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Shin pain is very common in runners, military recruits and athletes in jumping sports. Most of it is shin splints (medial tibial stress syndrome), an overload of the bone and its lining along the inner shin. When overload continues, the bone can develop a stress reaction and then a stress fracture. Telling these apart early matters, because a few stress fractures, especially at the hip, can break completely if they are missed.2,4

At a glance

  • Shin splints: diffuse tenderness along the inner lower half of the shin, worse at the start of a run
  • Stress fracture: pain in one spot that you can point to with a finger, worse with each run, and sometimes at rest or at night
  • Groin pain that builds with running can be a femoral neck (hip) stress fracture and needs prompt evaluation
  • X-rays are often normal early; MRI shows the injury and its grade
  • Most heal with a period of reduced loading and a gradual return to running

Shin splints vs. stress fracture

Shin splints usually cause aching along a long stretch (more than about 5 cm) of the inner border of the shin bone. A stress fracture is more focal: one tender spot, often with swelling, and pain that comes on earlier in each run. Hopping on the leg typically hurts with a stress fracture. These injuries sit on a spectrum, and an MRI grading system developed in runners helps match the injury to the right recovery plan.1

Why it happens

Bone constantly repairs small amounts of damage from training. Problems start when load builds faster than bone can adapt.2 Common factors include:

  • A sudden jump in mileage, speed work, hills or a new hard surface
  • Higher body mass index and a greater drop of the arch (navicular drop) when standing3
  • Not eating enough to match training (low energy availability), which can affect hormones and bone health in both women and men5
  • Low vitamin D, previous stress fractures and, in women, missed or irregular periods
  • Running form and footwear, and weak calf and hip muscles

High-risk stress fractures

Some stress fractures heal reliably with rest; others are “high risk” because they can progress to a full break or heal poorly. Areas that need closer attention include:

  • The femoral neck (top of the thigh bone at the hip): groin pain with running. A delay in diagnosis can lead to displacement, which has much worse outcomes; caught early, results are good.4
  • The front of the tibia (anterior cortex), sometimes called the “dreaded black line” on X-ray
  • The navicular in the midfoot and the fifth metatarsal; see Jones fractures and foot fractures

Diagnosis

  1. A detailed training, diet and menstrual history, and an exam of the leg, foot and hip
  2. X-rays, which may be normal for the first few weeks
  3. MRI when a stress fracture is suspected or a high-risk site is involved
  4. For repeat stress fractures, blood tests (for example vitamin D) and, when appropriate, a bone density scan

Treatment

Shin splints are managed by reducing running to a pain-free level, cross-training (cycling, swimming, pool running) and a gradual return. Many treatments have been tried; no single one has strong evidence, so the focus is on load management and addressing risk factors.6

Low-risk stress fractures usually heal with relative rest, sometimes a walking boot or crutches, then a structured return to running over weeks. High-risk stress fractures may need strict non-weight bearing and, in some cases, surgical fixation. A femoral neck stress fracture on the tension (outer) side is usually fixed with screws.4

Returning to running

Return follows a walk-run progression once you are pain-free with daily activity and hopping. Changes that lower the load on the shin, such as a slightly higher step rate (“running softer”) and calf strengthening, are part of rehab and prevention.2

Frequently asked questions

Can I keep running with shin splints?

Often yes, at a reduced, pain-free level. Pain that gets worse during a run, a single tender spot, or pain at rest are reasons to stop and get checked for a stress fracture.

Do I need an MRI?

Not always for typical shin splints. An MRI is recommended when a stress fracture is suspected, at a high-risk site, or when you need to know how long to rest before returning to sport.

How long does a stress fracture take to heal?

Many low-risk tibial and metatarsal stress fractures allow a return to running in about 6 to 12 weeks. High-risk sites and higher-grade injuries take longer, and some need surgery.

Why do I keep getting stress fractures?

Repeat stress fractures often point to a bigger issue such as training errors, low energy availability, low vitamin D or low bone density. These are checked so the cycle can be broken.

Is groin pain when running serious?

It can be. Groin pain that builds with running may be a femoral neck stress fracture, which should be evaluated promptly. Stop running and get seen.

Shin or groin pain that is getting worse with running? Request an appointment online or call 469-850-0680. Our staff will contact you by phone and text within an hour of your request (during business hours, Monday–Friday, 8 am–5 pm). Walk-in visits are welcome Monday, Wednesday and Friday, 8:30–10:30 am at 6700 Dallas Parkway, Suite 100, Frisco, TX 75034. Same-day appointments available. Dr. Dold accepts most major insurance plans, including Medicare and Tricare. Please call 469-850-0680 to confirm your coverage.

Request an AppointmentCall 469-850-0680
Related pages

Research cited on this page

  1. Fredericson M, Bergman AG, Hoffman KL, Dillingham MS. Tibial stress reaction in runners: correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med. 1995;23(4):472-481. PubMed
    An MRI grading system for tibial stress injuries in runners matched symptoms and exam findings, helping guide rehab and return to running.
  2. Warden SJ, Davis IS, Fredericson M. Management and prevention of bone stress injuries in long-distance runners. J Orthop Sports Phys Ther. 2014;44(10):749-765. PubMed
    Bone stress injuries come from load outpacing bone adaptation; training design, running “softer” or with a higher step rate, and calf strengthening can reduce risk.
  3. Winkelmann ZK, Anderson D, Games KE, Eberman LE. Risk factors for medial tibial stress syndrome in active individuals: an evidence-based review. J Athl Train. 2016;51(12):1049-1052. PubMed
    Higher BMI, greater navicular (arch) drop, greater ankle plantar-flexion and hip external-rotation range were linked to shin splints.
  4. Robertson GA, Wood AM. Femoral neck stress fractures in sport: a current concepts review. Sports Med Int Open. 2017;1(2):E58-E68. PubMed
    Femoral neck stress fractures are rare but should be considered in any athlete with exercise-related hip pain; delayed diagnosis and displacement worsen outcomes, while early detection gives good return-to-sport results.
  5. Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073-1097. PubMed
    Low energy availability (not eating enough for the training load) causes a range of health and performance problems in both female and male athletes.
  6. Winters M, Eskes M, Weir A, et al. Treatment of medial tibial stress syndrome: a systematic review. Sports Med. 2013;43(12):1315-1333. PubMed
    No treatment for shin splints was supported by high-quality evidence; shockwave therapy showed the most promise.

Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Your own diagnosis and treatment plan depend on your exam and imaging.