Why Runners Get Shin Splints: Injury Breakdown and 5 Exercises That Help

Marie Whitt
Jul 28
8 min read

No runner wants that ONE panic-inducing thought," Do I have shin splints?”

You start to see repeat rest-days turn into 3 missed weeks of running.

Your training cycle begins to fall behind.

And the starting line of your next race is slowly slipping away.

Not. Cool.

But you know what else isn't cool?

The same, generic running advice plastered all over the internet of ice, wear compression, do calf raises, take 3 rest days, maybe even do marble pick ups or theraband ankle exercises.

Did I cover it all? ;)

So let me give the REAL information as we break down the latest research behind shin splints, otherwise known as medial tibial stress syndrome.

Hi, if you're new here, I'm Marie, a Doctor of Physical Therapy and a runner of 15+ years.

Together we'll deep dive into shin splints and look at what actually causes them, how to tell whether the pain in your shin is really shin splints (MTSS), and the specific muscle groups that are often weak in runners dealing with MTSS.

And it wrap it up, I'll give you my top five targeted strength exercises designed to help your shins handle the load and get you back to pain-free miles.

Let's go.

What’s Actually Happening in Your Shins: A Quick Look at the Science

Commonly known as shin splints, a more accurate name for training-ending shin pain is medial tibial stress syndrome (MTSS).

But don't be confused: MTSS is a type of bone injury. When in its early stages, it's known as a bone stress injury (BSI). Comparatively, the most extreme version is a full blown stress fracture that most runners are familiar with

What you need to know as a runner:

"Bone stress injuries result from the accumulation of bony microdamage".
- Meaning microdamage to bone is a normal part of training; think of it as the bone equivalent of muscles DOMs. However, there's a tipping point.
"Microdamage accumulates when loading induces microdamage formation at a rate that exceeds the ability to remove and replace microdamage via targeted remodelling (ie, the site-specific and sequential activity of bone-resorbing osteoclasts and bone-forming osteoblasts)"
- What this means: Issues and potential injuries arise when damage brought on by training exceeds your body’s ability to remodel and repair the affected bone. Remodeling and repair are terms we use for the cells that break down old, damaged bone and the cells that rebuild that same area with new stronger ones (performed by osteoclasts and osteoblasts respectively).
- Essentially, think of it as your body can't keep up with the all repairs and it falls behind on it's to-do list.

"Accumulation of microdamage locally weakens the affected site leading to a heightened risk of an acute or complete bone fracture."

The results of accumulated microdamage: you can end up with weakened bone located focally at your shin, resulting in an increased risk of MTSS (or BSIs)

KEY TAKEAWAY: shins splints occur because of loading errors. Yes, they can happen from "running too much", but that's missing the big picture.

High mileage + intense workouts + walking around at Disney Land /vacation + walking the dog + household chores + stress + improper fueling...

IT ALL ADDS UP.

This isn't to say your body is fragile; this is to call out just how much your body needs RECOVERY.

Is It Really Shin Splints? How to Self-Assess Your Symptoms

You can read all the descriptions on the internet about how you might be experiencing vague, even pain that moves around along your inner shin, maybe around the back portion of your shin...

While those can be a place to start, they're not always the most helpful.

So I made you a detailed checklist so you can compare what you're feeling to similar nitty-gritty questions a doctor or a physical therapist might ask to confirm that yup, you're dealing with shin splints.

Shin Splint Checklist: Self-Assess Your Shins:

Where is your pain located? (Medial/ inner tibia = classic MTSS, but it's ok if it's some where else!)
Does your pain worsen with weight-bearing activity like walking or running?
Does it linger and NOT improve with a warm-up?
Have you had any recent spikes in training load, mileage, or intensity?
Have you had any increased life-activities that require you to spend more time on your feet in addition to running? (home remodeling projects, Disneyland vacations, big travel trips, a job where you walk almost your entire shift, etc)
Do you have pain when you press over your shin bone (basically, if you press on the spots that hurt while running, can you recreate that pain while sitting)?
Does hopping and jumping on ONLY the injured leg bring on your pain?
Have you had a bone stress injury/shin splints before?

KEY TAKEAWAY: If you answered YES to 6 of 8 questions, I would strongly suggest starting the exercises I have for you later in the blog, but also get checked out by a medical provider. Please, take care of yourself.

The Muscles That Matter: Where Weakness Is Holding You Back

The Short Version: research has found that when specific muscles in your lower leg are weak, you are potentially at greater risk for developing MTSS.

These muscles include:

Flexor hallucis longus (FHL)
Soleus
Tibialis anterior
Peroneals

(with actually an over-development of your lateral or most outside gastroc!)

The easy answer the internet will give you: Do exercises to strengthen these "weak musckes", and you'll be good to go.

But that's over simplifying things.

Those muscles listed off have an the important job of creating "the ability of the lower leg to attenuate the ground reaction forces generated at foot-ground contact during running".

Meaning, these muscles help absorb the high impact force of every time your foot hits in the earth, compounded by the effects of gravity.

As a result, those lower leg muscles need to be not only stronger, but also require endurance.

Which was something researchers found was lacking with runners who struggled with MTSS:

"a large effect size was found for MTSS symptomatic participants who displayed a statistically significant deficit in ankle plantar flexor endurance capacity, completing on average 56 % fewer heel raises compared to control participants."

KEY TAKEAWAY: it's not always about "just get stronger". Recovering from shin splints also requires the smaller muscles of your lower leg and feet to be able to go the distance.

