Key Risk Factors for Shin Splints

Shin splints, more formally known as medial tibial stress syndrome or tibial periositis, are a common injury among athletes – especially those engaging in running. Shin splints account for approximately 13-17% of all running-related injuries.1 They are caused by repeated trauma to the connective tissue and tibialis anterior muscle on the front of the tibia or lower leg bone. Symptoms include pain or a dull ache present in the front portion of the lower part of the leg. If left untreated, shin splints could result in a stress fracture to the tibia bone.

Risk factors for shin splints:

  • One study showed that during running, the tibialis muscle increased in activity and fired above the fatigue threshold 85% of the time in those with shin splints.2  This increased muscle activity during running may account for the high number of injuries seen in runners.
  • Females are 1.5 to 3.5 times more likely to progress to stress fractures due to diminished bone density.3
  • Muscle imbalance, including weakened core muscles
  • Inflexibility or tightness of the calf musculature
  • Training errors such as increasing activity, intensity, and duration too quickly
  • Improper footwear causing excessive pronation at the foot
  • Performing high impact exercises on hard, non-compliant surfaces4

Treatment for shin splints often consists of rest, ice, non-steroidal anti-inflammatories or NSAIDs, and physical therapy. During a physical therapy evaluation, the therapist would perform a biomechanical evaluation to determine potential causes and muscle imbalances which could be contributing to shin splints. Advice regarding footwear, orthotics or training may also be provided. Prognosis is favorable for these individuals if compliant with advice. Surgery is a last resort if conservative treatment fails.

Shin splints can be a frustrating injury, but knowing the risk factors and trying to avoid them will hopefully allow one to perform pain free.


Clement D, Taunton J, Smart G. A survey of overuse running injuries. The Physician and Sports Medicine, 1981; 9, 47-58

Reber LJ et al. Muscular control of the ankle in running. AJSM. 1993; 21, 805-810.

Bennett JE,Reinking MF, Pluemer B, et al. Factors contributing to the development of medial tibial stress syndrome in high school runners. JOSPT. 2001; 31, 504-510

Yates, B, White, S. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. AJSM. 2004, 32(3), 772-780