Why Does My Shin Hurt When I Run?
Why Does My Shin Hurt When I Run? A Physical Therapist Answers
By Nova Physical Therapy | North Hollywood, CA
Shin pain is one of those running problems that can start quietly.
At first, you may notice discomfort only during the first few minutes of a run. You warm up, the discomfort becomes less noticeable, and you keep going.
Then it starts appearing earlier.
You feel it when running uphill, increasing your mileage, jumping, playing basketball, or walking after a workout.
Eventually you may wonder:
“Is this just shin splints, or should I stop running?”
“Why does the inside of my shin hurt?”
“Did I increase my mileage too quickly?”
“Could this be a stress fracture?”
“Should I stretch it, strengthen it, or rest?”
These questions are especially important because exercise-related shin pain does not have one single cause.
One common presentation is medial tibial stress syndrome (MTSS), often referred to as “shin splints.” However, tibial bone stress injuries, muscle-related pain, exertional compartment syndrome, and other conditions can produce symptoms in the lower leg.
A physical therapist can evaluate movement, muscle performance, activity tolerance, training history, and functional limitations—but shin pain should not be diagnosed from symptoms alone.
Learn more about Nova Physical Therapy's services.
Patient Question
“The inside of my shin starts hurting when I run, especially when I increase my mileage or run several days in a row. Is this shin splints, and can physical therapy help me return to running safely?”
The Short Answer
Running-related shin pain can occur when the demands being placed on the lower leg exceed its current capacity to tolerate those demands.
Medial tibial stress syndrome is one possible presentation and is common among runners and physically active individuals.
However:
Not every painful shin is simply “shin splints.”
Pain that becomes increasingly focal, occurs with ordinary walking, persists at rest, develops after a rapid increase in training, or is associated with significant bone tenderness deserves additional attention because bone stress injury and other conditions may need to be considered.
Recent research also shows that MTSS is not explained by one universal biomechanical fault.
A 2025 systematic review and meta-analysis examining alignment, range of motion, strength, and gait variables identified several associations with MTSS, but the findings varied across studies and publication bias was present for some variables.
A September 2026 systematic review evaluating noninvasive treatment for load-induced medial leg pain also highlighted the limited quality and consistency of treatment evidence.
So rehabilitation should not be reduced to:
“Your feet pronate, so that's why your shin hurts.”
The better approach is to evaluate the individual runner, understand recent training changes, screen for more concerning presentations, identify relevant impairments, and gradually rebuild running capacity.
What Are “Shin Splints”?
“Shin splints” is a common term used to describe exercise-related pain along the tibia, or shin bone.
In clinical and research literature, medial tibial stress syndrome is a more specific term for a common running-related presentation involving pain along the posteromedial border of the tibia.
Patients frequently notice symptoms during activities involving repetitive loading, including:
- Running
- Jumping
- Basketball
- Soccer
- Hiking
- Military training
- High-impact exercise
But the phrase “shin splints” should not be used as a catch-all diagnosis for every type of lower-leg pain.
The location, distribution, behavior, and severity of symptoms matter.
Why Does My Shin Hurt When I Run?
Running repeatedly loads the lower extremities.
Your bones, muscles, tendons, and other tissues normally adapt to appropriate loading over time.
Problems can develop when the amount or intensity of activity changes faster than the body is prepared to tolerate.
For example, a runner may suddenly change from:
10 miles per week to 20 miles per week
or add:
hills
speed work
more running days
longer runs
or
another impact-based sport.
The important concept is not that running is inherently harmful.
Running is a normal physical activity that the body can adapt to.
The issue is whether current loading and current capacity are appropriately matched.
Can Increasing My Mileage Too Quickly Cause Shin Pain?
Training changes are important to consider.
A runner who has comfortably tolerated a certain workload for months may experience symptoms after suddenly increasing:
- Weekly mileage
- Running frequency
- Running speed
- Hills
- Interval training
- Competition
- Jumping
- Other impact-based exercise
However, there is no universal percentage rule that guarantees injury prevention.
