Common runner’s pain explained

Runners (or people who play sports that involve a lot of running) commonly present to doctors and physiotherapists with pain in the lower part of the leg, below the knee.

There are a few potential causes for this type of pain and here are three important culprits, which are discussed below.

Shin Splints
This is also known as Medial Tibial Stress Syndrome or MTSS for short.

Shin splints usually affects both legs, resulting in pain anywhere along the shin from the knee to the ankle and can be caused by over-vigorous training.

It is essentially a stress reaction, with inflammation occurring where the muscles and tendons pull on the bone; the pain tends to be triggered as soon as exercise begins, and it may feel sore to press along the front of the shinbone.

Chronic shin splints are more common in women, people who are overweight or whose feet “over-pronate”- i.e. due to flat feet/collapsed arches, it’s important not to “run through the pain” if you have shin splints.

Treatment usually involves rest, ice-packs and anti-inflammatories.

A good physiotherapy program may help with recovery, if there are foot problems, a podiatrist opinion may be very useful, with attention to proper footwear and arch support if needed.

Chronic Exertional Compartment Syndrome (CECS):
This is when the Tibialis Anterior (the muscle on the shin) becomes swollen, leading to increased pressure and swelling in the capsule of the muscle.

This can cause pain and may interfere with the nerve and/or blood supply to the area.

It’s though CECS may account for around half of lower leg pain brought on by exercise or running, it’s equally common in men and women, tending to start in the early 20s.

People who have Diabetes have a higher risk, with CECS, pain and tenderness may start during exercise, in the muscular area on the shin.

This pain tends to arise after a specific amount of exercise each time, and then settles with rest, over time, the pain may start after shorter and shorter periods of activity, and the recovery time may also get longer.

Less commonly, pins and needles, numbness or weakness may occur if there’s nerve compression.

If CECS condition is suspected, a specialist opinion should be considered (i.e. an orthopaedic surgeon), as it can be serious and sometimes requires surgical intervention.

Tibial Stress Fractures
Tibial Stress Fractures can happen in runners, and particularly in people who have increased their exercise dramatically over a short period of time.

Stress fractures are caused by the muscles and tendons repeatedly pulling on the tibia bone. Symptoms include tenderness and pain in a specific point on the shin, the diagnosis is confirmed by performing an X-ray and sometimes additional tests.

If an X-ray is normal but the pain continues or worsens, a second X-ray may be advised a few weeks later, as sometimes a stress fracture does not show up initially.

Other tests such as MRI scans may be needed, if the diagnosis is uncertain. Specialist advice and management is usually recommended, treatment involves rest, reduced weight-bearing, and then a gradual return to activity, under the guidance of a physiotherapist/specialist.

If you’ve got recurrent or ongoing pain in your shins or lower leg, it’s very important to speak to your doctor or physiotherapist for further advice.

Epic Health’s Dr Bethan Knapp is a general practitioner and sports doctor with a special interest in sports and preventative medicine; having worked in the UK as a Sport Physician with several elite sports teams, Dr Knapp takes a holistic approach to health and wellbeing and leads an active life in Ocean Grove with her four kids.