MEGA CIRCUIT: Fix Shin Splints FAST

Circuit:

4-5 sets each* (sets/reps vary per exercise) // medium weights + resistance bands

Banded Great Toe Flexion in Elongated Runner's Stance

5x8 with light to medium resistance bands

Knee Bent Calf Raise in Elongated Runner's Stance

4x8 with 2 second ascent: 3 second descent with or without weight

Foot on Edge of Step Mid Runner's Stance: Isometric

5 x10-30 second hold with body weight to heavy weight

Forward & Backwards Gallop

3 x 5 yrds both directions

Slanted Single Leg Calf Raise

5 x 8 with or without towel roll/pool noodle/etc

5 Strength Exercises for the Runner Struggling with Shin Splints

Banded Great Toe Flexion in Elongated Runner's Stance (strengthens Flexor hallucis longus)

Can't you just do this sitting or standing?
PRO TIP: yes, you can but...I've been playing around with this in the clinic and on my own. It's fine to learn how to move your big toe is isolation when you're sitting, standing, whatever. But something cool happens when you're in this runner's stance. (ok, PT-nerdy cool).
This elongated runner's position places 90% of your body weight on the front leg, asking your foot to be fully activated, sending a bunch of information to your brain, which can sometimes make the isolated big toe movement easier. But this set up also engages your "foot tripod", these natural, major zones of support in your foot. As a result, I personally feel like my foot is working harder, I'm getting better muscle activation and coordination when I do this exercise in the runner's stance vs sitting.

Bent Knee Calf Raise in Elongated Runner's Stance (strengthens the soleus)

Hey, don't knock these till you try them. Same stance, different exercise.
THE REASON: I got sick and tired of looking at bent knee calf raises that looked like an awkward monster walk. So I made a version that's running-specific, still strengthens your soleus, but also goes to the next level and challenges your itty bitty foot muscles.
Pay attention to coming up onto your toes and descending back to the ground. Shaking is ok (that's your nervous system and muscles coordinating), but I still want your descent to be slooow and controlled; no crashing back down to earth. Previous research hypothesized that strong solei were one of the keys to preventing shin splints.

Foot on Edge of Step Mid Runner's Stance: Isometric (strengths anterior tibialis)

WARNING: if you are super ouchy/flared up, you may need to wait on this.
THE SECRET: this is an isometric that I love to start my shin-splint runners on, but you need to be mindful of pain. If you do these with tolerable discomfort, you won't make anything worse. But there's no need for tears while performing these next 2 exercises.
A lot of times runners will jump straight into anterior tib raises and while those are great to work your way up to!...you sometimes need an in-between exercises before you're ready for those. This is my solution. You can always make this exercise harder by holding onto a heavy weight. And as always, hold on to something for balance as needed.

Slanted Single Leg Calf Raise (strengths peroneals)

Don't worry, I need to work on these too.
THE KEY: the leaning into the wall lengthens your peroneals, placing them a little bit more on stretch so we get stronger muscle activation. Work smarter, not harder.
Be sure though to stay grounded and pushing through your big toe as you raise your heel, but don't lose contact with the ground with your pinky toe. It's ok if this calf raise isn't super high at first. Learn first; perfect later.

Forward & Backwards Gallop (strengths anterior tibialis)

WARNING: if you are super ouchy/flared up, you may need to wait on this.
THE KEY: Trust me, I know it looks ridiculous. I know you're thinking of completely skipping this one. DON'T.
I use this frequently with my runners as a test. If you're shin splints are NOT 100% better, you will feel tenderness along your shins as you gallop. That being said, it is OK to do this exercise with minor discomfort (max 4/10), mainly because you're not going to do further damage, you are strengthening your ant tib, working on anterior tibialis deceleration, and pre-running movement pattern coordination. Basically, it does a lot of good things for you and it's a really go way to tell if your shin splints are still lurking beneath the surface.

WRAPPING UP

If you walk away learning only one thing, it's this: Shin splints aren’t an inevitable part of running.

They’re a sign your current training + life load exceeds what your body can regularly, consistently repair.

Whether it’s due to a sudden jump in mileage, under-recovery and fueling, or weak surrounding and supporting muscles, medial tibial stress syndrome (MTSS) is your body’s way of asking for a reset.

The good news?

There's hope.

But realize, yours could clear up in 3 weeks. Or 3 months. Sometimes it just takes time, patience, and progressive overload.

But you're taking the first step learning about load management, and strength training.

By understanding what’s actually happening beneath the surface, assessing your symptoms accurately, and targeting the right muscle groups, you can rebuild your running resilience from the ground up.

Want even more exercises to help prevent shin splints before they start?

Grab your free copy of my Calf and Achilles Cure Toolkit, made for runners sidelined by stiff, injury-prone calves and shins who want to protect their training cycle and show up to the starting line strong, pain-free, and ready to race.

Access the FREE Toolkit Now!

Dare to Train Differently,

Marie Whitt, PT, DPT //@dr.whitt.fit

References:

Hoenig, T., Hollander, K., Popp, K. L., Fredericson, M., Kraus, E. A., Warden, S. J., & Tenforde, A. S. (2025). International Delphi consensus on bone stress injuries in athletes. British Journal of Sports Medicine, 59(2), 78–86. https://doi.org/10.1136/bjsports-2023-107309

Mattock, J., Steele, J.R. & Mickle, K.J. Lower leg muscle structure and function are altered in long-distance runners with medial tibial stress syndrome: a case control study. J Foot Ankle Res 14, 47 (2021). https://doi.org/10.1186/s13047-021-00485-5

Naderi A, Fallah Mohammadi M, Heidaralizadeh A, Moen MH. Effects of Integrating Lower-Leg Exercises Into a Multimodal Therapeutic Approach on Medial Tibial Stress Syndrome Management Among Recreational Runners: A Randomized Controlled Study. Orthopaedic Journal of Sports Medicine. 2025;13(2). doi:10.1177/23259671241311849