Expert advice on shin pain when running from the team at Central Performance Running Centre, Surry Hills
Why Do My Shins Hurt When I Run?
If you’ve ever experienced shin pain when running, you’re certainly not alone.
Shin pain is one of the most common running injuries we see at Central Performance’s Running Centre in Surry Hills. It affects everyone from beginner runners training for their first 5km event through to experienced marathon runners preparing for the Sydney Marathon, City2Surf, half marathons and trail races.
The challenge is that “shin pain” isn’t actually a diagnosis. Pain along the shin can be caused by several different conditions ranging from relatively minor overload injuries through to more serious bone stress injuries and stress fractures. Understanding exactly what’s causing your symptoms is critical because the right treatment for one type of shin pain may be completely wrong for another.
The good news is that most runners recover well with early diagnosis, appropriate load management, and a structured rehabilitation plan.
Shin Pain when Running – Key Takeaways
The Most Common Causes of Shin Pain When Running Include
- Medial Tibial Stress Syndrome (shin splints)
- Bone stress reactions
- Tibial stress fractures
- Muscle overload
- Tendon irritation
- Training errors and overload
When You Can Usually Continue Running
- Pain is mild and settles during or shortly after running
- Symptoms are not progressively worsening
- Pain is spread along a larger area of the shin rather than one specific spot
When You Should Stop Running
- Pain becomes severe
- Pain occurs at rest or during walking
- Pain wakes you at night
- Symptoms continue to worsen despite reducing training
When To See a Running Physio
- Symptoms persist for more than 1-2 weeks
- Pain is affecting training consistency
- You have recurring shin pain
- You suspect a bone stress injury or stress fracture
What Causes Shin Pain When Running?
The Short Answer
The most common cause of shin pain running is Medial Tibial Stress Syndrome (MTSS), often called shin splints. However, runners can also develop bone stress reactions, stress fractures, tendon irritation, muscle overload, and other conditions that create similar symptoms.
When runners search for answers about sore shins after running, they often assume every case is shin splints. Unfortunately, that’s not always true. Some causes, for example bone stress injury or stress fracture, can be serious and need professional management
Common Causes of Shin Pain When Running
| Condition | Typical Symptoms | Severity |
|---|---|---|
| Medial Tibial Stress Syndrome (MTSS) | Diffuse pain along inner shin | Mild to moderate |
| Bone Stress Reaction | Localised bone pain that worsens with loading | Moderate to severe |
| Tibial Stress Fracture | Focal pain, often severe | Moderate to severe |
| Muscle Overload | Tightness and soreness in lower leg muscles | Mild |
| Tendon Irritation | Pain around tendon attachment sites | Mild to moderate |
| Training Errors – too much load &/or not enough recovery | Can be a main contributor to all of these conditions | Variable – mild to severe |
Most running-related shin pain exists on a spectrum. At one end is simple overload and irritation. At the other end are significant bone stress injuries requiring immediate management.
What Is Medial Tibial Stress Syndrome (Shin Splints)?
Short Answer
Medial Tibial Stress Syndrome (MTSS) is the medical term for shin splints. It causes pain along the inside border of the tibia (shin bone) and is typically related to repetitive loading from running.
MTSS is one of the most common injuries affecting runners.
Common Symptoms
- Pain along the inside edge of the shin
- Symptoms during or after running
- Tenderness over a broad area of the shin
- Pain that initially improves as you warm up
- Symptoms that worsen with increasing training volume
Why Do Runners Develop MTSS?
MTSS develops when the tissues (muscles and tendons) attached to the tibia are exposed to more load than they can currently tolerate.
Common examples we see in Sydney runners include:
- Rapid increases in weekly kilometres
- Marathon training blocks
- Preparing for City2Surf
- Adding hill sessions too quickly
- When returning to running after injury, especially if a longer break was needed
- Increasing speed work without adequate preparation
Risk Factors
- Previous shin pain
- Low calf strength
- Reduced lower leg endurance
- Sudden training increases
- Previous bone stress injuries
- Inadequate recovery
- Poor sleep and nutrition
Common Misconceptions
“Shin splints are just inflammation.”
