Shin splints and stress fractures may look and feel almost the same, but they are two different medical conditions. Shin splints are more tolerable and considered less severe than stress fractures.
A shin splint results from inflammation of the tissues attached to the tibia due to excessive stress. The pain in shin splints affects a large area of the inner side of the shin bone. The pain is also less intense than a stress fracture and usually decreases after a warm-up exercise. Often, an individual experiences little or no pain when at rest or during low-impact exercises such as walking, but the pain intensifies during high-load exercises.
In stress fractures, radiographic images of the shin bone will expose tiny breaks and cracks. The pain from a stress fracture is more extreme and can be felt even while at rest.
It may be difficult to determine if you have shin splints or a stress fracture, as both are characterized by pain and swelling along the shinbone. However, one key difference is that with a stress fracture, the pain is localized to a specific location of the leg and will likely get worse with more physical activity.
By contrast, the pain from shin splints often covers a slightly larger area and may improve slightly after warming up. Although pain is relative to each individual, shin splint pain tends to be more tolerable than pain from a stress fracture.
In stress fractures, radiographic images of the shin bone will expose tiny breaks and cracks. The pain from a stress fracture is more extreme and can be felt even while at rest. In stress fractures, the pain is also usually limited to a small area. It is also likely to increase during weight-bearing activities even when performing low-impact exercises.
Table 1: Difference Between Shin Splints and Stress Fractures
|Parameters||Shin splints||Stress Fractures|
|Pattern of Pain||Diffuse (inner side of the shin bone)||Localized|
Swelling may be present
|Intensity of Pain||Low||Severe|
|Effects of Activities||No pain after low impact activities|
Pain improves after stretching
|Pain consistently present|
Worsens after low impact activities
|Pain at rest||Absent||Present|
|X-ray Findings||Normal||Fracture line seen|
What are Shin Splints?
Shin splints, also known as medial tibial stress syndrome, refer to an inflammation of the muscles, tendons, and tissues that surround the shinbone (tibia), which is accompanied by pain in the front of the lower leg.
Shin splints are a common exercise-related condition caused by repeated strain on the shinbone and its surrounding connective bone tissues (periosteum). 
Individuals with shin splints often experience pain, mild swelling, tenderness, and soreness along the border of the shinbone during or after physical activity.
Shin splints commonly occur after running or doing vigorous exercise. Individuals who have just started a fitness program, suddenly changed the intensity of their exercise or routine, or increased their weight-bearing exercise are likely to experience shin splints. The abrupt load on the muscles and surrounding tissues results in overwork leading to pain and inflammation. 
What is a Stress Fracture?
Small cracks or breaks in the tibia caused by high-impact and repetitive activities characterize a stress fracture. The leg creates force when it pushes off the ground and propels the body forward, which results in an equal amount of reaction force placed on the leg by the ground.
The tissues on the joints and muscles of the leg absorb this force, which prevents the bone from receiving too much stress. If the muscles are already overworked or there is poor mechanics and malalignment, too much stress is received by the bone, making it weak and brittle, resulting in stress fractures.
Stress fractures are ultimately the outcome of untreated shin splints. Frequent overtraining and increased workload strain the shin bone. Without adequate time for rest and healing, the shin bone weakens, making it vulnerable to breaks.
While this type of injury is most common in long-distance runners and military recruits who carry weight backpacks long distances, anyone who endures repetitive force to the legs can develop a stress fracture.
Are shin splints or stress fractures more serious?
Stress fractures are frequently considered to be more serious than shin splints. While both injuries can have similar causes and symptoms, shin splints can often resolve on their own with conservative treatment, whereas stress fractures usually require more serious treatment and rehabilitation. Regardless, both injuries should be taken seriously and treated appropriately.
Do shin splints heal faster than a stress fracture?
Barring complications, shin splints typically heal between two to six weeks, whereas a stress fracture requires roughly six to eight weeks to recover. 
Should I visit a doctor if I suspect shin splints or a stress fracture?
If you are experiencing mild pain in your shinbone, it may be useful to consider the possible causes for injury. You should also begin to rest your leg immediately and begin conservative treatment.
If your symptoms do not improve within a week or if they worsen, you should seek medical attention. The common signs of an injury or infection are redness, swelling, and pain.
Can you make shin splints and stress fractures worse?
Absolutely. Both injuries can become more serious without proper treatment. Without adequate time to recover, shin splints can worsen in both pain and severity and may even progress to a stress fracture. 
Stress fractures can also become more painful and severe if the cracks in the bone become deeper or wider. In both cases, the recovery process will be longer and the risk of reinjury will be higher.
Normally, in response to mechanical load, your bone undergoes a gradual remodeling process, with an equal amount of bone resorption and formation. When your bones sustain an unusually large force, like from a sudden increase in intensity of physical activity, it will reabsorb cells more quickly than it can rebuild them.
As a result, your bones are much more susceptible to stress fractures. At first, cracks in the bone may be very small, causing a mild pain in the front of the leg, but as the cracks widen, the pain will likely become more severe. The pain may also be accompanied by tenderness and swelling around the injured area. 