You may have heard:
“Never increase mileage more than 10% per week.”
That can be a simple planning concept, but it should not be treated as a scientifically guaranteed injury-prevention threshold.
Training progression should consider the individual runner's experience, recovery, previous injuries, current symptoms, overall exercise load, and goals.
Is Shin Pain Always Caused by Overpronation?
No.
Foot posture may be one factor considered during an examination, but it should not become the entire explanation.
A 2025 systematic review and meta-analysis examining 21 studies found associations between MTSS and several variables, including foot posture, inversion range of motion, eversion strength, and dynamic arch-height change.
However, associations do not prove that one factor caused the person's symptoms.
This is an important distinction.
A person can have pronated feet and never develop shin pain.
Another person can develop shin pain without obvious excessive pronation.
Physical therapy should therefore evaluate the whole person rather than blaming one anatomical feature.
Can Weak Hips Cause Shin Splints?
It is too simplistic to say:
“Weak hips cause shin splints.”
Recent research has examined relationships between proximal muscle function and tibial loading.
A 2026 study involving 174 recreational runners with MTSS used musculoskeletal modeling and machine-learning methods to examine associations between proximal muscle forces and tibial loading.
The researchers identified relationships involving several trunk and hip muscles.
However, the study was cross-sectional.
That means it identified associations rather than proving that a particular muscle weakness caused MTSS or that strengthening one muscle will cure the condition.
Hip and trunk muscle performance may still be relevant during an individualized running assessment, particularly when meaningful deficits are present.
Is Shin Pain a Bone Problem?
Sometimes bone loading may be involved.
The tibia continuously adapts to mechanical loading.
This is normal.
But repetitive loading without adequate recovery can contribute to a spectrum of bone stress.
That spectrum is important because not every case of exercise-related shin pain should be treated identically.
A diffuse region of exercise-related discomfort along the medial tibia may behave differently from highly localized bone pain.
This is one reason a physical therapist should ask:
Where exactly does it hurt?
How large is the painful area?
Does it hurt only during running?
Does it hurt when walking?
Does it hurt at rest?
Has your training changed recently?
Can you hop comfortably?
The answers may influence whether routine rehabilitation appears appropriate or whether additional medical evaluation should be considered.
How Can I Tell Shin Splints From a Stress Fracture?
You should not attempt to make this distinction based solely on an internet checklist.
Symptoms can overlap.
However, certain findings may raise concern for a tibial bone stress injury and warrant medical assessment.
These may include:
- Increasingly focal bone pain
- Pain that begins occurring with ordinary walking
- Pain that continues despite reducing activity
- Pain at rest
- Significant localized bone tenderness
- Increasing symptoms with repeated impact
- Difficulty bearing weight
- Symptoms that are progressively worsening rather than improving
A tibial stress fracture is different from medial tibial stress syndrome and may require different activity restrictions, imaging, medical management, and return-to-running progression.
When the clinical presentation raises concern for bone stress injury, referral for appropriate medical evaluation is important.
Should I Keep Running Through Shin Pain?
Not automatically.
There is an important difference between appropriately progressing activity and repeatedly ignoring worsening symptoms.
Some runners may be able to continue modified running.
Others may temporarily need to reduce:
- Running distance
- Running frequency
- Running intensity
- Hills
- Speed work
- Jumping
- Other high-impact activities
And some presentations warrant stopping impact activity and obtaining additional medical evaluation.
The decision should depend on the symptom behavior and clinical presentation.
The goal is not necessarily:
“Stop everything until you have zero symptoms.”
Nor is it:
“Just push through it.”
The goal is to find an appropriate level of activity while addressing the factors relevant to the individual.
Do I Need Complete Rest?
Not necessarily.
For many musculoskeletal conditions, complete inactivity may not be required.
A runner may be able to maintain cardiovascular fitness using lower-impact activities while running volume is temporarily modified.
