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Shin Splints vs. Bone Stress Injury: How to Tell the Difference
- Kate Mihevc Edwards PT, DPT
- Oct 10
- 3 min read
It’s a scenario most runners know well: you add miles to your long run, switch from treadmill to pavement, or start pushing paces and suddenly, something hurts. Sometimes the pain is a dull, nagging discomfort that fades as you warm up. Other times, it sharpens into a pinpoint spot in your shin that makes every step miserable.
That’s when the questions start: Is this just shin splints, or is it something more serious—like a bone stress injury?
Both conditions sit on the same spectrum of overuse problems in runners, and both are linked to repetitive loading of the tibia (shinbone). The challenge is that symptoms often overlap in the early stages. Recognizing the difference can be incredibly helpful because while shin splints can often be managed with smart adjustments, bone stress injuries demand rest and medical attention.
What Are Shin Splints?
Shin splints officially called medial tibial stress syndrome (MTSS) occur when repetitive stress irritates the muscles, fascia, and bone along the inner shin. They’re one of the most common running injuries, especially during training cycles that spike in volume or intensity.
Pain pattern: Diffuse, aching pain along a broader section of the shin.
When it hurts: Often at the start of a run, may improve with warming up, then return later.
Contributors: Rapid training progression, harder surfaces, or worn-out shoes. Weak hips, poor ankle mobility, and intrinsic foot fatigue also contribute.
Shin splints signal that tissues are under more load than they’re ready to handle but the tissue is still adapting.
What Are Bone Stress Injuries?
A bone stress injury (BSI) represents the more advanced stage of the same process. Instead of just irritation, the tibia develops a small crack or structural weakness from repetitive stress exceeding the bone’s capacity to recover.
Pain pattern: Sharp, focal pain in a very specific spot usually the size of a fingertip.
When it hurts: Pain builds during activity and lingers afterward, sometimes present during daily walking or even at rest. Hopping and jumping also cause pain. Unlike shin splints, it does not improve with warming up.
Contributors: Training errors, insufficient recovery, inadequate nutrition, and low bone density. low energy availability or menstrual irregularities are at especially high risk.
BSIs require time off running and formal medical evaluation. Continuing to run through them significantly lengthens recovery.
How to Tell the Difference
Location: Shin splints = diffuse, broad pain. BSI = sharp, pinpoint tenderness.
Warm-up effect: Shin splints may improve mid-run. BSI pain worsens the longer you go.
Palpation: Shin splints feel tender across a wide area. BSI pain is concentrated in one spot.
Rest response: Shin splints often settle with relative rest. BSI pain can persist with walking or at night.
What to Do if You’re Unsure
Seek medical attention. The best way is to see an expert and get imaging. If shin pain is diffuse, tied to recent mileage changes, and easing with rest, it may be shin splints. Scale back training, strengthen the hips and calves, and work on intrinsic foot strength to support load distribution.
If pain is focal, worsening, or not improving after several days, treat it as a possible BSI. Imaging (MRI is the gold standard) may be necessary to confirm the diagnosis, and rest from running is usually required.
Prevention Strategies
Progress Gradually: Avoid sudden increases in mileage or intensity.
Strength Training: Improves tissue resilience and reduces risk of both MTSS and BSIs.
Adequate Fueling: Low energy availability is one of the biggest predictors of bone stress injuries.
Recovery: Sleep and training modification give tissues time to adapt and remodel.
Shin splints are a warning that load is outpacing recovery. Bone stress injuries are a breakdown that requires rest and medical management. Learning the difference and adjusting early keeps you running consistently instead of sidelined.
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