Lower Leg Pain in Runners

Learn more about the various causes of leg pain due to running.

Dr. Keith Meister, Medical Director of Sports Medicine at Medical Center Arlington and Team Physician for the Texas Rangers, continues to share important tips for parents and athletes here on our blog. Today Dr. Meister discusses the various causes of leg pain that can result from running.

The constant pounding of the pavement and consequently the repetitive stresses absorbed through the lower leg in running results in several very common lower leg complaints in runners and other endurance athletes: stress fractures, shin splints and chronic exertional compartment syndrome. Any or all of these entities can afflict runners at any time during their training routines. Stress fractures are small, often incomplete fractures that occur as a result of the repetitive stress to the bone. Bone responds to stress just as muscle does by increasing in strength. If the stress occurs at a level that does not allow the bone to strengthen quickly enough, fracture can occur. Shin splints occur most probably secondary to inflammation that occurs at the lining (periosteum) of the shin bone (tibia) from a repetitive pull of the attached muscles. Chronic exertional compartment syndrome occurs as a result of a rise in the pressure in the muscles of the lower leg as blood flow increases with increasing activity.

Shin Splints
The most common of the three leg complaints are distinguished by pain along the inner, generally lower third of the leg along the inner margin of the shin. Pain is usually spread across the lower third of the leg and begins with initial strides. Typically symptoms will begin to ease with a short period of warm-up and often return after completing the activity during the cool-down phase. The leg is usually exquisitely tender along the inner border of the lower leg

Stress Fractures
Pain is usually more focal and present with initial steps and every step thereafter. Pain is unremitting and can often worsen with increasing activity. Completion of the activity will usually correspond with a significant decrease in symptoms. Tenderness is generally very focal and can be present anywhere along the course of the tibia.

Exertional Compartment Syndrome
This syndrome occurs in any or all of the 4 compartments of the lower leg. Commonly, pain becomes present 10-15 minutes into a run or exercise routine after blood flow increases to the lower leg and pressure rises in the muscles. The anterior compartment is most commonly involved and therefore pain is felt along the front or outer side of the leg. After 10-15 minutes of rest, the symptoms usually resolve.

Further work-up should include x-rays of the lower leg, as well as MRI and sometimes CT scan and/or bone scan in the presence of possible fracture. Treatment is first and foremost a modification of activity with a switch to lower impact levels of cardio activity, such as swimming, biking, elliptical trainer. An appropriate stretching/strengthening and soft tissue conditioning program is additionally useful with all 3 diagnoses. Use of orthotics and a proper evaluation of footwear can be a useful and necessary adjunct in treatment. A slow/graduated return to activity is initiated once symptoms have resolved. Rarely is surgery required, but release of the muscles of the lower leg has been utilized in shin splints as well as compartment syndrome. Rarely fractures need to be fixed.  

Are you a runner experiencing leg pain? Medical Center Arlington can help diagnose the injury and treat it before it worsens. Please call 1-855-868-6262 for a physician referral.

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