If you’re a runner or an endurance athlete, you’re probably familiar with shin splints. You might start fearing for potential shin splints when your shins begin to hurt. But the pain between your knees and ankle may also indicate a stress fracture. While both stress fractures and shin splints affect your lower leg, each has an entirely different prognosis.

But how do you know your shin pain is due to a stress fracture or shin splints? Here’s how you can differentiate, treat and prevent them in the future.

Shin Splints vs. Stress Fracture – Difference Between The Two:

1. Shin Splints:

Medial tibial stress syndrome (MTSS), aka shin splints, refers to the discomfort or pain along the tibia (shin bone), which occurs due to the inflammation of muscles, tendons, and tissue bone around the shin bone. Shin splints are a frequently occurring problem in gymnasts, runners who have intensified their training, runners who have returned to sports after a prolonged time, and new runners [1].

People with shin splints may feel that their bone is affected, but the actual pain is due to the inflammation of muscles, tendons, and tissues around the tibia.

Symptoms:

Lower leg pain is the most frequently occurring symptom of shin splints that usually worsens after weight-bearing or running activities. The symptoms indicative of pain include:

• Shooting pain that radiates along the inner border of the tibia.
• Mild swelling in the lower side of the leg.
• Soreness and tenderness in the affected area.

Causes: 

The following are common factors that may trigger shin splints in runners:

• Having poor running form.
• Having tight calf muscles, which puts stress on your shins.
• Wearing unsupportive shoes while running.
• Poor muscle endurance around the lower limb and shin.
• Excessive speed of foot pronation.
• Increasing the intensity of a training session.
• Running on uneven or hilly surfaces [2].

Treatment Options:

The following are treatment options for relieving pain caused by shin splints:

• Ice: Applying cold compresses to your shins helps alleviate the pain and swelling of shin splints. Ice should be applied as frequently as tolerable.
• Rest: Taking a break from repetitive activities, like running, helps your muscles and bones recover.
• Supportive Footwear: Wearing supportive shoes also relieves pain associated with shin splints. If you have flat feet, you should wear shoes with arch supports. If you have high arches, you should wear shoes with cushioned insoles.
• NSAIDs: Certain over-the-counter medications, like non-steroidal anti-inflammatory drugs, also ease the pain.
• Increase training slowly: If you start your training but feel the same pain, you should stop exercising for some time. You should return to training slowly to reduce the risk of shin splints returning [3].

2. Stress Fracture:

A stress fracture is a severe bruise, tiny crack, or a group of cracks formed in a bone due to cumulative strain on the bone. The lower part of the tibia is the most common site of stress fractures. Stress fractures are typically caused by repeated jumping and long-distance running. If you have a weak bone structure due to osteoporosis, you may suffer from a stress fracture from just everyday activities [4].

Runners, especially when they begin a new training program, are at great risk of stress fractures. In a stress fracture, the bone is unable to bear repetitive mechanical loading.

Symptoms:

The following are some signs and symptoms to look out for a stress fracture:

• A deep, throbbing pain felt at the site of the fracture.
• The pain intensified while walking, running, and doing other activities.
• Compared to shin splints, the pain persists at rest, too, and worsens at night.
• Pinpoint pain, which is specific to the bone itself, as with shin splints.
• Tenderness and swelling at the fracture site.

Causes:

Common causes of a stress fracture include:

• Overuse or repetitive activity.
• An increase in the duration (number of times you exercise) or frequency (a sudden increase) of the activity.
• Changing the type of exercise.
• Changing the surface on which you exercise.

Some other factors that contribute to bone stress include:

• Poor diet with poor caloric intake.
• Low levels of vitamin D
• Irregular menstrual cycle in females [5].

Treatment:

The treatment for stress fractures is much more restrictive than shin splints. Preferred treatment options include:

• RICE: The RICE method includes rest, ice, compression, and elevation. This method helps relieve pain and swelling associated with a stress fracture.
• NSAIDs: Pain and swelling of a stress fracture can also be alleviated by NSAIDs, including aspirin and ibuprofen.
• Protective footwear. Wearing protective shoes, such as a wooden-soled sandal or a stiff-soled shoe, can help reduce extra stress on your leg and foot.
• Crutches: In some cases, the use of crutches is also recommended to keep weight off an injured leg or foot [6].

Stress fractures usually heal within a period of six to eight weeks. A proper diet with enough calories and vitamin D supplementation is also necessary.

The following table helps you better understand the difference between shin splints and stress fractures:

Difference	Shin Splints	Stress Fractures
Type of Pain	A dull, aching pain radiating along the entire length of the shin bone.	A deep, throbbing pain, which is localized to the bone itself.
Frequency of Pain	The pain is felt when you’re running at top speeds.	The pain flares up more frequently. Pain worsens at night and while resting, too.
Tenderness to Touch	Pain eases away when you massage the lower leg.	Pain will not be alleviated while massaging or putting pressure in the affected area.
Recovery	Shin splints go quite away quite quickly. You feel fine once you resume physical activity.	Pain doesn’t go away easily. You can still feel pain while walking or running.

 

Preventing Overuse Injuries:

The following are some preventive tips for shin splints and stress fractures:

• Maintaining overall flexibility with the help of a good training program.
• Make sure to warm up before performing any activity.
• Wearing supportive shoes before running.
• Starting new activities by gradually increasing intensity, time, and speed.
• Eating a well-balanced and healthy diet with enough calories.
• Practicing strength training to prevent bone loss and early muscle fatigue.

Conclusion:

If you’ve recently been experiencing lower leg pain, it might be a symptom of either a shin splints or a stress fracture, or even both. The biggest difference between shin splints and stress fractures is the longevity and intensity of the pain. With stress fractures, pain is more localized to the bone, while with shin splints, the pain runs along the entire length of the tibia. Adopting preventive measures can help reduce the risk of both these overuse injuries

If you are still experiencing pain, reach out to an orthopedic surgeon for information on how to best manage and monitor your pain.

 

References:

1. Wilder RP, Sethi S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med 2004;23:55–81. https://doi.org/10.1016/S0278-5919(03)00085-1.
2. Sievers M. The Relationship Between Lower Extremity Range of Motion, Balance, and Single-leg Hop with Prior Incidence and Occurrence of Shin Splints in Collegiate Runners. Student Symp 2020.
3. Carr K, Sevetson E. How can you help athletes prevent and treat shin splints ? Aging (Albany NY) 2008;57:406–8.
4. Yong JR, Silder A, Montgomery KL, Fredericson M, Delp SL. Acute changes in foot strike pattern and cadence affect running parameters associated with tibial stress fractures. J Biomech 2018;76:1–7. https://doi.org/https://doi.org/10.1016/j.jbiomech.2018.05.017.
5. Baggaley M, Esposito M, Xu C, Unnikrishnan G, Reifman J, Edwards WB. Effects of load carriage on biomechanical variables associated with tibial stress fractures in running. Gait Posture 2020;77:190–4. https://doi.org/https://doi.org/10.1016/j.gaitpost.2020.01.009.

Milgrom C, Zloczower E, Fleischmann C, Spitzer E, Landau R, Bader T, et al. Medial tibial stress fracture diagnosis and treatment guidelines. J Sci Med Sport 2021;24:526–30. https://doi.org/https://doi.org/10.1016/j.jsams.2020.11.015