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Lower Leg Pain while Running: Causes and Prevention

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Running is one of the world’s most popular forms of exercise with millions of regular partakers. It tones your muscles, burns calories and relieves stress. Runners voraciously look forward to the runs and miles they cover, fixating on the fact that each mile is NOT a given. Although running is an effective way to achieve many health benefits, it is associated with a high risk of injury; yearly, up to half of the runners report an injury and face regular complaints of lower leg pain after running.

What causes lower leg pain?

It can result from a problem in the leg or can radiate from another part of the body, such as the spine or buttocks. Although some injuries are traumatic, most are due to overuse. An injury is an unavoidable aspect of physical exercise – for both amateurs and professionals. Some injuries are easier, while others will keep you away from exercising for weeks.

I run…
…when I’m stressed.
…when I’m sad.
…when I’m happy.
…when I need to think.
…for me.
It’s my Therapy!
– The Pirate Mama

Running is a great thing for your body. But running too hard too soon can lead to tightness in the calf muscles, shin splints, a painful swelling of the muscles, tendons, and bone tissue at the front of the lower leg. If you’ve finished an especially intense bout of running, you might find yourself asking – why do I have lower leg pain?

Your question is very valid, as it can point to several causes. One of the biggest paradoxes about physical fitness is that occasionally running can cause pain despite the fact that it is essential for good health. Worse still, the irony of your aches and pains is that you must exercise in order to prevent future issues. That awkward moment when you’re wearing Nikes and can’t do it? However, with some people, the initial pain can be a barrier to continued exercise.

lower leg pain
Running

Running injuries have been attributed to a number of anatomic variables, but the literature does not support many of these commonly held beliefs. While not consistently identified as a risk factor for running injury, age has been associated with a number of injuries in several observational studies. Abrupt changes in training regimens can also contribute to running injuries.

How to determine if you require leg pain treatment?

Examination of an injured runner mostly includes an assessment of not only of the injured area but of all related structures, i.e. the runner’s entire “kinetic chain”. This is to note any imbalances or deficits in structure, for example, leg length discrepancy, strength, flexibility, or motion. One way to organize each element, e.g. observation, strength testing of the physical examination is, to begin with proximal structures i.e. the spine and the pelvis and work distally.

Table of Contents

  • Lower Leg Pain while Running
  • Shin Splints and Their Treatments
  • Medial Tibial Stress Syndrome (MTSS)
  • Posterior Shin Splints
  • Tibial Stress Fracture
  • Chronic Compartment Syndrome
  • Achilles Tendinopathy/Achilles Tendinitis
  • Peroneal Tendonitis
  • Soleus Pain
  • Runner’s Knee
  • Stress Fractures
  • Other Injuries and Conditions

Lower Leg Pain While Running

The risk factors, diagnosis, management, and prevention of some common lower extremity injuries associated with running are reviewed here.

Shin Splints and Their Treatments

Shin pains are common in runners and they’re often referred to as ‘shin splints’. With shin splints, your pain is typically confined to the tibialis anterior muscle on the front of your lower leg. Shin splints are caused by repetitive pounding movements such as running and jumping.

While shin splints are generally more annoying than dangerous, if left untreated, they can progress to stress fractures, which take much longer to heal. Rest, in most cases, is the best cure. Alternating ice and heat therapies may provide some relief. It is easy to confuse shin splints with other causes of shin pain, some of which can be dangerous if left untreated.

lower leg pain
Shin Splints and Their Treatments

Shin splints are very common, accounting for about 60 percent of all overuse injuries of the leg. About 10 to 20 percent of runners develop shin splints at some point in their careers.

Shin splints is a very generic term – there are several different conditions that can cause this type of pain, and knowing which one you’re suffering from is important for getting the right treatment.

Medial Tibial Stress Syndrome (MTSS)

This is often associated with the way your foot strikes the ground when you run and is unable to absorb the shock properly.

In other words, pronation. The condition could also be linked to running with worn out shoes or on hard surfaces. While its treatment would mean taking a break from running for a bit, you could just as well keep up with your cardiovascular fitness by cycling or swimming instead.

lower leg pain
Medial Tibial Stress Syndrome (MTSS)

Apart from this, you would require some physiotherapy to improve the strength and flexibility of your Achilles tendon and ankle. You might also be required to assess your running program to spot and eliminate anything which could add to the injury. To eliminate the chances of a stress fracture, your doctor will arrange for you to have an x-ray or a bone scan before actually diagnosing you with MTSS.

