Posterior Shin Splints: Causes, Symptoms and Treatment

Posterior shin splints are a common cause of inner shin pain in runners and active people. Pain tracks along the inside rear border of your shin bone and often builds up with running, brisk walking or jumping.

If you ignore the early warning signs, posterior shin splints can progress to more serious problems, including tibial stress fractures.

This condition is also known as medial tibial stress syndrome. It involves the tibialis posterior and soleus muscles where they attach to the inner back of the tibia. These muscles control your foot arch and help absorb load every time your foot hits the ground.

Read more: Shin Pain

Why Do Posterior Shin Splints Occur?

Posterior shin splints usually develop when the tibialis posterior muscle and nearby tissues become overloaded. As these structures fatigue, they stop controlling the foot arch properly.

Your arch then collapses or rolls in too far, which increases strain along the inner shin. Over time this extra load irritates the bone surface and the soft tissues attached to it.

The result is a dull, nagging inner shin pain that may warm up slightly with activity, then return strongly afterwards.

How Do Posterior Shin Splints Develop?

Posterior shin pain usually arises from a mix of training errors, biomechanical issues and footwear problems.

• Training errors: Sudden spikes in running distance, speed, hills or hard surfaces place extra stress on the medial shin.
• Biomechanical issues: Overpronation, reduced ankle flexibility, weak calves or poor core and hip control increase tibial load.
• Footwear: Worn-out shoes, minimal cushioning or shoes that do not suit your foot type can aggravate symptoms.

These factors combine to create repeated micro-trauma in the muscles, periosteum and bone. Without enough recovery time, the shin becomes painful and irritated.

Read more: Shin Splints Overview

Who Gets Posterior Shin Splints?

Inner shin pain from medial tibial stress syndrome most often affects:

• Distance runners and sprinters.
• Jumpers and field sport athletes.
• People starting a new running program or rapidly increasing training load.
• Military and defence recruits who march and run with heavy loads.

People who stand or walk for long periods on hard floors may develop milder forms of medial shin discomfort.

Read more: Running Injuries

Symptoms of Posterior Shin Splints

Posterior shin splints cause a dull, aching pain along the inner rear border of the tibia. Pain usually:

• Starts during or after running, walking or jumping.
• Improves with rest but returns when you load the leg again.
• Covers a longer strip of bone rather than one small point.
• Feels worse the morning after heavy training or long runs.

As the condition worsens, pain can occur earlier in your run and linger into everyday activities. Ignoring the symptoms increases the risk of a tibial stress fracture.

Read more: Tibial Stress Fractures

How Are Posterior Shin Splints Diagnosed?

Your physiotherapist will diagnose posterior shin splints by taking a detailed history and examining your leg, foot and running style.

They will:

• Palpate the inner shin border to locate the sensitive area.
• Assess calf, foot and hip strength plus ankle flexibility.
• Review foot posture and your walking or running pattern.

In most people, imaging is not required. However, X-rays, bone scans or MRI may be recommended if your physiotherapist suspects a stress fracture or another cause of shin pain.

Read more: Physiotherapy Assessments

Posterior Shin Splints Treatment: 5 Key Phases

Best practice management for posterior shin splints follows a staged plan. Your physiotherapist will tailor each phase to your sport, goals and training history.

1. Calm the pain and protect the shin. Short-term rest from impact, ice, taping and activity modification reduce irritation. Your physio will help you maintain fitness with low-impact exercise such as cycling or deep-water running.
2. Restore ankle and calf mobility. Hands-on treatment, soft tissue techniques and targeted stretches help regain normal range of motion and reduce muscle tightness.
3. Normalise foot and leg biomechanics. Your physiotherapist will assess your running technique, foot posture and core control. They may recommend specific running cues, strengthening exercises or temporary orthotics to offload the inner shin.
4. Build calf and foot strength. Progressive strengthening of the calf, tibialis posterior and intrinsic foot muscles is essential to stop the problem returning.
5. Guide your graded return to running. A structured, step-by-step running program helps you return to sport without flare-ups. Your physio will adjust volume, pace and surfaces based on your symptoms.

Read more: Sports Injury Rehabilitation

New Research on Posterior Shin Pain

Recent research into medial tibial stress syndrome supports a conservative, exercise-based approach for most people. Studies highlight the importance of progressive loading programs, strength work and gait retraining to reduce recurrence risk.

Evidence also suggests that prefabricated orthotics can lower the incidence of medial shin pain in high-load groups such as military recruits. For stubborn cases, your healthcare team may review vitamin D and calcium status and address broader training and recovery habits.

One clinical summary of medial tibial stress syndrome management is available here: McClure CJ, Oh R. Medial Tibial Stress Syndrome. StatPearls. 2024.

What to Do Next?

Posterior shin splints respond best when you act early. If inner shin pain is limiting your running or sport, do not keep training through it and hope it settles on its own.

Book an assessment with a physiotherapist who regularly manages running-related leg pain. They can diagnose the cause of your shin pain, rule out stress fractures and design a clear treatment and return-to-sport plan.

Read more: Book an Appointment

Related Articles

1. Shin Pain – Common causes and treatments for shin pain, including medial tibial stress syndrome.
2. Shin Splints – How posterior shin pain differs from anterior shin splints.
3. Anterior Shin Splints – Symptoms and treatment for pain at the front of the shin.
4. Tibial Stress Fractures – When persistent shin pain progresses to bone injury.
5. Running Injuries – A guide to common running problems and prevention tips.
6. Foot Biomechanics – How foot posture and control influence shin and leg pain.
7. Sports Injury Rehabilitation – Structured rehab to get you back to sport safely.
8. Physiotherapy Assessments – What to expect at your initial physio consultation.
9. Sports Taping – How taping can support shin pain during rehab.
10. Orthotics – When arch supports may help prevent recurrences.
11. Shin Splints vs Stress Fractures – How to distinguish medial shin splints from stress fractures.

Posterior Shin Splints FAQs

1. What are posterior shin splints?
Posterior shin splints describe pain along the inner border of the shin bone, usually where the tibialis posterior and soleus muscles attach. It is a form of medial tibial stress syndrome often linked to running or jumping overload.

2. How long do posterior shin splints take to heal?
Most cases improve within four to eight weeks with load management, calf and foot strengthening and corrected training errors. More severe or long-standing cases can take several months to fully settle.

3. Can I keep running with posterior shin pain?
Some people can continue a reduced running program if pain is mild and settles quickly after exercise. If pain worsens, lingers into daily activities or becomes sharp and focal, stop impact loading and seek physiotherapy assessment to rule out a stress fracture.

4. How are posterior shin splints diagnosed?
A physiotherapist diagnoses posterior shin splints by assessing your history, palpating the inner shin border and testing calf, foot and hip strength and biomechanics. Imaging such as X-ray, ultrasound or MRI is reserved for suspected stress fracture or other pathology.

5. What is the best treatment for posterior shin splints?
Best practice treatment combines activity modification, progressive calf and foot strengthening, stretching where needed, footwear or orthotic changes and a graded return to running. Training on more shock-absorbing surfaces and managing load spikes reduce recurrence risk.

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References

1. McClure CJ, Oh R. Medial Tibial Stress Syndrome. StatPearls. 2024.
2. Newman P, Witchalls J, Waddington G, Adams R. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access J Sports Med. 2013;4:229-241. Published 2013 Nov 13. doi:10.2147/OAJSM.S39331