Why Do My Legs Hurt When I Run?

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The elite athletes that compete in the Olympics will be focussed on staying fit and avoiding injuries. Although traumatic injuries such as knee ligament ruptures receive a lot of attention, there are a number of lesser known conditions that cause leg pain in athletes of all levels.

‘Shin splints’ is a general term used to describe exercise-induced pain in the front of the lower legs, or shins.

As well as general considerations, such as the the type of surface you run on and the footwear you use, there are many specific causes of exercise induced leg pain.

Some of the more common ones are outlined below:


Tibial Stress Fractures

These are incomplete cracks in the tibia where repetitive loading has overcome the ability of the bone to resist it. They may occur more frequently in specific sports such as long-distance runners.


Medial Tibial Stress Syndrome 

This is a common cause of ‘shin splints’. Pain is usually felt in the lower, inner aspect of the shin secondary to repetitive stress and subsequent periosteal (the outer layer of bone) stimulation and inflammation.


Muscle strain 

Muscle fibres may be damaged by over-stretching; the most likely site being at the front of the shin. Symptoms are acute pain within the muscle at the site of the tear. The area may also be swollen and warm.



This is where microtears in a tendon cause inflammation in the surrounding tissue. It is an overuse injury, generally caused by excessive repetitive movements, particularly over-stretching and loading of a muscle. Pain occurs mainly at the start of and after exercise.


Chronic exertional compartment syndrome

This overuse condition, caused by tight fascia (connective tissue) around the muscles, produces symptoms during and for about 15 minutes after training. Typical post-exercise examination findings include tightness in the back of the lower leg and paraesthesia (pins and needles). Pain is often described as cramping. There may also be associated muscle tears.


Nerve entrapment syndromes 

Peripheral nerves can become trapped leading to symptoms in the affected nerve distribution. This is particularly common when nerves run in confined spaces and can occur due to local trauma. Patients often describe the pain as sharp and shooting. Specific examples of sporting nerve entrapments include the ilio-inguinal nerve (hockey player’s groin) and the medial plantar nerve (jogger’s foot).

Essentially many of these conditions are caused by overuse. It is therefore important not to try to ‘run through the pain’, undertake a period of rest, and seek expert advice where appropriate.

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