Understanding Medial Shin Splints: Causes, Mechanism, and Management

If you've ever experienced a nagging pain along the inner part of your shin after a run or workout, you might be dealing with medial shin splints—clinically known as Medial Tibial Stress Syndrome (MTSS). This condition is common among runners, dancers, and athletes who regularly engage in high-impact or repetitive lower leg movements. Let’s break down what’s really going on in your leg when shin splints strike.

What Are Medial Shin Splints?

Medial shin splints involve pain along the tibia, or shin bone, often caused by repetitive stress and overuse. The pain originates in the periosteum, the tissue lining the tibia, which becomes inflamed due to the constant pulling and pounding that occurs during physical activity—especially when the body doesn't have time to recover between sessions.

What Causes This Pain?

Repetitive Inflammation and Tissue Breakdown

Shin splints develop when repeated physical activity—like running or jumping—leads to microtrauma in the tissues around the tibia. If the body doesn’t get enough rest, these tissues don’t have time to heal properly, resulting in inflammation and pain. Over time, this can lead to a more serious injury if not addressed.

Biomechanical Stress

One of the biggest culprits behind shin splints is poor biomechanics, particularly overpronation—when the foot rolls too far inward during stride. This movement alters how stress is distributed through the lower leg, increasing the load on the tibia and surrounding structures.

The Role of the Soleus Muscle

The soleus muscle, which runs along the back of your lower leg, plays a key role in this condition. It forms what’s called the “soleus bridge” over the deep compartment of the leg. When the heel excessively pronates, the soleus muscle becomes overstressed, leading to increased metabolic activity and inflammation (periostitis).

Where Does It Hurt?

Pain is typically felt along the posterior medial edge of the tibia—the inner border of your lower leg. This is where the posterior tibial muscle originates and where inflammation or even small tears can occur due to chronic stress.

How to Manage and Prevent Shin Splints

Managing medial shin splints starts with rest—giving your body time to recover from the inflammation. But long-term relief also involves addressing the root cause:

• Correct biomechanical imbalances: Custom orthotics, strengthening exercises, and gait analysis can help correct overpronation and improper mechanics.

• Modify your activity: Gradually return to exercise with low-impact movements and a proper warm-up.

• Strengthen and stretch: Strengthening your calf muscles (especially the soleus) and improving flexibility can reduce future risk.

• Consider footwear: Supportive shoes that match your foot type can make a world of difference.

Final Thoughts

Medial shin splints are more than just a nuisance—they're your body’s signal that something isn’t quite right with your training load or biomechanics. The good news? With the right recovery plan and proactive adjustments, you can treat the pain and get back to doing what you love—pain-free and stronger than ever.

Sources and Further Reading:

(2012). Medial Tibial Stress Syndrome (Shin Splints). **, 617-620. https://doi.org/10.1016/b978-1-4160-5650-8.00278-8

Amin, I., & Moroz, A. (2017). Medial Tibial Stress Syndrome (Shin Splints). **, 281-282. https://doi.org/10.1007/978-3-319-50512-1_63

Michael, R., & Holder, L. (1985). The soleus syndrome. The American Journal of Sports Medicine, 13, 87 - 94. https://doi.org/10.1177/036354658501300202

Holder, L., & Michael, R. (1984). The specific scintigraphic pattern of "shin splints in the lower leg": concise communication.. Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 25 8, 865-9.

D'Ambrosia, R., Zelis, R., Chuinard, R., & Wilmore, J. (1977). Interstitial pressure measurements in the anterior and posterior compartments in athletes with shin splints. The American Journal of Sports Medicine, 5, 127 - 131. https://doi.org/10.1177/036354657700500306

Bhusari, N., & Deshmukh, M. (2023). Shin Splint: A Review. Cureus, 15. https://doi.org/10.7759/cureus.33905