Not entirely. Modern research suggests MTSS is more accurately viewed as a loading-related injury involving bone and surrounding tissues.
“You should completely rest until pain disappears.”
Not always. Many runners improve faster with carefully modified training rather than complete rest. Plus maintaining a level of activity that does not excessively aggravate symptoms can minimise detraining and deconditioning while you recover, helping you return more quickly and with less risk of further injury.
“Shin splints always become stress fractures.”
No. Most cases recover successfully with the right early management, but it is important to recognise when symptoms are getting worse or not improving and get some help to minimise the risk of progressing to a bone stress injury or stress fracture.
Can Shin Pain When Running Be a Stress Fracture?
Short Answer
Yes. Shin pain can sometimes indicate a tibial or fibula stress fracture, which is a more serious injury than shin splints and requires professional assessment and treatment
A stress fracture occurs when repetitive loading exceeds the bone’s ability to repair itself, so over time micro-fracturing occurs and, if not managed properly, can go on to become a full stress fracture, where a fracture line is visible through the bone on imaging.
Shin Splints vs Stress Reaction vs Stress Fracture
| Feature | Shin Splints | Stress Reaction | Stress Fracture |
|---|---|---|---|
| Pain Area | Broad area | More localised | Very localised |
| Pain During Running | Often improves after warm-up | Usually worsens | Worsens & need to stop |
| Pain At Rest | Rare | Common | Very common |
| Night Pain | Rare | Possible | Common |
| Risk Level | Lower | Moderate | Highest |
Warning Signs of a Stress Fracture
Seek assessment promptly if you experience:
- Pain that gets worse when you run
- Pain at rest, including pain that lasts for longer times after you finish your run
- Night pain
- Sharp localised tenderness
- Progressive worsening
- Pain with walking
- Pain when hopping on one leg
When Is Imaging (Xray, MRI, CT) Appropriate for Shin Pain When Running?
A running physio assessment will help determine whether imaging is necessary. Your physio will discuss with you if they feel a scan is needed. Imaging may be recommended when:
- A bone stress injury is suspected
- Symptoms persist despite treatment
- Diagnosis remains unclear
- Return-to-running decisions are difficult, e.g. deciding if you can run in (or keep training for) an upcoming event
For more detailed information, see our Bone Stress Injury guide.
Should You Keep Running With Shin Pain?
Short Answer
Sometimes yes. Sometimes no.
The answer depends entirely on the diagnosis and severity of symptoms. A runner with mild shin splints may continue modified training. A runner with a suspected stress fracture should stop running immediately.
Traffic Light System for Shin Pain When Running
🟢 Green Light: Continue Training
You can often continue running when:
- Pain remains below 3/10
- Symptoms do not worsen during running
- Pain settles quickly afterwards
- No pain is present the next day
🟠 Amber Light: Modify Training
Reduce training when:
- Pain reaches 3-5/10
- Symptoms linger after running
- Pain is becoming more frequent
- Recovery is taking longer, i.e. pain lasting longer after stopping running
Possible modifications include:
- Reduced weekly volume
- Fewer hills
- Less speed work
- More recovery days
🔴 Red Light: Stop Running
Seek assessment if:
- Pain exceeds 5/10
- Pain occurs during walking
- Pain is worsening rapidly, especially lasting longer after runs
- Pain occurs at rest or at night
- You suspect a stress fracture
For more guidance, read our article on: Shin Pain: Should You Keep Running?
Why Runners Develop Shin Pain
Short Answer
Most shin pain occurs because training load exceeds tissue capacity.
In simple terms, your training has increased faster than your body has adapted.
Common Contributors to Shin Pain When Running
1. Rapid Increases in Training Load
This is the most common factor we see.
Examples include:
- Jumping from 20km to 40km per week
- Suddenly introducing speed sessions
- Starting marathon training too aggressively
2. Marathon Preparation
Sydney Marathon preparation often involves:
- Higher weekly mileage
- Longer long runs
- More cumulative fatigue
Without appropriate progression, shin pain risk increases.
