Shin splints: symptoms, treatment and how long they last

The NHS says shin splints usually get better within a few weeks and that there are things you can do to get better more quickly. Most people are managed with self-care, a gradual return to exercise and, if it does not settle, physiotherapy.

The NHS says shin splints usually get better within a few weeks, and suggests using painkillers such as paracetamol or ibuprofen gel (or ibuprofen tablets if you need them), putting an ice pack or bag of frozen vegetables in a towel on the shin for up to 20 minutes every 2 to 3 hours, switching to gentle exercise such as yoga or swimming while healing, exercising on soft ground when you feel better, warming up before and stretching after exercise, and making sure your trainers or shoes support your feet.

It advises not continuing the exercise that caused the problem and not rushing back to the previous level: build the routine up slowly. The clinical pathway matches this with relative rest from impact to a level that keeps pain low or absent, lower-impact options such as cycling or deep-water running to maintain fitness, graduated return-to-run programmes as pain settles, progressing distance, frequency and intensity gradually, and avoiding sudden spikes in training load or changes in surface hardness.

The NHS says shin splints usually happen when you do exercise such as running, and that you will have pain and tenderness along the front of your lower leg (shin).

The NHS Greater Glasgow and Clyde pathway, which uses the clinical name medial tibial stress syndrome (MTSS), describes exercise-induced pain along the lower two thirds of the inner edge of the shinbone, provoked by physical activity and relieved by relative rest. On examination, the tenderness is spread over more than 5cm of the bone.

The NHS says shin splints is a type of shin pain usually caused by exercise, that it is not serious, and that there are things you can do to get better. The pain and tenderness run along the front of the lower leg, typically while running or doing other repeated impact exercise. NHS Greater Glasgow and Clyde's clinical pathway uses the clinical name medial tibial stress syndrome (MTSS) and defines it as exercise-induced pain along the posteromedial border of the shinbone, provoked over a diffuse area of more than 5cm.

The exact mechanism is not settled. The same pathway describes two theories: inflammation or swelling of the bone surface due to micro-cracks, and tension from the attachment of the deep calf fascia to the shinbone. Both may occur together, which is one reason treatment concentrates on the load the bone and muscles are handling rather than on a single structure.

According to the NHS, shin splints happen when you put too much stress on your leg, and you are more likely to get them if you have started exercising after not being active for some time, if you run or jump on hard surfaces, or if you do not have a good running technique.

The clinical pathway lists further risk factors: a change in training, increased running volume and intensity, more activity on hard surfaces, carrying external weight while exercising, high BMI, a pronated foot posture, low aerobic fitness, previous running injury and fewer years of running experience. It reports that being female carries about twice the risk compared with males and a previous history of MTSS about 1.5 times the risk. It also notes that shoes with high cushioning or high mass may increase loading or the energy cost of running.

• A sudden jump in distance, speed or frequency.

• Hard surfaces or a change of surface.

• Returning after a long break at the old level.

• Footwear that is worn out or does not support the foot.

The NHS says shin splints usually get better within a few weeks. The Greater Glasgow and Clyde pathway is more cautious for people who keep getting episodes: it says 90 to 120 days for recovery with multiple episodes is common, and that women can take longer to recover than men (mean days to recovery 89 compared with 64).

The same pathway defines recovery as being able to run for 18 minutes with pain of less than 4 out of 10. It suggests referral to an orthopaedic clinician if conservative management has failed, usually over 3 to 6 months, or if episodes keep recurring and limit function.

The NHS says you should see a GP if you have tried things to help but the pain is getting worse or is not getting better.

The NHS says shin splints can usually be diagnosed by examining the leg and asking about symptoms and that, if symptoms do not improve, you may need physiotherapy, which is free on the NHS throughout the UK although waiting times can be long, and can also be obtained privately. In many areas you can refer yourself to a community MSK service.

The Greater Glasgow and Clyde pathway sets out a stepwise approach. First-line care is education and self-administered measures. Second-line care adds progressive strengthening of the calf and foot muscles, hip and core strengthening, flexibility work particularly for the calf, attention to restricted ankle movement, and, if a biomechanical problem is found on assessment, foot orthoses chosen by the clinician. Third-line care revisits the basics and may consider referral for extracorporeal shockwave therapy. It states ultrasound is not recommended as an investigation because of the prevalence of findings in people without symptoms. It also describes recovery in terms of running 18 minutes with pain below 4 out of 10, with an average of 89 days for women versus 64 for men.

Shin pain has more than one cause. The Greater Glasgow and Clyde pathway lists the conditions a clinician will consider and how they differ. The table summarises it; a clinician is needed to tell them apart.

The NHS says to get help from NHS 111 if you have shin splints and the pain is severe, or you have injured your shin. You can call 111 or use 111 online.

The pathway lists signs that suggest something other than simple shin splints and warrant orthopaedic referral: focal bone tenderness over less than 5cm, night pain, pain at rest, pain with a single-leg hop, and a clear pattern of declining function despite reduced load. The NHS says to see a GP if home treatment is not working and the pain is getting worse.

The NHS says that in many areas you may be able to get help, such as physiotherapy, from community musculoskeletal (MSK) services without needing a referral from a GP. Physiotherapy is free on the NHS throughout the UK, but waiting times can be long, and you can also get it privately.

If shin splints do not settle, the next steps are a GP or MSK physiotherapy review, then orthopaedic or sports medicine review if a stress fracture or compartment syndrome is suspected. The pathway advises against routine ultrasound because findings are common in people without symptoms, so it is worth asking whether a test will change the plan.