pain:

Later, your therapist will help you progress back to full activity using a step-wise plan.

Key Exercises for Shin Splints

Below are examples of exercise categories commonly used in shin splint rehab. Always check with your physical therapist before starting or progressing exercises, especially if your pain is significant.

1. Calf Stretching

Tight calves can increase stress on the shinbone and surrounding tissues.

Standing Gastrocnemius Stretch

  1. Stand facing a wall, hands resting on the wall for support.
  2. Step one leg back, keeping the back knee straight and the heel on the floor.
  3. Lean forward until you feel a stretch in the upper calf of the back leg.
  4. Hold for 20–30 seconds, then switch sides.

Repeat 2–3 times per leg. You should feel a gentle stretch, not pain.

Standing Soleus Stretch

  1. Use the same position as above, but this time bend the back knee slightly while still keeping the heel on the ground.
  2. You should feel the stretch lower in the calf, closer to the Achilles.
  3. Hold 20–30 seconds, then switch sides.

Again, repeat 2–3 times per leg.

2. Anterior Tibialis Activation

The anterior muscles along the front of your shin help control foot motion and absorb shock.

Toe Raises (Standing)

  1. Stand tall, holding a counter or wall for balance.
  2. Keeping your heels on the ground, lift your toes and forefoot off the floor.
  3. Lower slowly with control.

Start with 2–3 sets of 10–15 repetitions. Stop if pain increases significantly.

3. Calf Strengthening

Stronger calves help manage impact forces and support your lower legs.

Double-Leg Calf Raises

  1. Stand with your feet hip-width apart, holding a stable surface for balance.
  2. Slowly rise up onto the balls of your feet.
  3. Pause briefly, then lower your heels back down with control.

Begin with 2–3 sets of 10–15 reps. As you get stronger and pain improves, you can progress to single-leg calf raises under the guidance of your PT.

4. Hip and Glute Strengthening

Your hips help control the alignment of your knees and lower legs.

Side-Lying Hip Abduction

  1. Lie on your side with legs straight, bottom leg bent slightly if needed for balance.
  2. Keeping your top leg straight, slowly lift it up toward the ceiling without rolling your hips backward.
  3. Lower with control.

Perform 2–3 sets of 10–15 reps per side.

Glute Bridge

  1. Lie on your back with knees bent and feet flat on the floor, hip-width apart.
  2. Tighten your glutes and lift your hips until your shoulders, hips, and knees form a straight line.
  3. Hold 2–3 seconds, then lower slowly.

Perform 2–3 sets of 10–15 reps. This exercise helps strengthen your glutes and hamstrings, contributing to better leg alignment during walking and running.

5. Balance and Proprioception

Improving your body’s awareness of foot and ankle position can reduce overloading.

Single-Leg Balance

  1. Stand near a counter or wall for safety.
  2. Shift your weight onto one leg and lift the other foot slightly off the ground.
  3. Try to maintain your balance for 20–30 seconds.

Repeat 2–3 times per leg. To progress, you can eventually add gentle head turns or perform the exercise on a softer surface, guided by your PT.

Recovery Timeline: How Long Do Shin Splints Last?

Recovery time depends on:

Mild shin splints caught early often improve within a few weeks with appropriate rest, activity modification, and exercises. More persistent cases may require several months of structured rehab.

The goal of physical therapy is not only to get rid of pain, but also to:

This reduces the risk of recurrence and helps you stay active more consistently.

Shin Splints and Athletes in Northeast Pennsylvania

Whether you’re a student-athlete, weekend runner, or someone who enjoys regular walks on NEPA’s hills and trails, shin splints can be a major frustration. Weather, terrain, and seasonal training changes can all influence how your legs feel.

Working with a local physical therapist who understands these demands can help you tailor your recovery and prevention plan to:

Dealing with shin pain that just won’t go away?
 Reach out to Cawley Physical Therapy’s team to discuss an evaluation and treatment plan by visiting our website

How Cawley Physical Therapy Supports Patients with Shin Splints

At Cawley Physical Therapy & Rehabilitation, our clinicians take a whole-body approach to shin splints and lower leg pain. Your care may include:

We understand that your goal isn’t just to “have less pain”—it’s to get back to doing what you love, whether that’s running a 5K, playing sports, or simply walking without discomfort.

Frequently Asked Questions About The Ultimate Guide to Shin Splints: Causes, Prevention, and Physical Therapy Treatment

1. How do I know if my shin pain is just shin splints or a stress fracture?

It can be hard to tell on your own, which is why an evaluation is important if pain is significant or persistent. In general, shin splints tend to cause a more diffuse ache along a broader area of the shin that starts with activity and may ease with rest. A stress fracture often feels more localized—like a specific sore spot on the bone—and may hurt even at rest or with light activities. You might also notice pain that worsens with impact and does not improve when you cut back on training. Only a medical provider can definitively differentiate the two, and sometimes imaging is needed. If you’re worried, especially if pain is sharp, constant, or keeping you from normal walking, it’s best to get checked sooner rather than later.

2. Can I keep running if I have shin splints?

In many cases, you don’t have to stop all activity—but you likely do need to modify it. Continuing to push through pain with the same mileage, speed, or hills that triggered your symptoms can worsen the problem and push you closer to a stress fracture. A physical therapist can help you determine your “tolerance threshold,” which is the level of impact and duration you can handle without symptoms getting worse over the next 24 hours. That may mean temporarily reducing distance, slowing your pace, adding rest days, or switching some workouts to lower-impact cross-training. As pain settles and strength improves, you can gradually build back. The goal is to stay as active as possible while still allowing your tissues to heal.

3. What kind of shoes should I wear to help prevent shin splints?

There is no one perfect shoe for everyone, but there are general principles that can help. Look for a shoe that feels comfortable and supportive for your foot, with enough cushioning for your activity and the surfaces you use. Replace shoes regularly; as the sole wears down and support breaks down, your legs absorb more shock. If you have flat feet or tend to over-pronate, a shoe with more structure or a supportive insert may be helpful. On the other hand, if you have a high, rigid arch, you may benefit from a shoe with more cushioning. A physical therapist can look at how you walk or run and offer personalized guidance, often more specific than generic “neutral vs. stability” categories you see in stores.

4. How long should I rest if I develop shin splints?

“Rest” is a bit of a misleading term. Completely stopping all movement for weeks is rarely needed and can actually make you deconditioned and more injury-prone when you resume activities. Instead, most people benefit from relative rest, which means reducing or modifying the activities that cause pain while staying active in other ways. For example, if running aggravates your shins, you might temporarily switch to cycling, swimming, or elliptical training while you work on strength and flexibility. The exact duration depends on symptom severity, but you should see gradual improvement over a few weeks if your plan is appropriate. If pain persists despite reducing load and doing targeted exercises, or if it worsens, it’s a sign you need a professional assessment.

5. Can physical therapy really prevent shin splints from coming back?

Yes, physical therapy can significantly reduce the likelihood of recurrent shin splints by addressing the underlying reasons your shins became irritated in the first place. A PT doesn’t just treat the sore area; they analyze your biomechanics, strength, flexibility, and training patterns. If your calves are weak, they’ll build a plan to strengthen them. If your hips collapse inward with each step, they’ll tackle hip and core strength. If your stride or foot strike is contributing to overload, they’ll suggest adjustments and help you practice them. They also guide you in designing a training plan that progresses gradually and fits your life. While no approach can guarantee you’ll never have shin pain again, combining smart training, good footwear, and a tailored strength and mobility program through physical therapy gives you the best chance for long-term success.