3. Hills
Hill running increases loading through the calves and lower leg.
A sudden increase in hill sessions commonly triggers symptoms.
4. Speed Sessions
Intervals, threshold runs and track sessions place greater stress on the tibia and surrounding tissues.
5. Recovery Errors
Training adaptation occurs during recovery.
Risk increases when runners have:
- Poor sleep
- High work stress
- Inadequate nutrition
- Insufficient recovery days
6. Previous Injury
Previous shin pain is one of the strongest predictors of future shin pain.
7. Bone Health Factors
Bone stress injuries are more common when:
- Energy intake is inadequate
- Recovery is poor
- Bone density is reduced
- Training loads rise too quickly
Running Technique Factors That May Contribute to Shin Pain
Short Answer
Running technique can contribute to shin pain, but it is rarely the only cause.
It’s important not to assume that gait is automatically the problem.
Potential Contributors To Shin Pain When Running
1. Overstriding
Landing too far in front of your body may increase braking forces and lower leg loading.
2. Cadence
A slightly higher cadence may reduce certain loading patterns in some runners, so a slower cadence may increase load and contribute to shin pain.
3. Running Mechanics
Each runner is different. Your running style and gait is influenced by many factors such as your body type/shape, natural foot position, injury history, and lifestyle factors such as desk work and other sports and exercise that you play. So the goal is not to force everyone into the same technique, but to identify whether your specific mechanics and running gait may be contributing to your symptoms.
This is where a professional Running Assessment can be really valuable. At Central Performance we combine video gait analysis with strength and biomechanical assessment to identify individual factors that may affect your injury risk as well as your running economy and performance. This is far more effective than relying on generic running advice.
Do Running Shoes Cause Shin Pain?
Short Answer
Shoes can contribute to shin pain, but they are rarely the major cause. Most cases involve a combination of training load increases, inadequate strength, not enough recovery, and reduced tissue capacity.
Situations Where Shoes May Matter
1. Recent Footwear Changes
A sudden switch to:
- Minimalist shoes
- Carbon-plated racing shoes
- Different heel-to-toe drops
These running shoes changes may temporarily alter loading patterns, which increase the risk of injury including shin pain.
2. Worn-Out Shoes
Old shoes can lose cushioning and stability characteristics, which may alter the distribution of forces as you run. This can contribute to injury, including shin pain when running
3. Poor Shoe Selection
While there are a lot of theories and lots of marketing material around what makes “the best running shoes“, the evidence is definitely not clear, probably because there is so much variation in individual runners’ bodies, biomechanics/footstrike, injury history, running history and numerous lifestyle factors e.g. weight. This means that there is really no “best” running shoe that suits every runner, even if they have similar foot postures – it’s really individualised. So in general, the best running shoe for you is usually the one that:
- Feels comfortable
- Matches your training needs
- Allows gradual adaptation, especially if changing from a different type of running shoe
There is no universally perfect shoe for shin splints.
Best Exercises for Shin Pain When Running
Strength training is very protective against many running injuries, including shin pain
The best exercises address calf strength, overall lower limb strength and endurance, tissue capacity and gradual loading progression.
1. Calf Raises
Why They Help
Strong calves help absorb force during running, improve running economy, and reduce load on other structures.
How To Perform
- Standing, rise up onto toes
- Pause briefly
- Lower slowly
- Progress from double-leg to single-leg then add weight
2. Bent-Knee Calf Raises
Why They Help
These target the soleus muscle, which plays a major role during distance running.
How To Perform
- You can do bent knee calf raises in the gym, sitting in a smith machine with the bar across your knees, or sitting with a weight resting on the knee, and raising up onto your toes to lift the weight
- You can also do bent knee calf raises using the same movement as above for calf raises except you keep your knees bent to 40-50 degrees
3. Tibialis Posterior Strengthening
Why It Helps
The tibialis posterior works with your calf muscles and helps support the foot and control loading through the lower leg.
