Medial Shin Pain

Shin Splints / Medial Tibial Stress Syndrome / Tibial Stress Reaction

Medial shin pain is a frequently seen lower leg presentation and Medial Tibial Stress Syndrome is considered one of the most common causes of exertional leg pain in athletes.

The pathoanatomy behind medial shin pain is still debated and expert opinion not consistent; but the primary cause is most widely understood to be a bone stress reaction caused by chronic repetitive loads that induce tibial bending forces.

It has been hypothesised that Medial Tibial Stress Syndrome may be the result of persistent strain on remodelling bone that generates a feedback loop leading to chronic remodelling of cortical bone. A tibial stress fracture is also a diagnosis that must be considered in presentations of medial shin pain.

Whilst a bone stress reaction is likely to be the primary underlying pathology, there are a number of tissues that can respond adversely to repetitive stress and contribute to medial shin pain.

These include: Myofascial (Tibialis Posterior; Soleus; Flexor Digitorum); Periosteum (Periostitis; Periosteal remodelling); Tendon (Tibialis Posterior; Flexor Digitorum); Bone (Tibial Stress Reaction).

Medial shin pain is a complex presentation that may involve a combination of tissues and contributing factors.

Symptoms associated with medial shin pain presentations most commonly include:

  • Pain at the beginning of activity that diminishes and returns after completing
  • Pain on palpation of the posteromedial border of the tibia (>5cm); Primarily the distal 1/3
  • Pain can be described as sharp or aching

As with all the running injuries we have covered so far, there a number of contributing factors to be considered when managing medial shin pain. Again, we can divide them into intrinsic and extrinsic factors.

Intrinsic factors: Gender, biomechanics, foot posture, running history, bone density, running technique etc.

Extrinsic factors: Training errors, shoes, surface type & inclination etc.


So…what can we do to manage, fix & prevent medial shin pain?

  • Assess for contributing factors & most likely symptom source: as there are a number of tissues that may be implicated in shin pain, it is important to assess for the most likely tissue contributions to each presentation. We are all different, what may contribute to or be implicated in one persons’ presentation may not be in the next.


  • Activity modification: this doesn’t necessarily mean no running! But, essentially load needs to be modified as best it can to reduce symptoms and allow management to progress.


  • Biomechanics: an increase in hip internal rotation and reduction in knee flexion during running gait are two biomechanical variances that have been linked to medial shin pain.


  • Strength: important to reduce load through our lower leg and improve biomechanics. Hip strength is always important when considering the biomechanics of running, and we can not forget that the foot can be strengthened too. The foot, just like any other part of us can be strengthened and re-trained.


  • Running Technique: there are variances in running technique that can result in an increased load through your lower leg. Primary things to be considered include: stride length, cadence, foot strike.


  • Shoes: footwear can have a significant impact on medial shin pain; both the level of support and heel-drop. Specific assessment of foot biomechanics, running technique and physical presentation is advised when choosing the most appropriate shoes.


  • Dry Needing / Myofascial Cupping: both techniques can help to improve the health of affected tissues and reduce pain.


Managing medial shin pain involves a complete and accurate assessment of symptoms and biomechanics to determine the most appropriate approach. Essentially, load needs to be reduced to allow healing and contributing factors addressed to ensure recovery and prevention of future injury.

If you have any questions about shin pain that you may be experiencing please don’t hesitate to call or email: (03) 5229 3911 or

Or follow the links for services that may help…



Louden, J.K., Reiman, M.P. 2012. Lower Extremity Kinematics in running athletes with and without a history of medial shin pain. International Journal of Sports Physical Therapy. 7(4), 356-64.

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