Stress Fracture or Shin Splints? Signs and Recovery

Written by the Phoenix Rehab physiotherapy team.Clinically reviewed by Louise Yow, Principal Physiotherapist and Director, AHPC A1300363H.Last reviewed 4 October 2026.

A stress fracture is a small crack in a bone from repeated load, not one big blow: too many kilometers, too soon, on bone that has not had time to adapt. It usually starts as an ache that comes on during a run and goes with rest, then arrives earlier each time. Most low-risk stress fractures heal in six to eight weeks. A few sites heal slowly and need a doctor’s plan from day one.

Stress fracture or shin splints?

Both ache along the shin in runners. They are not the same, and the difference changes what you do this week.

	Shin splints	Stress fracture
Where it hurts	Spread along the inner edge of the shin, a hand’s length or more	One spot you can cover with a fingertip
During a run	Often eases once warmed up	Gets worse as you go
At rest and at night	Usually settles	Can ache at rest, and at night
Hopping on that leg	Uncomfortable	Sharp pain at the spot

Only imaging confirms a stress fracture, and a doctor decides whether you need it. An early stress injury often does not show on an X-ray. See shin splints.

Where it happens, and which ones are high risk

Bone	Usually felt	Risk
Inner shin (tibia)	A spot on the inner edge of the shin	Usually low risk
Long bones of the foot (second and third metatarsals)	The top of the foot, swelling after a run	Usually low risk. See foot fracture
Front of the shin (anterior tibia)	The front of the shin in jumpers	High risk: heals slowly. Doctor’s plan
Top of the midfoot (navicular)	A vague ache on top of the midfoot	High risk: easily missed. Doctor’s plan
Fifth metatarsal (outer edge of the foot)	The outer edge of the foot	High risk at the shaft. Doctor’s plan
Neck of the thigh bone (femoral neck)	Deep groin or front-of-hip pain on running	High risk. Stop running and see a doctor the same day

Why it happened

Bone adapts to load, slowly. A stress fracture is the gap between how fast the training went up and how fast the bone could keep up: a new marathon block, a switch to road, NS route marches, a jump in jumping or skipping volume. Low energy intake makes bone slower to adapt. In women, missed or stopped periods while training are a warning sign, and in men and women, so is unplanned weight loss.¹ That is a doctor’s conversation, not only a training one.

What is the fastest way to heal a stress fracture?

Take the load off the bone enough that it stops hurting in daily life, and keep the rest of you moving. That usually means stopping running, walking as comfort allows, and cycling or swimming if they do not hurt. Some people need a boot or crutches; your doctor decides. Rushing back is the slow way. A stress fracture that is run on can become a full fracture.

Back to running: what we measure

Daily life first. Walking and stairs with no pain at the spot, and no tenderness when it is pressed.
Hop test. Hopping on that leg, then repeated hops, with no pain at the spot.
Calf and hip strength. Single-leg heel raises and hip strength measured against the other side, because these muscles take load off the bone.
Running. Walk-run intervals on alternate days, built up in steps, with the measures deciding each step.²

Tested, not dated. You run again when the measures say so. Pain is the first thing to leave. Strength is the last to train and recover.

When to see a doctor first

Go to the emergency department now if you suddenly cannot put weight on the leg after running on a sore spot.
See a doctor the same day for groin or front-of-hip pain that comes on with running, or a pinpoint sore spot at the front of the shin, top of the midfoot or outer edge of the foot.
See a doctor soon for a sore spot on a bone that is not easing after a week off running, a second stress fracture, or missed periods or weight loss while training.

Where are you with this right now?

1. It is settling on its own

If daily walking no longer hurts, the spot is less tender each week and your doctor is happy, keep cross-training and be patient. You are probably in Stage 1 or 2 of 4.

2. It has stopped improving

Eight weeks off running. The X-ray says healed. You tried an easy 3 km and the same spot was talking by the end. Now you do not know whether to rest another month or push through. The bone may be ready. The calf on that side, and the plan for loading it again, are what have not been measured. That is what we test.

WhatsApp us · Get Assessed & Treated · One 45-minute appointment, $230, nett, no GST.

3. You have had surgery, or you have a date

Some high-risk stress fractures are fixed with a screw. After that, the stages are set with your surgeon. See physiotherapy after surgery. All of it runs on the four stages of the Phoenix Recovery Protocol.

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