What are shin splints?
Shin splints is the common name for pain along the inner edge of the tibia. The medical name is medial tibial stress syndrome, or MTSS. It comes on when the bone and the tissue around it get overloaded, and that is usually because training volume or intensity climbed faster than the body could adapt.
In rugby it turns up most in pre-season, when players go from doing very little to running high volumes on hard ground. It can affect any position.
What does it feel like?
- A dull, aching pain along the inner border of the shin, usually the middle to lower third
- Pain that starts during exercise and initially eases with warm-up, but worsens as the condition progresses
- Tenderness when pressing along a broad area of the shin (not a single pinpoint spot)
- Mild swelling along the inner shin in some cases
- Pain that eases with rest but returns when training resumes
Why does it happen?
Bone is living tissue and it rebuilds around what you ask of it. Load it gradually and it gets stronger. Load it faster than it can rebuild, or skip the recovery, and resorption outruns formation, which is the stress reaction you are feeling. The muscles and fascia attaching along the tibia add to it by pulling on the bone lining.
| Risk Factor | Why It Matters |
|---|---|
| Sudden increase in training volume | The most common cause. Pre-season spikes, extra fitness sessions, or coming back from a break too fast. |
| Hard playing surfaces | Artificial turf and firm ground increase impact forces through the lower leg |
| Foot mechanics | Flat feet, or overpronation, change how force travels through the tibia. A physiotherapist can assess this. |
| Previous history of MTSS | The single strongest predictor of future episodes |
| Low bone density | More relevant in female athletes and younger players, and nutrition plays into it. |
| Worn-out footwear | Boots and trainers lose shock absorption over time, so replace training shoes regularly. |
What will a physio do?
A sports physiotherapist will examine the lower leg to differentiate MTSS from other causes of shin pain (stress fracture, compartment syndrome, nerve entrapment). They will assess tenderness patterns, muscle flexibility, foot mechanics, and running gait. In some cases, imaging (MRI or bone scan) may be recommended to rule out a stress fracture.
Recovery and prevention
- Relative rest. Drop running volume to a pain-free level rather than stopping altogether, and your physio will help you find where that level sits.
- Cross-training on low-impact activities (cycling, swimming, pool running) to maintain fitness
- Gradual return to full training once pain-free, following a structured plan from your physio
- Calf and soleus strengthening, which is the part most people skip and the part that holds up over a season.
- Footwear assessment and possible orthotics if overpronation is identified
- Monitoring training loads across the season, especially during pre-season ramp-up periods