Shin Splints Versus Stress Fracture: How to Tell the Difference

You’re completing your morning run when you suddenly feel pain in the lower part of your leg. You try to tough it out, but the pain isn’t going away. Is it just a shin splint—or could it be a stress fracture?

Both tend to happen to active people, and often, they share the same symptoms. But there are a few telltale signs you can use to know the difference.

Here, HSS primary sports medicine physicians Jaclyn McKenna, MD, and Ashley V. Austin, MD, unpack the facts about both types of injuries and how you can prevent and treat them.

Shin splints and stress fractures: What are they?

A shin splint is one of the more common lower leg injuries in runners, treated about 3 million times each year in the United States. Stress fractures are less common, comprising between 1% to 7% of all athletic injuries.

“A shin splint is almost always an overuse problem,” Dr. Austin says. “It’s caused by inflammation where muscles of the leg meet the bone due to the repetitive stress of activities like running or jumping.” In contrast, a stress fracture is a break or crack in the bone. Stress fractures in runners are most common in the foot, ankle and lower leg.

Causes of shin splints and stress fractures

One reason it’s difficult to tell shin splints and stress fractures apart is because they share many similar causes. Both types of injuries may occur when you:

• ramp up your exercise routine too quickly following a break
• increase the intensity of exercise too fast during a workout
• elevate your exercise regimen while preparing for a marathon or other high-impact event

What makes stress fractures unique is that they can also be caused by bone density conditions such as osteoporosis.

Additionally, “women are about two to three times more likely to suffer a stress fracture than men,” Dr. McKenna says. “That’s because women’s bone health tends to peak in their early 20s, and they lose bone density faster than men, especially as they approach and go through menopause.” As your bones weaken, you can develop a stress fracture even from normal daily activities, such as walking up stairs.

What do shin splints and stress fractures feel like?

It can be difficult to differentiate between the two types of injuries, because pain and tenderness are the main symptoms of both shin splints and stress fractures. However, the type of pain associated with each is different.

People with stress fractures will feel pain in a specific area of their leg, foot or ankle (where the break has occurred). Often, that area will be tender to the touch. Stress fracture pain is reproducible, which means that it continues to occur, and doesn’t improve with continued exercise.

With a shin splint, pain tends to radiate across a larger area, often inside or outside the entire length of the lower leg. Sometimes, pain from a shin splint will improve during exercise.

When to see a doctor for shin splints or stress fractures

Because stress fractures and shin splints share many commonalities, getting an accurate diagnosis is critical. Red flags that indicate it’s time to see a sports medicine provider include:

• pain that doesn’t improve following rest and a slow progression back to activity
• experiencing pain while at rest or only in a localized area
• tenderness over the tibia (shin) bone

Failing to seek prompt treatment for a stress fracture can lead to long-term problems, says Dr. McKenna. “It’s common to see people try to work through the pain or not take the appropriate amount of rest,” she says. “When this happens, the injury can worsen. In more severe cases, pushing through the pain related to a bone stress injury can lead to a stress fracture that may require surgery.”

Treatment for shin splints and stress fractures

The first treatment for both injuries is RICE—rest, ice, compression and elevation. Subsequent treatments may include:

• Additional rest or immobilization. For shin splints, people should take a break from high-impact activities for at least one to two weeks. In the case of a stress fracture, supportive devices such as a walking boot may be prescribed to offload the pressure on the affected leg.
• Changing your daily activities. You may, for example, choose to use public transit for a few weeks instead of walking to work, or choose to take the elevators instead of the stairs.
• Addressing the root causes of your injuries. This can include having a doctor or physical therapist evaluate your running mechanics, choosing more supportive footwear, or taking steps to improve bone density conditions.

Shin splints will not require surgery, but some stress fractures might. Whether they do depends on their location and the blood flow surrounding the impacted area.

Preventing shin splints and stress fractures

Whether or not you’ve experienced a shin splint or a stress fracture, you can reduce your risk of future problems. A few best practices:

• Consult with a doctor or physical therapist when starting a new training regimen.
• Cross-train. For example, mix running with swimming or resistance training to limit repetitive loads on your bones and joints.
• Watch your diet. Eat a high-protein diet. Consider calcium or vitamin D supplements if needed for bone health.