Leg Pain in the Running Athlete
With Marathon season back in full swing, many of you runners have been in training for the past several weeks. Increases in duration and intensity to prepare for the recent and upcoming events naturally develop. But what if you start to develop leg pain while or after running? What could it be? Is it serious? And, most importantly, “can I run through it or not and still prepare for my race?” These are many questions that may be running through your mind.
The cause of leg pain could be one of several issues. Here are a few of the most common causes and what you can do to diagnose, treat, and possibly prevent these problems.
Medial Tibial Stress Syndrome (MTSS ) or Shin Splints
This most often occurs on the inner aspect of the leg about halfway down. Usually related to over pronation, it is usually seen when there is a significant increase in mileage or when switching routine like running hills versus flat surfaces. It will usually heal with ice, rest, anti-inflammatory medication and cross training.
If it lasts for more than a few weeks and doesn’t respond to the above treatment, then physician evaluation may be needed to rule out other possibilities. An x-ray may be necessary to check for these. Usually negative, long standing MTSS may show some cortical widening or periosteal reaction of the medial tibia. Once symptoms begin to resolve, revise your training program and gradually work your way back to the previous goals.
These overuse fractures occur when the tibia or less commonly the fibula “crack” under too much repetitive load. The bone which needs time to remodel and heal is never really allowed to do so.
The primary complaint is of pain with running. Often it is associated with swelling.
Early x-rays within 2-3 weeks of onset of symptoms are often negative. Your physician may order an MRI or bone scan if it is suspected.
This may take 4-8 weeks to heal! And no running is allowed. Other treatment may include bone growth stimulators, cast or brace immobilization, and use of medication to increase bone density. In some cases surgery is required to ensure healing.
Gastrocnemius/ Soleus Muscle Strain or Tear
Typically occurs along the medial border as a result of eccentric loading. Symptoms include tenderness along with swelling and possibly bruising. Usually self –limited and responds to rest, ice, and stretching. Severe injuries may require a walking boot for a while followed by physical therapy.
Chronic Exertional Compartment Syndrome
Rare condition affecting some runners. It is caused by elevated pressure in the muscle compartments of the leg.
Imaging studies are negative, so it is diagnosed by measuring the compartment pressures of the calf after a brief period of exertion. Once the diagnosis is made, the only treatment is surgical release of the fascial compartments of the leg.
Other less common conditions to consider are popliteal artery entrapment or peripheral nerve impingement. The etiology of persistent leg pain while running can sometimes be difficult to diagnose and treat. If you have tried rest, ice, and stretching and checked your shoe wear and yet the pain continues or worsens, definitely see your doctor. Be sensible about training and gradually increase your mileage and intensity. Remember, prevention is always better than treatment!