Posterior Shin Splints

This injury makes its presence known on the inner side of your leg, right where the calf muscle meets the big shin bone. The likely cause of it is straining a muscle that gives support to the arch of your foot. This would mean that you have flat feet.

lower leg pain
Posterior Shin Splints

To ease the pain, ice your shins for about 10-15 minutes while keeping your foot elevated. Reduce your mileage and take a few days off from running, but do not attempt running through the pain. Try wearing an arch strapping and a commercial arch support. If the pain is severe, you may have strained this area enough to cause a stress fracture in the tibia. If this is the case you should see a doctor immediately.

Tibial Stress Fracture

The symptom is similar to MTSS, however, with this injury the pain gets worse and lasts longer with each run. You may experience tenderness over an area of your tibia, along with a sharp, rising pain when you’re in bed at night. Stress fractures occur due to repetitive strain and overworking the bones.

Lower leg pain
Tibial Stress Fracture

They are known to occur more commonly in women, and are associated with low body weight, amenorrhea, which is the lack of periods, osteoporosis, and overtraining. Tibial stress fractures can be easily determined by an x-ray. It’s prescribed to give running a rest for about six to eight weeks to recover.

While it is important that you make necessary changes to your training program, your return to running needs to be gradual, starting off with shorter distances and giving running an alternate with other low impact exercises. Each individual experiences different time period of recovery, with the variance in fractures. In the case of an extreme injury though, you might need to completely rest and wear a plaster cast for a bit.

Prevent lower leg pain with Proper Running Form for Beginners – Guidelines to Follow

Chronic Compartment Syndrome (CSS)

This shows up as a pain in the lower leg muscles whilst running. This pain eases with rest and might feel like a cramp, tightening or burning sensation.

CSS can be caused by your leg muscles increasing in size and becoming too big for the tissues which surround them. These tissues (fascia) aren’t flexible enough to cope with the increase in size, causing pressure, nerve damage and reduced blood flow in the muscles. CSS, like MTSS, is also associated with over pronation.

Lower leg pain
Chronic Compartment Syndrome

It only occurs during the activity; hence, a doctor might not be able to spot anything by a physical examination. They might need to conduct some tests while you’re running to diagnose the condition. The pain will ease with rest, but should it return upon starting to run again, you might have to contemplate having surgery. The procedure is called fasciotomy – it simply opens up the fascia to relieve the pressure.

In order to keep shin splints from derailing your training, it’s advisable to follow these safety tips:

  • Purchase and wear good quality, running-specific shoes. The staff at specialty running stores would be more than accommodating to help analyze your foot structure and stride and recommend shoe models that compensate for any of your weak areas.
  • The task doesn’t end with the one-time purchase of good running shoes. You should track your total run distance and try replacing your shoes every 350 to 500 miles.
  • Orthotics is a good shoe accompaniment if you have flat feet, to provide additional arch support. Basic orthotics are available over the counter, or you could also have these made custom-fit to your foot.
  • Upon starting to run, gradually build upon your distance, intensity, and duration.
  • Remember to include some low-impact cross training along with your running program. Exercises such as biking, walking, and swimming not only provide a good cardiovascular workout but also helps in giving your shins some time off.
  • Throw in some strength training at least once a week. Exercises that target the lower leg such as calf raises are especially beneficial.

Achilles Tendinopathy/Achilles Tendinitis

An Achilles tendon injury is the kind of running-related lower leg pain that can happen to anyone, whether you’re an athlete or just going about your everyday life.

Did you know that the Achilles tendon is the largest tendon in your body?

It stretches from the bones of your heel to your calf muscles. This is the tendon that lets you point your toes toward the floor and rise up on your tiptoes. You can feel it — a springy band of tissue at the back of your ankle and above your heel. It’s common for this tendon to get injured. It can be mild or moderate and feel like a burning pain or stiffness in that part of your leg. A word of caution- if the pain is severe, your Achilles tendon may be partially torn or completely ruptured.

lower leg pain
Achilles Tendinitis

The most prominent way the Achilles Tendinitis makes itself known is the pain above your heel, especially when you stretch your ankle or stand on your toes. It may be mild, which may get better or worse over time. Sorry to say, but if the tendon ruptures, the pain is instant and severe. The area may also feel tender, swollen, and stiff.

However, the silver lining is- your doctor! He/she may conduct a physical exam, checking for problems that might have led to your injury when you walk or run. There is also the calf squeeze test.

