Shin Splints or a Stress Fracture? How To Tell

If you’re an athlete and your shins begin to hurt, you might think it’s “just” shin splints, keep right on with your running program and try to train through the pain.

But that pain between your knees and your ankle could be a stress fracture.

Whether your shin pain is due to shin splints or a stress fracture, it’s important not to keep training the same way through either injury. You can take steps to heal and avoid making the injury worse or getting it again later.

Different Conditions With a Common Cause

Shin splints happen when the muscles, tendons and bone tissue around your shin bone – the tibia – become inflamed. They are a common problem for runners, gymnasts and dancers.

Stress fractures are tiny cracks in the bone. They also are a common problem for runners, gymnasts or dancers and athletes in high-impact sports such as track and field, basketball or tennis.

While they are different medical conditions, shin splints and stress fractures share the same causes: an overload problem, says Laura Goldberg, MD, a pediatric sports medicine specialist with UH Sports Medicine.

Shin splints and stress fractures happen when you overtax your leg muscles, tendons or shin bone through a sudden increase in training.

“One of the most common causes is a sudden increase in weight-bearing exercise,” Dr. Goldberg says. “A runner may be progressing with running, but has added other weight-bearing activities such as plyometrics and is not allowing enough recovery time.”

If a patient mentions shin pain, one of the first things she asks her patients is to review their workout log. Dr. Goldberg recommends athletes keep a training log, which can help to identify training errors or pinpoint problems.

“The history really clues me in,” she says. “Sometimes people don’t realize how much they are doing or how much they are increasing.”

How To Tell Shin Splints From a Stress Fracture

How to tell these two conditions apart? With a stress fracture, the pain gets worse as you run and persists in a smaller location after you run, Dr. Goldberg says.

With shin splints, pain often occurs over a broad area, although it may be localized, affecting a small area. The pain usually lessens after you warm up, Dr. Goldberg says. In addition, shin splint pain may be more tolerable than pain from a stress fracture.

If you develop shin splints, avoid activities that cause pain, swelling or discomfort, but don’t stop all physical activity. It’s better to switch to low-impact exercises such as swimming, cycling or water running until you heal, she says. The pain will lessen over time as you get stronger.

You can treat shin splints at home by applying ice packs to the painful area for 15 to 20 minutes at a time, four to eight times a day for several days. You also can take an over-the-counter pain reliever such as ibuprofen (such as Advil or Motrin), naproxen (such as Aleve) or acetaminophen (such as Tylenol).

To avoid shin splints, make sure you’re wearing the right shoes for your foot and ones that are not too well-used.

“A lot of people try to treat it themselves, but it if recurs, it needs evaluation,” she says.

Why It's Important to Get Medical Care for Shin Pain

Stress fractures are the most serious of all running injuries.

Many runners will wave off shin pain and continue to train, Dr. Goldberg says. This is dangerous with stress fractures, however, because your bones can’t repair themselves while you’re increasing the duration, intensity or frequency of your training.

“Any pain that persists after you rest should be evaluated by a sports medicine specialist, and anything that causes you to limp should be evaluated,” she says. “If you’re limping, you shouldn’t be running.”

A stress fracture can cause chronic problems if not allowed to heal properly. Also, if the underlying causes of your stress fracture are not taken care of, you may be at higher risk for more stress fractures.

“The biggest thing with a stress fracture is that it’s an imbalance. Your body can’t keep up with the training and the healing process,” she says. “At some point, the damage from training gets ahead of the healing.”

Stress fractures won’t go away without some modification to your training routine, Dr. Goldberg says.

What to Expect From Treatment for Shin Pain

If you are diagnosed with a stress fracture, your sports medicine specialist may recommend wearing a walking boot, brace or crutches.

A sports medicine specialist can help design a training routine that will keep you moving but allow you to heal, too. A sports medicine specialist will consider your overall load, maintain your cardio and keep building strength. Your training routine may be modified to include cross-training and low-impact activities, such as low-gravity treadmills, ellipticals, pool running or cycling.

The sports medicine specialist also will look for an underlying cause, which might be a gait abnormality or a bone problem, to pinpoint how and why it’s happening.

“You may be out from running from four to six weeks,” Dr. Goldberg says, “but when you return, you’ll be ready for running.”

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The Sports Medicine program at University Hospitals provides specialized, integrated services for the diagnosis and treatment of conditions that affect athletes of all ages and abilities. Learn more about what UH Sports Medicine can do for you.