Depending on the presentation, this might include:
- Cycling
- Swimming
- Pool running
- Elliptical training
- Strength training
But these options are not universally appropriate.
If a bone stress injury or another medical condition is suspected, activity recommendations may need to be more restrictive.
Should I Stretch My Calves?
Calf stretching may be appropriate when clinically meaningful mobility limitations are identified.
But calf stretching is not a universal cure for shin pain.
If someone's symptoms are primarily related to rapidly increased running demand, simply stretching the calf without modifying the training load may not adequately address the problem.
Likewise, stretching should not be aggressively performed through significant pain.
The rehabilitation plan should match the findings of the evaluation.
Should I Strengthen My Calves?
Calf and lower-leg muscle performance may be important during running rehabilitation.
The calf complex contributes substantially to propulsion and force management during running.
A rehabilitation program may therefore include exercises such as progressively loaded heel raises when appropriate.
But strengthening should not stop at:
“Do three sets of calf raises.”
The eventual goal may be to tolerate:
walking → running → faster running → hills → jumping → sport
depending on what the patient wants to return to.
Do I Need Hip Strengthening?
Possibly.
Hip strengthening may be appropriate when the evaluation identifies relevant muscle-performance deficits or when it forms part of a broader lower-extremity conditioning program.
However, current evidence does not support telling every runner with shin pain:
“Your glutes aren't firing.”
That kind of explanation oversimplifies a multifactorial problem.
Strengthening should be prescribed because it addresses a meaningful impairment or functional requirement—not because one muscle is assumed to be the universal cause.
Can Running Form Contribute to Shin Pain?
Running mechanics may be relevant for some patients.
A physical therapist may observe:
- Cadence
- Step characteristics
- Landing strategy
- Lower-extremity movement
- Trunk movement
- Running speed
- Fatigue-related changes
However, there is no single “perfect” running form that everyone must adopt.
A runner's movement should be interpreted together with symptoms, training history, physical examination, and functional goals.
Changes to running mechanics should have a clear clinical reason rather than being based solely on appearance.
Do I Need New Running Shoes?
Not automatically.
Shoes can affect comfort and running experience, but replacing shoes is not a guaranteed treatment for shin pain.
A useful shoe should generally be:
comfortable
appropriate for the activity
and
tolerable for the individual runner.
Switching suddenly to a dramatically different shoe while simultaneously changing training volume may introduce another new variable.
If footwear appears relevant, changes can be introduced thoughtfully.
Do Orthotics Help Shin Splints?
Orthoses may be appropriate for selected individuals.
A 2025 systematic review and meta-analysis examining prevention of medial tibial stress syndrome included 12 randomized studies involving 8,197 participants.
The authors reported evidence supporting neuromuscular training and overpronation-targeted insoles for prevention in the studied populations.
However, prevention studies do not establish that every runner who already has shin pain needs orthotics.
Foot orthoses should not automatically replace progressive rehabilitation or appropriate training modification.
Can Shockwave Therapy Help Shin Splints?
Shockwave therapy has been studied for medial tibial stress syndrome.
A 2026 systematic review examining extracorporeal shockwave therapy for bone-related conditions included studies involving MTSS and bone stress injuries.
However, much of the broader shockwave literature for bone conditions consisted of lower-level evidence, and one level-I MTSS study found shockwave therapy to have similar effectiveness to an exercise program.
An even newer September 2026 systematic review examining noninvasive physical therapy-related treatments for load-induced medial leg pain emphasized that the overall evidence remains limited.
So shockwave therapy should not be presented as a guaranteed or universally superior treatment for shin pain.
For an appropriately selected patient, it may be considered as one potential adjunct depending on the clinical presentation, available evidence, device requirements, and applicable professional scope.
Can Physical Therapy Help?
For an appropriate musculoskeletal presentation, physical therapy may help address factors such as:
- Lower-extremity muscle performance
- Calf strength and endurance
- Ankle mobility
- Hip muscle performance
- Single-leg control
- Running tolerance
- Walking tolerance
- Jumping and landing
- Training progression
- Return to running
- Return to sport
Physical therapy can also help determine whether the presentation appears consistent with a condition appropriate for rehabilitation or whether additional medical assessment is warranted.
