Shin Splints (Medial Tibial Stress Syndrome): Exercises and Treatment

Shin splints—that aching pain along the inner edge of your shinbone—are one of the most common running injuries. If you've felt that familiar burn during or after runs, you're not alone. The good news: shin splints respond well to targeted exercise and training modifications.

Important: Severe, localized shin pain that doesn't improve with rest may indicate a stress fracture. If you have point tenderness, night pain, or pain that worsens, see a healthcare provider.

Understanding Shin Splints

What Are Shin Splints?

Medial Tibial Stress Syndrome (MTSS) is the medical term for shin splints. It involves irritation and inflammation where muscles attach to the inner (medial) edge of the tibia (shinbone).

What Causes Them?

Overuse: Too much, too soon—increasing running volume or intensity too quickly.

Muscle weakness: Weak calf muscles and tibialis posterior.

Biomechanics: Overpronation, poor running form.

Surface/Footwear: Hard surfaces, worn-out shoes.

Tight muscles: Tight calves restrict ankle mobility.

Symptoms

Aching or throbbing along inner shin
Pain during or after exercise
Tenderness along the shinbone (usually a broad area, not one spot)
Mild swelling
Pain that improves with rest but returns with activity

Shin Splints vs. Stress Fracture

Shin splints: Diffuse tenderness along a broad area of the shin, pain improves with warm-up, no night pain.

Stress fracture: Point tenderness at one specific spot, pain worsens during activity, may have night pain.

When in doubt, get evaluated.

Why Exercise Helps

Strengthens muscles that support the shin
Improves load tolerance
Addresses weakness contributing to the problem
Prepares you for gradual return to running

Calf Strengthening

Weak calves force the tibialis muscles to work harder.

Standing Calf Raises

Stand on step, heels off edge
Rise onto toes
Lower slowly below step level
3 sets of 15
Progress to single leg

Seated Calf Raises

Targets soleus (deeper calf muscle).

Sit with weight across knees
Rise onto toes
Lower slowly
3 sets of 15

Eccentric Calf Lowering

Rise on both feet
Shift to one leg
Lower slowly (4-5 seconds)
3 sets of 12 each side

Tibialis Strengthening

The tibialis anterior and posterior muscles are often weak with shin splints.

Tibialis Raises (Anterior)

Lean back against wall
Feet about a foot from wall
Lift toes toward shins, keeping heels down
Lower slowly
3 sets of 15-20

Heel Walks

Walk on heels, toes lifted off ground
30-60 seconds
3-5 repetitions

Toe Walks

Walk on toes (balls of feet)
30-60 seconds
3-5 repetitions

Resistance Band Dorsiflexion

Loop band around foot, anchor other end
Pull toes toward shin against resistance
3 sets of 15 each foot

Resistance Band Inversion

Targets tibialis posterior.

Loop band around forefoot
Turn sole of foot inward against resistance
3 sets of 15 each foot

Posterior Chain Strengthening

Weakness in hips and glutes can contribute to shin stress.

Glute Bridge

Lie on back, knees bent
Squeeze glutes, lift hips
Hold 3 seconds
3 sets of 15

Single-Leg Glute Bridge

Same position, one leg extended
3 sets of 10 each side

Clamshell

Lie on side, knees bent
Lift top knee, keep feet together
3 sets of 15 each side

Single-Leg Balance

Stand on one leg
Hold 30-60 seconds
Progress to unstable surface

Stretching and Mobility

Calf Stretch (Gastrocnemius)

Wall stretch, back leg straight
Keep heel down
Hold 30-60 seconds each side

Calf Stretch (Soleus)

Wall stretch, back knee bent
Keep heel down
Hold 30-60 seconds each side

Ankle Mobility

Half-kneeling, front foot flat
Drive knee forward over toes
Keep heel down
15-20 repetitions each side

Foam Rolling Calves

Sit with roller under calf
Roll from ankle to knee
Rotate leg to hit all angles
1-2 minutes per leg

Sample Treatment Program

Phase 1: Rest and Recovery (Weeks 1-2)

Goal: Reduce pain, maintain fitness without impact.