Worried what is the calf squeeze test? Well, your doctor will gently squeeze the calf muscle on your healthy leg while you kneel on a chair or bench or lie on your stomach on the exam table. This will pull on the tendon and make your foot move. The doctor will then repeat this action on your other (injured) leg. If your Achilles tendon is torn, then the foot won’t move, because your calf muscle won’t be connected to your foot. But hey don’t worry, there are quick treatments for Achilles’ tendons.

Minor to moderate Achilles tendon injuries should heal on their own. For speeding up the process, you can do the following:

  • Give your leg complete rest. Resist putting any weight on it, you could use crutches to assist you in this.
  • Ice is the best option. Every three to four hours, ice the injury for about 30-40 minutes. Continue this for 2 or 3 days, or until the pain is gone.
  • Using an elastic bandage, compress your leg around the lower leg and ankle to keep down swelling.
  • Keep your leg elevated. When sitting or lying down, use a pillow to prop your leg.
  • Anti-inflammatory painkillers will help with pain and swelling.
  • During recovery, you might be advised to use a heel lift or an insert within your shoe. This will help protect your Achilles tendon from further stretching.
  • Physical therapy, stretching and strengthening exercises as recommended should be regular.

Peroneal Tendonitis

Dear Runners, if you have constant pain around the outer side of your foot, then you might be suffering from Peroneal Tendonitis.

It is a common cause of pain around the back and outer side of the foot caused by inflammation, irritation or degeneration of the tendons. We have two peroneal muscles, peroneal longus and peroneal brevis, which run down the back of the fibula through a groove on the outer side of the ankle behind the lateral malleolus.

lower leg pain
Peroneal Tendonitis

The tendons then split with peroneus brevis inserting into the base of the little toe bone (fifth metatarsal) and peroneus longus crossing the sole of the foot to attach to the outer side of the big toe (first metatarsal). Their job is to pull the foot and toes downwards, known as “plantarflexion” and to turn the foot outwards, known as “eversion”.

There are mainly four reasons for peroneal tendonitis.

  • Typically if the heel is turned inwards slightly, known as “hindfoot varus” or you have high arches, you are at increased risk of peroneal tendonitis as these make the peroneal muscles and therefore tendons work harder.
  • If you suffer from recurrent ankle sprains, the weakness and the injury around the ankle could make you prone to peroneal tendonitis. Tightness in the calf muscles and weakness in the calf and peroneal muscles can also lead to tendonitis. But, overuse is the most common cause of peroneal tendonitis.
  • Sudden increases in training levels, inappropriate footwear or poor training techniques tend to be to blame.
  • Runners, who frequently run along slopes (e.g. cambered roads or uneven surfaces) which cause the foot to excessively roll out into eversion, are more prone to peroneal tendonitis.

Figure out if your outer foot is too tender to touch. If you do have acute pain then give a rest to your leg. The pain will set in gradually over a few weeks/months. Do remember, the pain is the most intensified in the morning. It may also hurt to turn your foot inwards, known as inversion.

How could you ease your pain? Well, the treatment measures for Peroneal Tendonitis are relatively similar to that of Achilles Tendonitis, with resting, icing, and elevation making a prominent comeback.

Soleus Pain

Do you have acute pain in your calf muscles during your run? Well, your calf muscles have turned stiff!

Soleus pain is felt deep in your calf. In the initial stages, you might experience the pain only when you run. However, as time passes the pain can also continue at rest – particularly if choose to continue running through the pain. Your calf will also feel tight and stiff.

lower leg pain
Soleus Pain

In the case of a more serious injury like a muscle tear bruising and swelling will also occur. The soleus muscle kicks into high gear when you run uphill or up stairs as this muscle helps propel your body forward, it has to work harder when you run fast.

Want to know why a runner suffers from soleus muscles?

Well, the answer is -Uneven surfaces like Sand, grass, gravel that requires your calf muscles to work harder to keep your balance. Roads that are unevenly paved often have slanted edges where athletes run to avoid traffic.

Terrible right? To understand read more about Calf Pain After Running- Ways to Treat and Prevent it

Runner’s Knee

Next on the lower leg pain is the common Runner’s knee!

Runner’s knee or referring to its proper term ‘patellofemoral pain syndrome’, is basically pain and inflammation behind the kneecap. It is a persistent or throbbing pain behind the kneecap, often accompanied with some heat or swelling.

Lower Leg Pain
Runner’s Knee

It tends to worsen after long periods of sitting or walking downstairs. Tight quads or calves, weakness on the inner side of the quadriceps muscle; inappropriate running shoes are some common factors. Short term relief solution would be to ice it and tape. To prevent recurrence, make strengthening the weak muscles and stretching the tight ones a focus point.

Stress Fractures

If you are a runner you would agree that fractures are the last thing in your running dictionary!

