Paul Hobrough of IchatPhysio takes a look at how to treat what can be a painful leg problem

The title of shin splints is not actually using a correct medical term. Shin splints fall into a category of Medial Tibial Stress Syndrome (MTSS). Wherever we see an injury being classified as a ‘syndrome’ we fall into a knowledge black hole, whereby we cannot be sure of a single symptom, rather a collection of signs and symptoms that can correlate to a certain injury.

It means that a whole host of complaints can in fact be diagnosed as medial tibial stress syndrome.

“(MTSS) is an overuse injury or repetitive-stress injury of the shin area. Various stress reactions of the tibia and surrounding musculature occur when the body is unable to heal properly in response to repetitive muscle contractions and tibial strain” –

Shin splints (as we will continue to call them) are often caused by an increase in load on the lower limbs – and running has an uncanny ability to provide this increased load.

Doing too much too soon in training is a major factor and, frankly, it’s the reason why I see so many marathon runners with this compliant six to eight weeks into their new training programmes. It’s not the only culprit, however.

Other factors are:

» Running downhill too much

» Worn out trainers

» Some say running on hard surfaces (see ‘worn out trainers’ and ‘increase training’ before this, however)

» Past history of ankle, shin injuries

» Biomechanics

The actual problem occurs within the muscle and inflammation of the fibrous tissue that surrounds the tibia and fibula (the two long bones in the lower leg) called the ‘periostitis’. There is a link to stress response and stress fracture in the tibia – many think that shin splints could be a precursor to this more serious bone issue.


Shin splints produce a pain in the lower third of the medial (central) shin bone. This initially seems to occur just as you start or finish a run, however progress is swift and you can be plagued by the sensation almost all the time within a very short time period.


When you consider that downhill running is probably the worst thing you can do, then one trick is to take to the treadmill and put the machine on a five per cent incline and run consistently uphill. This has, on many occasions, allowed someone with mild shin splints to continue running while they do their rehabilitation.

There is also the option to buy an off-the-shelf insole for running which may just lift the inner edge of the heel and medial longitudinal arch up and give the tibialis posterior (the key stabilising muscle of the lower leg) a little break from being overworked.

These can be used for a couple of months and either taken out once you have more strength or exchanged for a properly fitted pair of bespoke insoles if you feel you need to keep them longer term.


The sooner you seek help the better with shin splints. The longer you keep trying to run through it, the worse things are going to get and therefore the longer you will be with a physio and in rehabilitation.

If you look at the reasons for the injury outlined previously, you will see that simply googling exercises to do is potentially foolhardy, as a trained expert needs to work through the issues that have led to the injury and help you work through the process to eliminating the cause, as well as providing the right treatment for you to recover.

I see a large number of athletes via the ichatphysio app for this and it is easy to work through the issues on a zoom call and provide the very best exercises for the fastest result.

There some key exercises you can do, but first make sure you are certain of the cause before entering into just following these.

Toe raises

Stand with your back to a wall, feet about one foot forwards of the wall. Lift the toes up and down metronomically for 20 repetitions x 3.

Tibialis posterior strength

Sit on a chair and cross one foot over the other thigh. Wrap a resistance band around the involved foot and place your other foot on the band on the floor to create resistance. Raise your foot upwards (arch first) and slowly lower down. 3 x 20 reps.

Perform calf raises while holding a tennis ball between the backs of your ankles. As you rise up, squeeze to keep the ball in the place. Do this 4 x 15-20 reps.

All of these exercises can be done daily to either prevent shin splints or help with recovery from the injury.


Don’t forget that you can submit your questions to ask Paul for his expert answers and treatment advice. If you have an injury problem you need solved or any sort of physio query, please send your messages via our social media channels, using the hashtag #AWaskthephysio

» Paul Hobrough is a chartered physiotherapist, sports scientist and Clinical Director of

» Book a one-on-one physiotherapy session with Paul virtually, via:

» This feature was first published in the December edition of AW magazine, which is available to order online in print here and read digitally here

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