Why Shin Splints Keep Coming Back

Every spring I get some version of the same conversation. Someone signed up for a race back in January, built mileage steadily through February, and by March there’s a burning ache along the inside of the shin that shows up around mile two and lingers well after the run ends. They’ve usually already Googled it. They’ve usually already heard the explanation: too much, too soon.

That explanation isn’t wrong. It’s just incomplete enough to be useless as advice.

What shin splints are

The clinical name is medial tibial stress syndrome, and it describes pain along the inside border of the tibia caused by repetitive loading (1). It sits early on a continuum that ends, if ignored long enough, at an actual tibial stress fracture (1). A 2025 scoping review pulled together 37 studies on the condition and found it shows up most in athletes and military recruits, with recreational marathoners in one Indian cohort reporting prevalence above 69 percent (1). That’s not a rare or unusual injury. It’s one of the most common overuse complaints in anyone who runs regularly.

What causes it is where the research gets more specific than “overuse.” The consistently identified risk factors include excessive navicular drop, which means more collapse through the arch than the foot can control, restricted ankle dorsiflexion, and limited hip external rotation range of motion (2). A separate prospective study on runners diagnosed with MTSS found they also carried tighter iliotibial bands, greater rearfoot eversion during stance, and more pelvic drop on the opposite side compared to runners without the condition (2). None of that reads like a training log problem. It reads like a joint capacity problem that shows up under repetitive load.

Why ankle and hip mobility matter here

Here’s the mechanical chain. Every footstrike during running requires the ankle to dorsiflex under load as the body moves over the planted foot. If that range isn’t available, the load doesn’t disappear. It travels somewhere else in the chain. A controlled study using a step-down test found that people with lower ankle dorsiflexion range showed greater hip adduction and greater knee external rotation during the same loading task compared to people with more range (3). Restricted motion at one joint gets absorbed as compensatory motion at the next joint up, and the tibia sits right in the middle of that chain, between a foot that’s often overpronating and a hip that isn’t rotating enough to share the load.

This is the same logic behind why I look at ankle and hip mobility together in the trail and hiking population, where uneven terrain magnifies exactly this kind of compensation. If you want the deeper mechanism on that, I wrote about it in mobility for trail running and hiking. Road runners deal with a flatter version of the same problem, repeated thousands of times per run instead of hundreds.

The training load story is messier than the 10 percent rule suggests

The 10 percent rule gets repeated so often that people assume it has strong research behind it. A 2018 systematic review looked specifically for evidence connecting sudden changes in weekly training load to running injury and came back with a blunt conclusion: very limited evidence exists supporting that a sudden change in training load raises running injury risk at the weekly level (4). The rule isn’t nonsense, but it’s also not the settled science people treat it as.

A much larger 2025 study changes where the real signal seems to live. Researchers tracked 5,205 runners over 18 months using Garmin data, comparing week-to-week mileage changes against something more specific: how a single run’s distance compared to the runner’s longest run in the previous 30 days (5). The finding held up. Runs that exceeded that 30-day longest effort by more than 10 percent carried a meaningfully higher injury rate, and the risk climbed further as the spike got larger (5). Week-to-week totals didn’t show the same relationship. If you’re trying to protect your shins during a training block, the number worth watching isn’t last week’s total mileage. It’s how today’s run compares to the longest thing you’ve done in the past month.

What the research supports doing about it

Strength training has the strongest evidence base of any single intervention here. A 2014 meta-analysis of exercise-based injury prevention trials found overuse injuries were roughly cut in half in groups doing structured strength work compared to groups that didn’t (6). That’s not a mobility finding. It’s a tissue capacity finding, and it’s the reason I don’t treat calf and hip strength as separate from mobility work in a running program. Range you can’t load under stress isn’t range that protects you.

Cadence is a smaller lever but a real one. A controlled study on step rate manipulation found that runners who increased their cadence modestly without changing pace reduced loading at the hip and knee during the gait cycle (7). It’s a five to ten percent bump, not a wholesale gait rebuild, and it’s one of the few running-form changes that holds up outside of a single study.

On the mobility side, this is where CARs and end-range loading through the ankle and hip earn their place, not as a general warm-up ritual but as a way of restoring the specific ranges the research keeps flagging. I go into the joint-by-joint logic behind that approach in joint-by-joint training, and the broader running-specific version lives in strength training for runners in Austin.

Where this usually goes wrong

The mistake I see most is stacking generic fixes without knowing which one applies. Someone buys new shoes, adds a stretching routine, and cuts mileage all at once, then has no idea which change helped when the pain finally settles down. Ankle dorsiflexion restriction, hip rotation limits, training load spikes, and calf strength deficits produce the same symptom through different mechanisms, and they don’t all respond to the same fix. That’s the argument for getting your ankle and hip range measured directly instead of guessing from a list of symptoms, which is what the Functional Range Assessment is built to do.

Related ground worth reading if this is a recurring problem for you: IT band pain in runners covers a lot of the same lateral chain compensation from a different angle. If you’re in Austin and want your ankle and hip range measured before you guess at a fix, schedule with us.

References

1. Saad MA, Jamal JM, Aldhafiri AT, Alkandari SA. Medial tibial stress syndrome: a scoping review of epidemiology, biomechanics, and risk factors. Cureus. 2025;17(3):e81463.
2. Medial Tibial Stress Syndrome. StatPearls [Internet]. NCBI Bookshelf. Updated 2025.
3. Rabin A, Portnoy S, Kozol Z. The association of ankle dorsiflexion range of motion with hip and knee kinematics during the lateral step-down test. J Orthop Sports Phys Ther. 2016;46(11):1002-1009.
4. Damsted C, Glad S, Nielsen RO, Sørensen H, Malisoux L. Is there evidence for an association between changes in training load and running-related injuries? A systematic review. Int J Sports Phys Ther. 2018;13(6):931-942.
5. Frandsen JSB, Hulme A, Parner ET, et al. How much running is too much? Identifying high-risk running sessions in a 5200-person cohort study. Br J Sports Med. 2025;59(17):1203-1210.
6. Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2014;48(11):871-877.
7. Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB. Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc. 2011;43(2):296-302.

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