Examples include:
- Resisted inversion exercises
- Single-leg balance work
- Calf raises as above
4. Plyometric Exercise Progressions
Why They Help
Running is essentially a series of controlled hops, from one foot to the other. Plyometrics prepare tissues for higher-speed running demands by increasing their resilience to high-speed loading forces.
Examples:
- Pogos
- Skipping
- Bounding progressions
- Single-leg hopping drills
5. Return-to-Running Loading
A progressive running program is one of the most important rehabilitation tools. While a bone stress injury will often require a period of no running initially, avoiding running completely for too long can sometimes delay recovery and cause weakness in many of our body’s tissues, which increase overall injury risk when you return to running.
The goal is gradual exposure to appropriate running loading. The exact program to return safely to running is very individualised and will vary according to your injury, running history, overall strength and other factors. For more information read our blog on how to prepare for a successful return to running program.
How Can a Physio Help With Shin Pain When Running?
Short Answer
A running physio helps identify the exact cause of shin pain and develops a personalised rehabilitation plan. Personalisation is vital, because the “right” management plan will vary widely depending on individual factors such as your diagnosis, severity or stage of injury, previous injury, strength and flexibility, running history and lifestyle factors such as other exercise or sport.
At Central Performance’s Running Centre, our approach focuses on accurate diagnosis, load management, running assessment and exercise rehabilitation. This approach reflects our philosophy of helping runners recover quickly and minimise unnecessary time away from running, while ensuring that their return to running is safe and sustainable. It is also based on the latest research and best-practice guidelines for running performance and injury management.
A Running Physio Can Help With:
1. Accurate Diagnosis of Your Running Injury
Identifying whether symptoms are:
- Shin splints
- Bone stress injury
- Stress fracture
- Tendon-related
- Muscle-related
2. Load Management
We always try to work with modifying training appropriately, rather than simply stopping all running. And if we do need to you to stop completely we always minimise the time that this is for.
3. Running Assessment
A detailed running assessment where we analyse your running gait and biomechanics with an experienced running coach / physio can identify:
- Running mechanics issues
- Training factors that may be affecting your injury risk, recovery and performance
- Strength deficits, which are a major injury risk
- Movement limitations
4. Exercise Rehabilitation
Structured rehabilitation programs improve:
- Strength
- Endurance
- Running resilience
5. Return-To-Running Planning
Working with an experienced running coach / physio will help guide you safely back to:
- Marathon training and ultra-marathon preparation
- Half marathon preparation
- City2Surf training
- General recreational running such as park runs, 5k and 10k fun runs
If you’re looking for a running physio Sydney, physio for shin pain, or running injury physio in Sydney, working with someone who understands both injury management and running performance can significantly improve outcomes.
When Should You See a Physiotherapist for Shin Pain?
You should se a running physio for shin pain when running if;
1. Symptoms Last Longer Than 1-2 Weeks
Persistent symptoms deserve investigation. Also remember that there is no exact rule about timing, for example if your symptoms are worsening significantly or any bone stress is suspected, you should see a physio straight away
2. Pain Is Affecting Training
If you’re modifying sessions regularly because of pain, assessment is worthwhile.
3. Symptoms Keep Returning
Recurring shin pain usually indicates an underlying issue hasn’t been fully addressed. In this case often just resting for longer is not the answer! We need to diagnose and correct the underlying problem, and this usually allows you to return to running without your pain returning.
4. Red Flags Are Present
Red Flags are signs that may indicate a more serious injury. Red flags include;
- Night pain
- Pain at rest or pain that persists into the next day after a run
- Severe tenderness, especially if it is localised to a specific area of your shin
- Worsening symptoms, e.g. unable to hop or run
Early assessment is particularly important if red flags are present because they may progress significantly and become more serious if ignored, for example some bone stress injuries. Also, some red flags indicate that we need to screen for other types of pathology not specifically related to running, for example some inflammatory conditions, nutritional deficiencies or metabolic and hormone problems. Experienced running physios are experts in identifying these problems early, referring for appropriate imaging or further investigation if needed, and helping to prevent more serious injuries developing.
