Many runners brush off lower leg pain as “just shin splints.” But sometimes, that ache is a warning sign of something more serious: a tibial stress fracture.
Understanding Shin Splints (MTSS)
Medial tibial stress syndrome is inflammation of the tibial periosteum. It causes dull, aching pain along the inner shin—especially with running or jumping. Many runners try to push through or manage this themselves, but they often underestimate the risk of this progressing to a boney stress reaction or a boney stress injury (BSI).
When It’s More Than Shin Splints
Key red flags:
– Pain that worsens with each session
– Night pain or pain at rest
– Focal point tenderness along the shin
– Pain during walking, hopping or when putting more weight through the affected side
These signs suggest a deeper bone issue—possibly a stress reaction or stress fracture.
How Physios Assess
As a bone-focused physiotherapist, I use a combination of clinical tests and load response monitoring. These tests include palpation, strength and power tests, functional tests and site specific tests. I take a detailed history and identify key risk factors for higher severity injuries, and address training errors quickly. At times, I refer for imaging (MRI or bone scan) to facilitate the diagnosis and ensure that we can be specific in our treatment.
Different BSI have different levels of management, expected recovery times and treatment pathways. It is important to get an accurate diagnosis to ensure your recovery.
Why Early Action Matters
Stress reactions caught early often respond really well to rest, offloading, and strengthening. But left unchecked, they can progress to higher grade BSI, possibly even full fractures, requiring weeks of immobilisation and many more months of treatment. Getting assessed early not only gets you back to your sport pain-free quicker, but reduces the risk of this injury derailing your entire season and race plans.
Summary
Don’t ignore bone pain. A physio trained in bone stress injuries can help you recover without losing your fitness.
Think you might have more than shin splints? Book an assessment and let us give you clarity around your injury and training.
By Riley Anastasi, Physiotherapist & Exercise Scientist at Form & Practice Olinda