Periostitis – the medical term is shin splints or medial tibial stress syndrome – is one of the most common overuse injuries among runners. Many affected athletes initially dismiss the early symptoms as harmless and continue training until the pain becomes so severe that running is hardly possible. How it develops, what the warning signs are, and what helps.
Expert:
Dr. med. Rubén Oliver, Head of Sports Medicine, Medbase Wetzikon
Specialist in General Internal Medicine (FMH), Sports Medicine (SEMS), Manual Medicine (SAMM)
Periostitis While Running: What’s Behind It
If your shin keeps hurting, it is often what’s commonly known as shin splints, or medically more precisely: medial tibial stress syndrome. This overuse injury affects the tissue surrounding the shinbone. Tendon attachments and connective tissue become irritated, and repeated or improper loading can lead to pain. The onset is usually gradual, and symptoms increase until training load is significantly reduced or further measures are taken.
Typical symptoms include burning or stabbing pain on one or both sides along the inner edge of the lower leg, usually in the lower half. Sometimes the front of the shin is affected as well. At first, the pain appears shortly after starting a run, eases somewhat during exercise, and then returns the next morning or at the beginning of the next training session.
Why Runners Are Particularly Affected
The causes of medial tibial stress syndrome are varied. In most cases, several factors contribute to overload — for example, when running volume or intensity is increased too quickly. Inappropriate footwear can also play a role: shoes with overly soft midsoles, heavily worn-out shoes, or shoes that lack sufficient stability. Biomechanical issues such as overpronation (excessive inward rolling of the foot on landing), flat or splayed feet, or weak calf muscles may also contribute. Frequent training on hard surfaces such as asphalt or tartan tracks, running on slanted terrain, or excessive downhill running can further increase strain. Tight foot flexors and insufficient calcium intake are additional risk factors.
Warning Signs
Periosteal irritation rarely occurs completely suddenly. It typically develops gradually. You should take the following warning signs seriously:
- Recurrent burning pain in the lower leg shortly after starting training
- Symptoms that ease somewhat during exercise but return later in the day or the next morning
- Marked tenderness along the shinbone
If pain returns during training or persists after the session and remains noticeable in daily life, you should take at least a one-week break. If symptoms worsen during exercise to the point that you have to stop, this indicates inflammation in the tissue. In that case, you should take a break of at least two weeks — otherwise, symptoms are very likely to recur.
What to Do at the First Signs
Early symptoms can often be relieved with simple measures, helping to prevent worsening.
If pain persists during a workout, stop the session and walk home or switch to walking. Cooling the painful area and applying anti-inflammatory ointments can be helpful. You can also gently massage the soft tissue around the shin with your fingers to relieve tension.
Once acute symptoms have subsided, begin stabilizing exercises — such as single-leg stands or barefoot running on soft surfaces. Specific foot-strengthening exercises can help strengthen the foot and lower leg muscles and improve stability.
In addition, reduce your training volume by about 50% and temporarily avoid interval training, downhill running, and plyometric exercises.
What If Shin Splints Are More Advanced?
If symptoms persist or repeatedly return, a break of several weeks is necessary. This does not mean you must stop endurance training altogether. Instead, switch to low-impact activities such as cycling or swimming.
The key is choosing endurance sports that do not involve impact loading — for example, aqua jogging with a flotation vest.
Additional measures may include:
- Accompanying physiotherapy
- Treatment of the lower leg muscles and surrounding soft tissue
- Trigger point therapy
- Focused shockwave therapy
- Stretching exercises to reduce tension in the shins
Orthopedic insoles or taping can provide additional support and help accelerate the return to running.
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The Way Back to Running
When returning to running, it is essential to start slowly and increase load gradually:
- Begin with short, slow jogging sessions — no interval training and no fast pace changes
- Take at least one rest day between sessions at the beginning
- Train on softer surfaces such as forest trails instead of asphalt to reduce impact
- Increase volume and distance gradually — several short sessions are better than aiming for long distances too quickly
- Wear stable running shoes and everyday shoes that provide sufficient support
- Continue regular foot-strengthening exercises to build lower leg strength and improve stability
These same basic principles also help with general prevention and reduce the risk of other overuse injuries. A key factor: include variety in your training. That means not only running, but incorporating alternative endurance sports from the very beginning.
Conclusion
Periostitis is not an unavoidable side effect of running. It usually results from a combination of training errors, inappropriate footwear, and biomechanical overload. If you take early warning signs seriously, build your training plan carefully, and include stabilizing exercises to strengthen your lower legs, you can prevent these common complaints — especially when starting or intensifying running training — and enjoy running pain-free from the outset.
Who Is Medbase?
Medbase is the largest multidisciplinary sports medicine network in Switzerland. It provides specialized sports medical services for athletes, clubs, and sports federations of all activity levels in the fields of sports medicine, sports physiotherapy, performance diagnostics, and training consultation.