A runner's rehabilitation may progress from:
symptom management
to
strength and conditioning
to
graded impact
to
running
and eventually
the speed, distance, terrain, or sport-specific demands that matter to that person.
The goal is not simply to make the shin feel better while resting.
The goal is to restore the capacity required for meaningful activity.
What Does Research Say?
2026 Systematic Review of Noninvasive Treatment
A systematic review published in Physical Therapy in Sport in September 2026 evaluated noninvasive physical therapy-related treatments for load-induced medial leg pain in runners.
The researchers searched MEDLINE, CENTRAL, SPORTDiscus, EMBASE, and Web of Science through June 2, 2025.
The review highlights an important limitation in this area:
There is still not one clearly established treatment protocol that should automatically be applied to every runner with MTSS.
That supports individualized rehabilitation rather than one-size-fits-all treatment.
2026 Machine-Learning Study of Tibial Loading
A 2026 study in Archives of Physical Medicine and Rehabilitation evaluated 174 recreational runners with MTSS.
Researchers used biomechanical modeling and machine-learning methods to examine relationships between proximal muscle forces and tibial loading.
Several trunk and hip muscle-force characteristics were associated with modeled tibial loading.
These findings are interesting, but the study was observational.
They should not be converted into rigid clinical thresholds or claims that one particular muscle causes shin pain.
2025 Systematic Review of Biomechanical Factors
A systematic review and meta-analysis published in the Journal of Sport Rehabilitation evaluated 21 studies examining alignment, range of motion, strength, and gait biomechanics associated with MTSS.
Several factors showed statistical associations, including foot posture, inversion range of motion, eversion strength, and dynamic arch-height change.
However, publication bias was identified for several variables.
The practical message is that MTSS appears multifactorial.
2025 Prevention Meta-Analysis
A 2025 systematic review and meta-analysis included 12 studies and 8,197 participants.
The authors reported preventive benefits from neuromuscular training and overpronation-targeted insoles in the studied populations.
This provides useful prevention information but does not mean every patient with existing shin pain requires orthotics.
2026 Shockwave Therapy Review
A 2026 systematic review examined shockwave therapy for multiple bone-related conditions, including medial tibial stress syndrome and bone stress injury.
The review included 53 studies involving 1,835 adults, but most studies were lower levels of evidence.
The findings suggest shockwave therapy is an area of continuing research rather than a universally established treatment for running-related shin pain.
September 2026 Exercise Study
A study published September 13, 2026 evaluated how two targeted exercise approaches influenced biomechanical and neuromuscular variables related to MTSS.
Twenty active participants were randomized to single-leg lateral hops or controlled step-downs.
The single-leg hopping intervention produced immediate changes in several laboratory measures, including loading rate and postural stability.
However, this was a small study examining immediate biomechanical responses.
It does not establish that one hopping exercise prevents or cures MTSS.
What Happens During a Physical Therapy Evaluation?
At Nova Physical Therapy, an evaluation for running-related shin pain may include, when appropriate:
- Detailed symptom history
- Recent changes in running volume
- Running frequency
- Running speed and intensity
- Hills and terrain
- Previous injuries
- Walking tolerance
- Location and distribution of shin symptoms
- Ankle range of motion
- Lower-extremity muscle performance
- Calf strength and endurance
- Hip muscle performance
- Single-leg control
- Balance
- Squatting
- Heel raises
- Hopping when appropriate
- Running assessment when appropriate
- Screening for findings that may warrant medical referral
We may ask:
When did the pain start?
Did you recently increase your mileage?
Is the pain spread along the shin or concentrated in one small area?
Does it hurt while walking?
Does it hurt at rest?
Does hopping reproduce significant pain?
Have you changed shoes?
Have you added hills or speed training?
What distance are you trying to return to?
Are you training for a race or sport?
