Will a young adult soccer athlete with no significant past medical history and a history of severe pain after running continue to experience recurring shin splints?

Will Shin Splints Keep Recurring in This Soccer Athlete?

Yes, shin splints have one of the highest recurrence rates of all running-related injuries, with prior bone stress injury increasing recurrence risk sixfold in females and sevenfold in males—but recurrence can be prevented through proper rehabilitation and addressing contributing factors. 1

Understanding the Recurrence Risk

Shin splints (medial tibial stress syndrome) are fundamentally caused by repetitive loading that exceeds the bone's ability to remodel and repair. 1 In soccer athletes specifically, the combination of running with sudden directional changes creates particularly high risk for this condition. 2

The key determinant of whether this keeps happening is whether the underlying contributing factors are identified and corrected. 2 Without addressing these factors, the injury will likely recur once training resumes at previous intensity levels.

Critical Factors That Determine Recurrence

Training Load Management

• Inadequate management of training parameters (distance, duration, frequency, intensity) contributes directly to the high recurrence rate of tibial bone stress injuries 1
• Progression that is too rapid amplifies recurrence risk significantly 1
• The athlete must build back to 50% of pre-injury distance before introducing any speed work or directional changes 2

Biomechanical and Strength Deficits

The following must be addressed to prevent recurrence:

• Calf and hamstring flexibility deficits 1, 2
• Hip and core muscle weakness 2
• Tibialis anterior and calf strength imbalances 2
• Running mechanics (forefoot contact running patterns may contribute to posteromedial shin pain) 3

Sport-Specific Risk Factors

For this soccer athlete specifically:

• Playing on natural grass increases injury risk compared to artificial turf (relative risk 0.53 for artificial turf) 2
• Defender and attacker positions carry higher risk due to opponent contact 2

Prevention of Recurrence: The Rehabilitation Protocol

Complete the following structured progression to minimize recurrence risk:

Phase 1: Initial Recovery (Mandatory)

• Achieve 10-14 consecutive days of pain-free walking before any running 4, 2
• Progress to 30-45 minutes of continuous pain-free walking 4, 2
• Ensure complete resolution of bony tenderness, especially since this is described as "severe pain" 1
• Achieve 75-80% strength symmetry between limbs in functional testing 2

Phase 2: Graduated Return to Running

• Begin with 30-60 second running intervals at 30-50% of pre-injury pace 2
• Perform exercises on alternate days only (bone cells regain 98% mechanosensitivity after 24 hours rest) 4
• Use treadmill or compliant surfaces initially, avoiding hard surfaces 4, 2
• Progress distance before speed, increasing approximately 10% per progression 2
• Monitor pain during and after exercise as the primary guide—if pain occurs, rest until resolved and resume at lower level 4

Phase 3: Sport-Specific Progression

• Build to 50% of pre-injury distance level before introducing speed work 1, 2
• Only introduce directional changes after achieving 50% pre-injury distance 2
• Progress to level surfaces before introducing hills 4
• Vary terrain only once back to normal training 4

Common Pitfalls That Guarantee Recurrence

Avoid these critical errors:

• Returning to running before achieving pain-free walking for 10-14 days 2
• Progressing speed before distance 1, 2
• Failing to address underlying strength and flexibility deficits 2
• Training on consecutive days during early return-to-running phase 4
• Ignoring pain signals during progression 4

Bottom Line on Recurrence

This will not be a recurring problem if the athlete:

1. Completes the full structured rehabilitation protocol outlined above
2. Addresses all modifiable biomechanical and strength factors
3. Progresses training load appropriately (distance before speed)
4. Maintains adequate rest between training sessions during return-to-sport

However, this will keep happening if the athlete returns to full soccer activity without completing proper rehabilitation or addressing contributing factors. 1 The high recurrence rate seen in the literature reflects athletes who do not adequately address these issues, not an inherent inevitability of the condition itself.