Can stress fractures feel like shin splints?
Although pain and tenderness in shin splints are usually in a broader area of the shin bone, an individual can also feel shin splint pain in a small, localized area like stress fractures. However, the pain is more significant in stress fractures than shin splints.
Resting the affected leg and minimizing the intensity of exercise can decrease the pain from shin splints. Stretching and warm-up exercises may also relieve shin splint pain. In stress fractures, exercise aggravates the pain. It also continues even at rest and during exercises with minimal load.
How can I only get shin splints in one leg?
Shin splints occur when the muscles, tendons, and connective tissues that surround the shinbone are overworked. In most cases, they will appear in only one leg, not both. One possible explanation is that when people exercise, they rely more heavily on one of their legs– usually their dominant one. Consequently, this leg sustains more weight than the other and has a higher risk of being overworked. 
Can shin splints turn into a stress fracture?
Shin splints can usually heal independently through adequate rest and substituting regular exercises with lower intensity activities. However, if overuse continues, shin splints may progress into stress fractures. Cumulative stress on the shin bone due to repetitive overloading leads to stress fractures. Without adequate time to heal and adapt to the additional stress, the shin bone becomes brittle. Therefore, shin splints that have been ignored and not taken care of for a long time are likely to result in stress fractures.
Risk factors for shin splints include a sudden increase in exercise training or change in terrain such as hill running, flat foot or rigid foot arches and wearing improper or worn-out shoes. If a shin splint is suspected, it is best to seek a doctor to receive guidance and evaluate proper treatment.
Treatment for a shin splint requires several weeks of rest and low-intensity exercises. Avoid high-impact exercises to prevent overworking the muscles and aggravating the injury. If pain persists after treatment, an X-ray or a Magnetic Resonance Imaging (MRI) scan may be prescribed by the doctor as stress fractures have likely occurred or other conditions might be causing the pain.
Do shin splints hurt at rest?
Shin splints do not usually hurt at rest, and the pain decreases after discontinuing the exercise. Resting the affected leg and limiting your activities to low-impact exercises for several weeks is sufficient to manage a shin splint.
One can also take non-steroidal anti-inflammatory drugs (NSAIDs) to minimize the pain. If pain continues after a few weeks of rest and pain medications, you should seek a doctor immediately to determine the cause of continued pain.
Can you exercise with an injured leg?
Exercising with an injured leg is never advised. Continuing the exercise that triggered the initial injury will only cause more pain and damage. Instead, with a suspected leg injury, it would be better to use a combination of rest, ice, compression or wrapping, elevation, pain medication, and cross-training. 
Physical activity should only be resumed when symptoms improve significantly or disappear completely. 
What is the best treatment for a stress fracture?
Unlike shin splints, the treatment for stress fractures will vary based on the location and severity of the fracture.  In addition to the conservative methods, doctors typically recommend the use of an orthotic device, such as a walking boot or brace with crutches.
These immobilization devices offer additional support by stabilizing the bone in the correct position and reducing the bone’s weight-bearing load.  Typically, surgery is not necessary, unless the fractured bone has limited blood supply, or the patient wants to resume training more quickly. 
- “Shin Splints.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 17 Sept. 2019, www.mayoclinic.org/diseases-conditions/shin-splints/symptoms-causes/syc-20354105.
- Alaia, Michael J, and Stuart J Fischer. “Shin Splints – OrthoInfo – AAOS.” OrthoInfo -AAOS, Aug. 2019, orthoinfo.aaos.org/en/diseases–conditions/shin-splints.
- “Running with Shin Splints? What You Need to Know.” Orthopaedic Associates of Central Maryland, 3 Aug. 2018, www.mdbonedocs.com/running-with-shin-splints-what-you-need-to-know/.
- “Stress Fractures.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 17 Sept. 2019, www.mayoclinic.org/diseases-conditions/stress-fractures/symptoms-causes/syc-20354057.
- “Stress Fractures of the Foot and Ankle – OrthoInfo – AAOS.” OrthoInfo – AAOS, Mar. 2015, orthoinfo.aaos.org/en/diseases–conditions/stress-fractures-of-the-foot-and-ankle/.
- “Stress Fractures: Causes, Symptoms, Tests & Treatment.” Cleveland Clinic, 12 May 2020, my.clevelandclinic.org/health/diseases/15841-stress-fractures.
- Hecht, Marjorie. “7 Shin Splint Stretches for Recovery and Prevention.” Edited by Gregory Minnis, Healthline, 6 Mar. 2019, www.healthline.com/health/shin-splint-stretches.
Elizabeth Miclau is an undergraduate at Harvard College, planning to pursue a concentration in life sciences or sociology. As a member of both Puerto Rico’s National Diving Team and Harvard’s Women’s Varsity Swimming and Diving Team, she has a strong background in elite athletics. In the past year, she has contributed to several journal publications and peer-review-funded research projects.