Daily:

Ice after activity: 15-20 minutes
Gentle calf stretching
Tibialis raises: 3×15
Foam rolling calves: 2 minutes per side

Cross-train:

Swimming
Cycling
Pool running
Elliptical (if pain-free)

Avoid: Running, jumping, high-impact activities.

Phase 2: Strengthening (Weeks 3-6)

Continue Phase 1, add:

Calf raises (bilateral): 3×15, progress to single leg
Heel walks: 3×30 seconds
Toe walks: 3×30 seconds
Glute bridges: 3×15
Clamshells: 3×15

Begin:

Walking (30+ minutes pain-free)
Light jogging on soft surface (end of phase, if pain-free)

Phase 3: Return to Running (Weeks 6-10+)

Continue:

Calf strengthening 3× per week
Tibialis work 3× per week
Hip strengthening 2-3× per week

Running progression:

Start walk/run intervals
Progress gradually (see protocol below)

Return to Running Protocol

Prerequisites

Pain-free walking for 30+ minutes
Can do 25 single-leg calf raises without pain
No tenderness with palpation

Week 1

Walk 5 min, jog 1 min × 4
Rest day between runs
3 sessions

Week 2

Walk 4 min, jog 2 min × 4
3 sessions

Week 3

Walk 3 min, jog 3 min × 4
3 sessions

Week 4

Walk 2 min, jog 4 min × 4
3 sessions

Week 5+

Continue progressing jog intervals
Add distance before intensity
Hills and speed work last

Rules

Pain during running <3/10
No increased pain next day
If symptoms return, back up 1-2 weeks

Footwear and Equipment

Running Shoes

Replace every 300-500 miles
Appropriate for your foot type
Adequate cushioning
Consider gait analysis for shoe selection

Orthotics

May help if you have significant pronation or foot mechanics issues. Try over-the-counter first.

Compression Sleeves

May provide comfort during activity but don't fix the underlying issue.

Training Modifications

The 10% Rule

Don't increase weekly mileage by more than 10%.

Avoid

Sudden mileage increases
Running on cambered roads
Excessive downhill running
Worn-out shoes
Running through pain

Consider

Softer running surfaces (trails, track)
Alternating running with low-impact cardio
Adequate rest days
Running form improvements (see below)

Running Form Considerations

Overstriding

Landing with foot far ahead increases impact. Cues:

Increase cadence (steps per minute)
Land with foot under body
Shorter, quicker steps

Heavy Footstrike

Loud, heavy landings = more impact. Cues:

"Run quietly"
"Run lightly"
Imagine hot coals

Cadence

Many recreational runners have low cadence (150-160 steps/min). Try increasing by 5-10%—this often reduces impact.

Prevention

After Recovery

Maintain calf and tibialis strength (2-3× per week)
Gradual mileage progression
Replace shoes regularly
Include rest days
Cross-train

For High-Risk Runners

Pre-run: Tibialis raises, ankle mobility
Post-run: Calf stretching, foam rolling
Weekly: Hip strengthening
Monitor for early warning signs

When to See a Professional

Red Flags

Severe pain at one specific point (stress fracture concern)
Night pain
Pain that worsens despite rest
Visible swelling or bruising
Pain that doesn't improve with 4-6 weeks of rest

See a Provider If

You're unsure if it's shin splints vs. stress fracture
Self-treatment isn't working
You want gait analysis or orthotics evaluation
You need a structured return-to-running plan

Common Mistakes

Running Through Pain

Continuing to run with shin splints usually makes them worse and prolongs recovery.

Not Enough Rest

Shin splints need time to heal. Cross-train for fitness; don't rush back.

Ignoring the Cause

Rest alone doesn't fix weakness or training errors. Address the underlying issues.

Returning Too Fast

The pain going away doesn't mean you're fully healed. Progress gradually.

The Bottom Line

Shin splints are frustrating but highly treatable. The keys are relative rest (not total rest), strengthening the muscles that support the shin, and gradual return to running.

Keys to success:

Reduce impact—cross-train while healing
Strengthen calves and tibialis—these muscles protect the shin
Address the cause—training errors, shoes, form
Return gradually—walk/run progression
Prevent recurrence—maintain strength, follow the 10% rule

Your shins are telling you something. Listen, address the issue, and come back stronger.

Strong muscles = resilient shins.