These details help determine what appears relevant and whether physical therapy is appropriate.
When Should You Seek Medical Attention?
Running-related shin pain should not automatically be assumed to be harmless “shin splints.”
Seek appropriate medical evaluation if you experience:
- Significant trauma
- Inability to bear weight
- Increasingly focal bone pain
- Significant localized bone tenderness
- Pain during ordinary walking that is worsening
- Persistent pain at rest
- Significant swelling
- Progressive numbness or weakness
- Significant lower-leg tightness accompanied by neurological symptoms
- Unexplained redness, warmth, or fever
- Symptoms that continue to worsen despite reducing activity
- Other concerning systemic symptoms
Certain presentations may require evaluation for bone stress injury, fracture, exertional compartment syndrome, neurological involvement, vascular problems, or other medical conditions.
A physical therapist should refer when findings warrant additional medical assessment.
Why Patients Choose Nova Physical Therapy
We Care.
At Nova Physical Therapy, we don't believe every runner with shin pain should automatically receive:
the same stretch
the same orthotic
the same strengthening program
or
the same machine-based treatment.
One runner may say:
“I doubled my mileage last month.”
Another:
“It only hurts during hills.”
Another:
“I have one very specific painful spot on my tibia.”
Another:
“I can run three miles, but symptoms start when I go farther.”
And another:
“My shin hurts even when I'm walking now.”
Those presentations deserve different levels of attention.
Our approach emphasizes:
individualized physical therapy evaluation
evidence-informed rehabilitation
progressive strengthening
appropriate load management
functional movement
patient education
graded return to running
and
appropriate referral when findings require additional medical assessment.
We want to understand not only:
“Does your shin hurt?”
but:
“What are you trying to get back to?”
Maybe that's your first 5K.
Maybe it's hiking in Los Angeles.
Maybe it's recreational basketball.
Maybe you're returning to soccer.
Or maybe you simply want to run around the neighborhood without worrying about your shin.
The rehabilitation plan should reflect those goals.
That's part of what We Care means to us.
Frequently Asked Questions
Why does my shin hurt when I run?
Running-related shin pain can have several causes. Medial tibial stress syndrome is one possibility, but bone stress injury and other lower-leg conditions can produce overlapping symptoms.
Are shin splints the same as a stress fracture?
No. Medial tibial stress syndrome and tibial stress fracture are different conditions, although symptoms may overlap.
How do I know if my shin pain is a stress fracture?
Increasingly focal pain, significant localized bone tenderness, pain with walking, pain at rest, or progressively worsening symptoms warrant appropriate medical evaluation. Symptoms alone cannot reliably confirm a stress fracture.
Can increasing mileage cause shin pain?
Rapid or substantial changes in training load can be relevant. Mileage, frequency, speed, hills, jumping, and other impact activities should all be considered.
Should I stop running if I have shin pain?
Not every runner requires complete rest, but continuing to run through progressively worsening symptoms may be inappropriate. Activity recommendations should depend on the clinical presentation.
Should I stretch my calves for shin splints?
Calf mobility work may be useful when a relevant limitation is identified, but stretching alone is not a universal treatment.
Should I strengthen my calves?
Calf strength and endurance may be important components of running rehabilitation when appropriate.
Are weak hips causing my shin pain?
Hip muscle performance may be relevant for some runners, but current evidence does not support blaming shin pain on one weak muscle.
Do orthotics help shin splints?
Orthoses may be useful for selected individuals, but they are not automatically necessary for every runner with shin pain.
Can shockwave therapy help shin splints?
Shockwave therapy has been studied for MTSS, but evidence remains limited and it should not be presented as a guaranteed or universally superior treatment.
When can I start running again?
Return to running should consider symptom behavior, walking tolerance, relevant physical findings, graded impact tolerance, and response to progressively increasing running demands.
Can physical therapy help shin pain from running?
For an appropriate musculoskeletal presentation, physical therapy may help address strength, mobility, movement, training tolerance, graded loading, and return to running while screening for findings that warrant medical referral.