Shin Pain When Running – Frequently Asked Questions
What causes shin pain when running?
The most common causes are shin splints (MTSS), bone stress injuries, stress fractures, muscle overload and training errors.
Are shin splints and stress fractures the same thing?
No. Shin splints are typically a loading-related irritation of tissues along the tibia, while a stress fracture involves an actual crack within the bone.
Can I run through shin pain?
Sometimes. Mild shin splints may allow modified running. Suspected stress fractures generally require stopping running and seeking assessment.
How long do shin splints take to heal?
Many cases improve within several weeks, but recovery depends on severity, training modification and rehabilitation.
What exercises help shin pain when running?
Calf raises, soleus strengthening, single-leg endurance exercises, tibialis posterior strengthening and progressive plyometrics are commonly used.
Can running shoes cause shin pain?
Shoes can contribute, particularly if recently changed or inappropriate for your current training demands, but they are rarely the sole cause.
Should I get an MRI for shin pain?
Not always. Imaging is usually reserved for suspected bone stress injuries, persistent symptoms or unclear diagnoses.
When should I see a physiotherapist for shin pain when running?
If symptoms persist beyond 1-2 weeks, affect training, recur frequently or involve red-flag symptoms.
What is Medial Tibial Stress Syndrome?
MTSS is the medical name for shin splints and refers to pain along the inner border of the tibia caused by repetitive loading.
Can a running assessment help shin pain when running?
Yes. A comprehensive running assessment can identify training, strength and biomechanical factors contributing to symptoms.
Summary of Shin Pain When Running
Most cases of shin pain when running improve well with appropriate management. The key is understanding that shin pain is not a diagnosis. Conditions such as shin splints, bone stress reactions and stress fractures may present similarly, but require very different management strategies.
Early assessment is important because it can prevent a relatively minor issue from progressing into a more serious injury that requires significant time away from running. If you’re feeling persistent shin pain, recurrent shin pain, pain that persists after running, or you’re unsure whether your symptoms may represent a bone stress injury, seeing a running physio to get an accurate diagnosis is the first step toward recovery.
At Central Performance’s Running Centre in Surry Hills, our team works with runners of all levels, from recreational runners and City2Surf participants through to marathoners, ultra-runners and elite athletes. Our focus is on helping runners recover efficiently, stay active whenever appropriate, and return to training with greater confidence and resilience.
Related Resources for Runners in Sydney / Surry Hills
- Running Physio Sydney
- Running Assessment Sydney
- Bone Stress Injuries in Runners
- Shin Pain: Should You Keep Running?
- How Can Strength Training Help Running?
The Central Performance Running Centre – Sydney / Surry Hills
The Central Performance Running Centre delivers everything Sydney runners needs in one central location. Our dedicated team of running physios, run coaches and running exercise physiologists love working with runners of all abilities.
Services Provided At The Running Centre
1. Running Physio: our team of expert running physios are continuously updating their skills and knowledge to ensure that you get the best and fastest possible recovery from injury. Whenever possible we keep you running as you recover, plus we work closely with some of Sydney’s best sports physicians and radiology practices so if further referral or investigation is required we can refer you easily and quickly.
2. Running Coaching: Want to feel what it’s really like to run well, with a more efficient gait that lets you run faster for longer with less chance of injury? Then our unique RunRight program is just what you’re looking for.
3. Running Strength & Conditioning Programs: A professionally designed strength and conditioning program can significantly improve your running performance plus reduce your injury risk. Our experienced strength and conditioning coaches are all degree-qualified Exercise Physiologists who love working with runners of all abilities. You have options to come and train with us in the clinic, or if you have a gym membership but need a program to know exactly which exercise to do then we can program your sessions for you to do independently.
If you have any questions for our running physios feel free to click the buttons to ask us a question or book online.
Disclaimer: This article is intended for educational purposes only and does not replace individual medical advice. If you are experiencing significant pain then please consult a qualified running physio for individualised assessment and treatment.