Stress fractures are hairline cracks in a bone caused by excessive force. The pain will be present in a very specific area along with tenderness that will normally feel worse not only when bearing weight but may also hurt when not weight bearing (even at night).

lower leg pain
Stress fracture

You may wonder what are the common zones which could bring a stress fracture! Well, inside edge of the tibia (shin bone) and the metatarsals (the long toe bones) are more prone to stress fracture.

The common causes for this include doing too much, too soon, basically overtraining. Imperfect biometrics or even poor technique could be a factor. In case you suspect a stress fracture, it’s better to seek medical advice and get diagnosed or face the risk of a full-blown fracture which will not only increase your recovery period but also keep you away from running that much longer.

Other Injuries and Conditions

We’d also like to mention some other conditions that can cause shin and lower leg pain while running – although, it’s always a good option to visit your doctor if you’re concerned about an injury.

1. Calf sprain

It is a tear in the calf muscles, fairly common and is best prevented by warming up thoroughly before exercise. In case you suffer a sprain, apply ice wrapped in a towel to ease the pain. How to heal it? Well, resting your leg, keeping it elevated and physiotherapy will also help.

Numerous factors have been proven to correlate with the development of ankle sprains (such as high arches, poor balance, tight calves, and decreased overall fitness); by far the best predictors of the future ankle sprain are prior ankle sprain and being overweight. In fact, heavy runners with a prior history of an ankle sprain are 19 times more likely to suffer another ankle sprain. Ankle exercises can be a big relief here!

2. Blisters

They are a more common kind of lower leg pain that occurs while running. These nasty looking things are basically a build-up of fluid caused by repetitive friction at a specific point of the foot. It starts off with generic irritation and pain leading to the formation of a blister.

Make no mistake while choosing your socks and shoes. They are the main reason for blisters. It also might be a sign of poor technique, indicating your foot landing on a specific point each time. We recommend you not popping the blisters unless you absolutely have to. Protect with a ‘second skin’ blister plaster until the fluid dissipates. The best cure, however, is prevention.

At the first sign of irritation in your shoe, address the problem rather than ignoring it by knowing about Blister on Feet While Running- Symptoms, Causes, and Treatments

3. Referred Back Pain

After a good long run, does your back ache? That’s just painful! But do understand that sometimes lower back pain can be felt in the legs and mistaken for a running injury.

4. Nerve Compression

If you run regularly you can definitely not afford a nerve compression. It is a trapped nerve or artery around the back of the knee which can also cause leg pain.

5. Black Toenail

Word of caution for downhill runners! You can be prone to black toenail, so better keep a check while running.

Black toenail or ‘subungual hematoma’ results from the nail being compressed onto the nail bed. This happens most commonly with the big toe, with signs of inflammation, bruising and, sometimes, a build-up of blood under the nail.

A lot of downhill running or shoes that allow the toes to slip forward or even overlong or badly cut toenails are the general reasons for this. If there is no blood, the nail will settle and grow out and eventually fall off at some time. In case there is painful pressure caused by blood behind the nail, see a medical expert to pierce the nail and drain it.

6. Tibialis Posterior Tendinopathy

is an overuse injury that is caused mostly due to degeneration the Posterior tendon. This tendon is located under the medial malleolus, which is the bony part of the ankle. Its main function is to hold up the arch of the foot, which is why, Tibialis Posterior Tendinopathy, if left untreated for a long time, can cause Tibialis Posterior Dysfunction, or flat feet, as the tendon will lose stability and not be able to support the arch.

This kind of a lower leg pain is mostly caused due to prolonged stretching of the tendon, like while running on tight bends; over-pronation is another cause of this injury.

But there is a fix for this lower leg pain.

An easy way to relieve this pain is to apply ice or an ice pack on the affected area, but make sure to do so after wrapping the ice in a wet cloth or towel.

Keep Calm, and Keep Running!

Up to half of regular runners report an injury each year, and returning to running post an injury pretty much blows. While injuries have their own motive in giving runners a bit of a reality check, it is necessary to not lose heart.

There is Magic in Misery. Just ask any Runner – Dean Karnazes, Ultramarathon Man

Yes, it is indeed important to gain perspective and not go overboard in catching up with the lost miles. The last thing you would want during a comeback is to re-injure yourself or develop a new one, sending you right back to the recovery stage. Keeping your dream alive is half the battle won. Pain is always inevitable but you have an option with suffering. You can run long and run as often as you want because you will never be able to outrun the joy of running.

Find your happy pace, coz It’s a Run-derful Life!

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