Schedule an Evaluation
If shin pain is limiting your ability to:
- Run
- Walk
- Hike
- Exercise
- Jump
- Play sports
- Increase your training
- Prepare for a race
an individualized physical therapy evaluation can help identify relevant impairments and determine whether rehabilitation is appropriate.
At Nova Physical Therapy, the goal is not simply to tell runners:
“Stop running.”
The goal is to understand the problem, appropriately manage current loading, rebuild physical capacity, and help patients work toward the activities that matter to them.
Explore Nova Physical Therapy's services to learn more about physical therapy care in North Hollywood, California.
Disclaimer
This article is intended for general educational purposes only. It does not constitute medical advice, medical diagnosis, imaging interpretation, individualized treatment recommendations, exercise clearance, or return-to-running clearance.
Shin pain during running cannot independently establish medial tibial stress syndrome, tibial stress fracture, another bone stress injury, muscle injury, exertional compartment syndrome, neurological involvement, vascular disease, or another musculoskeletal or medical condition.
Physical therapists in California evaluate movement, physical impairments, muscle performance, functional limitations, and activity restrictions within the California Physical Therapy Practice Act. Physical therapists do not diagnose disease.
Symptoms suggesting bone stress injury or another condition requiring medical evaluation should be appropriately referred.
Exercise, load modification, manual therapy, orthoses, shockwave therapy, gait modification, or other interventions cannot guarantee pain relief, tissue healing, successful return to running, or prevention of recurrence.
Individual results vary.
References
- Teles AI, da Silva Carto JP, Parpa K, Thuany M, de Vasconcelos GS. Load-induced medial leg pain in runners: A systematic review of non-invasive treatment approaches. Physical Therapy in Sport. 2026;81:101962.
https://doi.org/10.1016/j.ptsp.2026.101962 - Mazzotti A, Di Paola G, Arceri A, et al. Medial Tibial Stress Syndrome. Musculoskeletal Surgery. Published online March 14, 2026.
https://doi.org/10.1007/s12306-026-00953-w - Lee I, Jeon HG, Ha S, Jeong H, Lee SY. How Medial Tibial Stress Syndrome Is Affected by Alignment, Range of Motion, Strength, and Gait Biomechanics: A Systematic Review and Meta-Analysis. Journal of Sport Rehabilitation. 2025;34(2):134-155.
https://doi.org/10.1123/jsr.2024-0031 - Marques TBT, Rangel RPS, Martins LV, Vidal APC. Preventive interventions for medial tibial stress syndrome: Systematic review and meta-analysis. Gait & Posture. 2025;122:92-98.
https://doi.org/10.1016/j.gaitpost.2025.07.312 - Zhang Z, et al. Artificial Intelligence-Driven Elucidation of Mechanistic Links Between Proximal Joint Strength and Tibial Loading in Runners With Medial Tibial Stress Syndrome: Implications for Precision Rehabilitation. Archives of Physical Medicine and Rehabilitation. 2026.
https://doi.org/10.1016/j.apmr.2026.05.023 - Bouamama A, Büyüksaraç B. Impact of targeted lower-limb exercises on biomechanical and neuromuscular risk factors associated with medial tibial stress syndrome. Sports Biomechanics. Published online September 13, 2026.
https://doi.org/10.1080/14763141.2026.2730655 - Use of Extracorporeal Shockwave Therapy for the Management of Bone Pathologies: A Systematic Review.2026. PubMed PMID: 41495929.
https://pubmed.ncbi.nlm.nih.gov/41495929/ - George ERM, Sheerin KR, Reid D. Criteria and Guidelines for Returning to Running Following a Tibial Bone Stress Injury: A Scoping Review. Sports Medicine. 2024;54:2247-2265.
https://doi.org/10.1007/s40279-024-02051-y - Physical Therapy Board of California. Physical Therapy Practice Act.
https://www.ptbc.ca.gov/laws/pt_practice_act.shtml