The most common injury among runners is shin splints; but when the pain refuses to secede, how can one distinguish between that and something much worse: a stress fracture? I run cross country and track at Horizon and I can say that shin splints are not fun, but a stress fracture is a heartbreaking diagnosis for any runner to hear. I decided it would be beneficial for both my teammates, myself, and any curious runner to look into the facts behind the notorious shin splints and potentially stress fractures. 

Shin Splints

According to Healthline, “Shin splints is a cumulative stress disorder,” and can also be referred to as Medial Tibial Stress Syndrome or MTSS. Shin splints occur on the lower leg on either side of the shin. It is inflammation in the shin muscles caused by overuse and intense physical activity. Many claim that shin splints feel like a sharp pain when they put pressure on their leg or a persistent ache. Runners are often associated with the term because they are constantly putting pressure on their shins, and the repeated pounding can cause damage to muscles and bones, but really any athlete can fall victim to it. 

220 Triathlon notes that risk factors for shin splints include: poor conditioning, mild hyper-extending of foot, sudden increase in intensity, improperly-fitting footwear, and weak hip and knee muscles that put too  much pressure on shins. Many who are struggling with shin pain are told to get customized insoles and shoes with extra cushion which help lessen the force on shins. It is also important to remember that many running shoes can only be worn for so long with intense use. According to REI, the rule of thumb for when a replacement pair of shoes is recommended is when you hit 300-500 miles. By that standard, if you run 20 miles a week, those shoes are safe to run on for approximately 5 months. 

This overuse injury is quite tricky to heal from because it requires either a lot of attention or complete rest. For example, many athletes use foam rollers, periodic icing, and kinesthesiology tape to help with the pain. There are various stretching techniques that can help runners with shin pain: calf stretches, heel/toe walks, toe raises, and band exercises. Yet, even with these accommodations, shin splints can be very tricky to get completely rid of. I have personally used these techniques and have gotten frustrated when not seeing benefits. Sometimes this means runners need to take at least 4 weeks off and focus on other cross-training workouts like biking and swimming. Other times this raises the serious question of a stress fracture. 

Stress Fractures

In simple terms, stress fractures are a more serious form of shin splints and other overuse injuries as they involve small breaks in bone. Mayo Clinic highlights how stress fractures are, “Caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also develop from normal use of a bone that’s weakened by a condition such as osteoporosis.” This also explains why runners often confuse stress fractures with the more minor “shin splints”.

Stress fractures are often sharp pain at a localized point which lessens during rest. Commonly, stress fractures result from increasing activity too quickly and not giving the body enough recovery and to replace bone cells.

Additionally, stress fractures can be difficult to diagnose because they tend to be very microscopic; this means they will not appear on most x-rays. I can say that when I experienced extreme shin splints, I went to get an x-ray done for stress fractures and it showed nothing, and thus I got referred to a bone scan or MRI.

Treatment for stress fractures in the shin area include icing, resting, and possibly wearing a boot. For example, runners who believe they have stress fractures tend to refrain from all running activities and focus on cross training while wearing a boot for walking to recover. 

Differences Between the Two

As referenced before, stress fractures are more localized pain, also known as “pinpoint pain.” Adding on, University Hospitals points out, “With a stress fracture, the pain gets worse as you run and persists in a smaller location after you run, Dr. Goldberg says.” She also notes that if you begin to limp, that means you need to see a doctor. 

Stress fractures are often more sharp pain, especially when putting pressure on the shin. Meanwhile, shin splints are more of an aching feeling. If you experience pain just at the climax of a workout, it is likely that the pain is shin splints. But if the area is hurting while walking, that is a sign of a possible stress fracture. Some runners who struggle with shin splints experience pain at the beginning of their workouts but feel pain die down as they run it off. 

Recovery and Injury Prevention

Recovery for both shin splints and stress fractures is very simple, but hard for dedicated athletes to follow. Doctors will often call for complete rest from running (or other activity that caused the fracture) for up to 6-8 weeks. Sometimes, early prevention of stress fractures includes a 2-4 week break from running if you start to experience unwavering shin splints. Remember to consistently ice for 15 minutes 4-8 times a day. Although stress fractures require more intense precautions, stretching and foam rolling before and after running is a necessity. The stretch proven to be most effective for my shin splints has been a band stretch where I pull my toes toward my body as the band provides resistance(essentially a calf-stretch).

Moving forward, it is important to take proper precautions to avoid shin splints, stress fractures, and other overuse injuries. Gradually increasing intensity of workouts may be the most important rule to follow. At the end of the day, running and other sports that result in these types of injuries put a lot of stress on the body, this means extra attention is required. Stay healthy!