I am an older man who recently developed a debilitating—and agonizing—shin splint after I increased my daily steps in a good-faith effort to improve my health. What did I do wrong?

You probably overdid it—or maybe you just wore the wrong shoes. Medically called medial tibial stress syndrome (MTSS), shin splints are common, affecting up to 20 percent of runners, according to some estimates. But you don’t have to be a runner to develop them—just about anyone can, due to a variety of risk factors.

Shin splint pain typically occurs on the inside (medial) surface of one of the two lower leg bones known as the tibia, or shin bone, and it usually happens during or soon after the activity.

Shin splints often occur because your level of activity—whether the distance, frequency, or intensity—changes suddenly. Walking or running on hills when you usually go on flat ground, for example, can cause them, as can walking or running for longer periods or more frequently than usual.

A 2018 study in Medicine & Science in Sports & Exercise followed 24 young cross-country runners for two years to determine what factors were associated with shin splints. Among those identified were weakness in certain muscles (such as some of the gluteal muscles referred to as hip abductors), tightness of the iliotibial band (the thick band of connective tissue running down the lateral side of the leg), and biomechanical factors involving the foot and pelvis.

An earlier review paper in the Journal of Athletic Training identified more than a hundred risk factors for developing shin splints across 21 studies. The most significant ones were a high BMI (body mass index), a foot arch that collapses excessively when hitting the ground (so that the foot becomes quite flat), and greater ankle and hip flexibility. A higher BMI—which reflects both body weight and height—may contribute to shin splints because greater weight relative to height puts extra stress on the tibia.

You can also develop shin splints by running on hard surfaces or simply by wearing worn-out or improperly fitting shoes.

As an older person, are you more susceptible to developing shin splints? We couldn’t find any studies showing that, but it’s well documented that aging is associated with a decrease in muscle function and mass—a phenomenon known as sarcopenia. And, as noted, weak muscles may set the stage for shin splints if you’re doing too much exercise too quickly.

What’s the underlying mechanism? Shin splints have long been thought to be an inflammation of the tissue surrounding the bone, called periostitis. More recent thinking additionally attributes them to injury to the bone itself.

Here’s what happens: When you engage in weight-bearing exercise, the tibia responds to this stress by adapting through tiny bone injuries—a process called microdamage or microtrauma, which stimulates bone remodeling and growth. This is beneficial when the bone has enough time to repair and strengthen. But with repeated stress or overloading—especially when risk factors are present—the bone can’t repair itself fast enough, resulting in shin splints.

The key to treatment is to rest and ice the affected leg—and then modify your activity by substituting non-weight-bearing exercise, such as swimming or cycling, while the shin splint heals. Over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs, like ibuprofen and naproxen) may also help. There’s no set recommendation for how much rest is needed or for how long, but it typically takes about a month to fully recover; more severe shin splints without proper rest and icing can last several months.

To avoid recurrence, you’ll need to know what triggered the shin splints. In general, always start new exercise routines gradually—don’t do too much too soon. And, of course, make sure your athletic shoes are up to par.

If you’re a runner, a 2025 study in Biomechanics found that small modifications—increasing your running cadence (the number of steps you take per minute) by about 10 percent, reducing your pace a bit, or transitioning to a mid- or fore-foot strike pattern—can significantly reduce tibial stress and so may help prevent recurrence. But it may not be so simple to do this on your own; you may need professional guidance.

If you’re not sure what set off your shin splint, it can be a good idea to see a skilled physical therapist, who can assess whether you have muscle weakness or tightness, or any biomechanical issues that may be increasing your risk—and may recommend shoe insoles on a trial-and-error basis if overpronation is contributing to the problem. The physical therapist can also evaluate your exercise routine to identify what might be provoking shin pain and help you modify it (including tweaking your running form if you’re a runner). Physical therapists who work with athletes or dancers are a good choice because they see a lot of patients with shin splints.

A final note: It’s often difficult to distinguish between MTSS and a tibial stress fracture just by signs and symptoms alone. They both present with pain, but in some stress fractures, the pain is very localized and may be accompanied by swelling, as opposed to shin splints, where the pain is more diffuse along the inner edge of the shin. The only way to know for sure is with an X-ray or MRI. If your pain worsens despite resting and taking other self-care steps, you should see your healthcare provider for a proper diagnosis.