What to do about that lower leg pain?


Running is a sport with a relatively high incidence rate of lower leg injuries, with prevalence rates from 7 to 59 injuries per 1,000 hours of running. Most running injuries are overuse injuries which occur over time as a result of repetitive microtraumas of soft tissues or bones. Because of their slow development, they are challenging to diagnose and treat. The most prevalent musculoskeletal running injuries are Achilles tendinopathy and medial tibial stress syndrome (often called shin splints).

What to do if you develop lower leg pain?

Many runners, sooner or later, will experience some kind of lower leg pain. But what kind of pain is it? What do you do about it? Who to ask for advice? Read the experts’ opinion.

The Doctor

Dr David Hughes, Chief Medical Officer, Australian Institute of Sport

Some degree of pain/discomfort after strenuous exercise can be normal. If the pain resolves by the following day, it is generally not too serious. If the pain persists but actually decreases with exercise, once you warmup, this often indicates soft tissue inflammation such as periostitis (inflammation of the lining of the bone) or an acute, reactive tendinopathy. If the pain persists and becomes worse with exercise, then this indicates that there is more significant pathology and the runner would be advised to stop exercise and be assessed by a sports doctor or a physiotherapist. Pain which comes on instantly with hopping could potentially be due to bone stress and again this needs to be assessed by a qualified health practitioner.

If you develop running-induced lower leg pain, think about training load error. Research has indicated that increasing your training loads such that the average load over the past week is greater than 150% of your average training load over the past four weeks, predisposes to injury. As an example, if your average load over the past four weeks has been 20 km per week, increasing your load to 25 km for the coming week should be safe. Increasing the load for the coming week to >30 km however, increases your risk of sustaining a running -related injury. There is nothing wrong with striving to increase your training load. It must however be done gradually.

The Physiotherapist

Mr James Pearce, Physiotherapist, Movehappy Health Centre

The main risk factor for running-related injuries is a previous history of injury in the preceding 12 months. A recent systematic review found that overuse injuries such as stress fractures and tendinopathies could be almost halved just by incorporating a weekly strength program. Because running involves several eccentric contractions (muscle lengthening under load), performing exercises such as eccentric calf raises are an essential exercise to include in preventing Achilles tendinopathy.

Tendinopathies are notoriously recalcitrant, so ongoing maintenance exercise for these is required. It is also important to note that stretching, while useful if deemed absolutely necessary by a health professional, has shown no significant benefit in reducing running-related injuries of the lower extremity. This is particularly pertinent in Achilles tendinopathy, whereby excessive stretching of the calf could lead to additional compression of the Achilles tendon at its insertion onto the calcaneum and hence contribute to the pain seen in tendinopathy.

As well as looking at running biomechanics, a physiotherapist can assess many other contributing factors such as leg length discrepancies and what I believe to be most important, stabilisation of the hip and pelvis, as this ultimately helps to achieve a correct running posture. The proper distribution of force through both technique and the stabilisation qualities of muscles is vital to preventing unnecessary load on tendons and bone.

The Nurse

Ms Ruth Fazakerley, Registered Nurse, Australian Institute of Sport

Physical activity can be the cause of lower leg pain which can be a normal response to exercise such as DOMS (delayed muscle soreness) but sometimes it is the symptom of an injury that requires medical assessment, diagnosis and treatment to aid recovery.

Running injuries usually happen when you push yourself too hard or increase your training load too rapidly. The way your body moves also plays a part. While serious injury will often be obvious, deciding whether an ache or pain during or following exercise needs medical attention can be an unclear decision for some people.

Working at the Australian Institute of Sport, I am in the enviable position of being able to immediately refer athletes to expert practitioners to assess, diagnose and treat these injuries.

If you suffer an injury or experience pain during or after running immediate first aid using the R.I.C.E   method of acute injury treatment (rest, ice, compression and elevation) can assist in preventing complications and help you heal faster.  After a day or two of applying R.I.C.E first aid, many minor injuries will begin to heal.  But if your pain persists or is increasing make an appointment to see your doctor or physiotherapist.

The Scientist

Ms Maria Kozlovskaia, PhD Candidate, Bond University

Even though current knowledge of running technique, variety in shoe choice and healthy dietary habits give us an opportunity to get the most benefit out of running, it is important to consider non-modifiable factors such as genetics. Genetic variants contribute to the ability of bone and tendon tissue to adapt to increased training loads and recover from microtraumas.  Current knowledge of genetic predisposition to overuse injuries is restricted to several variants in collagen genes and genes responsible for tendon turnover and bone remodelling. Research of these variants will help us understand underlying processes and have an individual approach to injury treatment and prevention and therefore lead to better performance. A research project ‘Genetics of exercise-induced injuries in tendon and bone’ is looking for recreational runners to complete an online survey and provide a saliva sample for genetic analysis. To help us to find out more about the genetics of injuries, please click here.