Is it Shin Splints or a Stress Fracture?

Is it Shin Splints or a Stress Fracture?

Shin splints and stress fractures are two of the most common running injuries.  Unfortunately, if you are a runner dealing with lower leg pain, it can be difficult to determine which condition is plaguing you.  Shin splints and stress fractures have many similar characteristics, but there are some key differences between the two injuries.  Making the correct diagnosis is important for proper treatment and future injury prevention, so let’s take an in-depth look at both conditions.     


Stress fractures are literally tiny cracks in the bones that cause pain and tenderness.  They can occur in any bone, but for this article, we are most concerned with stress fractures of the lower legs since these are the fractures most often confused with shin splints.  In the early stages of a stress fracture, runners usually recognize minor tenderness with activity that improves with rest.  The tenderness is typically very localized and most runners can pinpoint the exact spot on the limb that hurts.  

Shin splints also cause pain and tenderness, but the pain tends to be more  of a radiating pain that runs along the length of the affected bone and muscles.  Some runners describe shin splint pain as a tight, achy pain, while stress fracture pain is usually described as a deep, throbbing pain.  Also, shin splints should not cause pain while walking or hopping.  In fact, sometimes runners with shin splints only notice sharp pain while running fast.  Stress fractures cause pain while running at any speed.  Runners with stress fractures might also notice pain while walking and hopping.    

is it shin splints or a stress fracture


Stress fractures are a type of overuse injury, resulting from cumulative strain on the bone over time.  According to the Mayo Clinic, if your bones are subjected to repetitive force without enough time for recovery, your body will reabsorb bone cells faster than it can replace them.  This imbalance results in weak bones that are susceptible to tiny cracks, or stress fractures.  Runners who over-train and runners who have high or low arches tend to be at an increased risk for developing stress fractures.  Additionally, women tend to have stress fractures more often than men, probably due to nutritional deficits, inadequate caloric intake, and low estrogen levels – all factors which impact bone health and density.

Shin splints are also a type of overuse injury.  The pain associated with shin splints is caused by small tears and inflammation in the muscles surrounding the tibia, or shin bone.  The muscles become torn and inflamed when runners do too much too soon, so the condition is very common among new runners, runners returning to training after extended break periods, and regular runners who rapidly increase mileage and training intensity.  High and low arches are also a risk factor for shin splints and wearing old shoes with insufficient support can also contribute to the development of the condition.

Treatment and Prevention

Stress fractures and shin splints can be differentiated most clearly by diagnostic imaging.  A bone scan is the most common test used to make the distinction. Scans will show a small, focused area of intense increased dye uptake if the patient has a stress fracture.  Shin splints, on the other hand, would demonstrate a less intense, elongated area of increased dye uptake.

In the case of a stress fracture, you must stop running completely in order to allow your body to heal.  Plan on 8-16 weeks of absolutely no running.  If you do not take the time off, or if you resume running too quickly, more severe stress fractures can occur and the fracture might never heal properly or completely.  After taking the required time off, you can slowly and carefully resume running.  It is important to build your mileage gradually and incorporate strength training into your routine to improve muscle strength and bone support.  Also, be sure to eat an appropriate amount of calories and eat a well-balanced diet.  Good nutrition and bone health go hand-in-hand.  If you have high or low arches, consider arch supports.

Shin splints are a bit less clear-cut when it comes to treatment.  Sometimes runners can continue to train at a lower level of intensity while incorporating stretching, strength training, ice, and anti-inflammatory medications.  In other cases, several weeks of rest is needed to allow the pain and tenderness to completely resolve.  You should not run through pain, so if running (even slow running) hurts, stop and rest.  When you do resume running, do so slowly and gradually.  A good rule of thumb is to increase your training by no more than 10% per week.  Arch supports and supportive running shoes are important in the prevention of shin splints, too.

Hopefully this overview has been helpful for differentiating between shin splints and stress fractures.  If you are a runner with lower leg pain, take the time to understand these two conditions and discern the appropriate course of action for your injury.  Contact us to learn more about shin splints, stress fractures, and other common running injuries.