Shin Splints (MTSS) vs Stress Fracture: How to Tell & What To Do

Q: How can I tell MTSS from a stress fracture?

MTSS pain is diffuse along the inner shin (> 5 cm) and may ease as you warm up; stress fracture pain is sharply focal (< 2 cm), worsens with loading, and can persist at rest/night. If in doubt, stop impact and get assessed.

Q: Do I need a scan?

Suspected stress fracture often requires imaging. Early X-rays can miss it; MRI is more sensitive. MTSS is usually a clinical diagnosis.

Q: Can I keep running with shin splints?

Often yes—on flat routes, with reduced volume/pace, keeping pain ≤ 2/10 and settling within 24 hours. If symptoms don’t settle, reduce further and seek help.

Q: How long until I can run after a stress fracture?

It varies by site/severity. Many runners need several weeks of off-loading before walk-run. Your clinician will guide the timeline.

Q: Do compression sleeves help?

They can feel supportive for MTSS, but strength, load management, and gait tweaks are the priorities.

Medial shin pain is common in runners—but not all shin pain is the same. The two big culprits are medial tibial stress syndrome (MTSS, “shin splints”) and tibial stress fracture. Knowing the difference matters: one typically responds to load management and strength work; the other needs impact off-loading and medical oversight. At The Recovery Room (Southampton & Romsey), we help you identify the cause, calm symptoms, and return to confident running with a clear plan.

Quick Distinctions: MTSS vs Tibial Stress Fracture

Pain location
- MTSS: diffuse, along the inner (medial) shin, often > 5 cm in length
- Stress fracture: focal “finger-tip” spot (< 2 cm), very tender to press
Behaviour
- MTSS: aches at the start, may ease as you warm up, then returns later
- Stress fracture: worsens with loading, can persist after, sometimes night/rest pain
Hop test
- MTSS: uncomfortable but often tolerable
- Stress fracture: sharp/focal pain—don’t keep testing if suspicious
Swelling
- MTSS: usually none
- Stress fracture: may have local swelling/thickening over the tender spot

If your pain is focal, worsening, or present at rest/night—treat it as a potential stress fracture until proven otherwise.

First 72 Hours: What To Do

If it’s likely MTSS (shin splints)

Modify load: switch to flat routes; reduce volume and pace; avoid back-to-back hard days
Cross-train: bike/elliptical/deep-water running to keep fitness
Self-care: compression sleeves can feel helpful; ice/heat as preferred; OTC analgesia per pharmacist/GP advice
Start gentle loading: pain-guided calf/soleus and foot intrinsic work (see below)

If you suspect a stress fracture

Stop impact now: avoid running and hopping
Off-load: walking only if pain-free; boot/crutches if advised by a clinician
Seek assessment: sports medicine/GP; early X-rays can be negative—MRI is more sensitive
Don’t “test it” repeatedly: repeated hops/jogs can worsen the injury

Why These Happen

Training spikes: rapid jumps in weekly mileage, hills, or speed
Load deficits: weaker calf/soleus or hip control; low ankle mobility
Gait factors: overstriding and low cadence increasing tibial load
Surfaces & shoes: cambered roads, abrupt shoe changes, worn soles
Recovery & energy: poor sleep, high stress, low energy availability

Our Clinic Approach

1) Assessment

Detailed training review (volume, intensity, terrain, footwear rotation)
Palpation to map pain area (diffuse vs focal) and simple loading screens
Strength tests (calf/soleus, hips), ankle mobility, single-leg control
Gait analysis: cadence, stride length, step width, posture
Risk screen for bone stress (training history, nutrition, menstrual history/RED-S risk where relevant)

2) Treatment & Rehab

For MTSS: progressive calf/soleus & tibialis posterior loading, foot intrinsic work, gait cues (cadence +5–7%), training structure, and terrain management
For stress fracture: impact off-loading, graded re-loading after clinical clearance, then the same capacity build (strength, mobility, gait) to reduce recurrence
Adjuncts: manual therapy for comfort, taping/strapping short term; footwear and surface advice; consider orthoses only if clearly beneficial during loading

Home Exercise Progression (MTSS Guide)

Progress when pain ≤ 2/10 during and settles within 24 hours.

Isometrics: wall sit 5 × 30–45s; calf isometric holds (bent- and straight-knee) 5 × 30–45s, daily
Calf raises: bilateral → single-leg, 3–4 × 10–12, slow tempo, 3–4×/week
Tibialis posterior loading: seated/standing resisted foot inversion, 3 × 12–15, 3×/week
Foot intrinsics: short-foot holds & toe yoga, 3 × 6–8 slow reps, daily
Plyometric prep (when settled): pogos/hops low volume, 2×/week

Return-to-Running Plans

For MTSS (example)

Start when brisk 30-min walk is pain-free and hopping is tolerable.

Week 1: Walk 4 min / Run 1 min × 6 (flat, 3 sessions)
Week 2: Walk 3 / Run 2 × 6
Week 3: Walk 2 / Run 3 × 6
Week 4: Continuous easy run 20–30 min
Week 5: Add gentle strides; keep strength 2×/week
Week 6+: Reintroduce hills or tempo—one variable at a time

For Stress Fracture (example—after medical clearance)

Only begin after pain-free walking and hopping, and your clinician confirms healing.

Phase 1 (impact-free): bike/elliptical/pool + strength 2–3×/week
Phase 2 (walk-run): start at Walk 4 / Run 1 × 6 on flat; progress weekly as symptoms allow
Phase 3 (continuous): 20–30 min easy; then gradually re-add volume, then speed, then hills

Prevention & Long-Term Care

Increase weekly load gradually (~10% average), schedule deloads
Strength for calves/soleus & hips 2×/week during training blocks
Small cadence increase (5–7%) if you overstride
Rotate shoes; replace around 500–800 km depending on wear
Prioritise sleep and adequate energy/protein to support bone & tendon

Book a Shin Pain Assessment

Initial assessment and treatment from £49. Clinics in Southampton & Romsey with early and evening appointments.

Call: 07748 483639
Email: enquiries@the-recovery-room.co.uk
Online bookings: the-recovery-room.co.uk

FAQs

How can I tell MTSS from a stress fracture?