The 5 Most Common Causes of Lower Leg Pain in Runners ( & how to deal with them)

Close up legs of man running and exercising on wood bridge in park

Lower leg pain is a common problem among runners.

In most cases, it’s blamed on overuse, mainly wear and tear to the muscles, joints, bones, tendons, and other tissue.

But determining the exact cause root-cause of lower leg pain is easier said than done as there’s a bunch of conditions that can strike the area between your knees and ankles.

We’re not talking about genetics and chronic problem yet.

But worry no more.

In today’s post, I’ll outline the main injuries that cause lower leg pain in runners and how to best treat and prevent them.

Note-If you think you might be dealing with one of these conditions, make an appointment to see your doctor or a physiotherapist as soon as possible.

1. Shin Splints

Also known as medial tibial stress syndrome, or MTSS, shin splints is the broad term used to describe pain along the inner (medial) side of the tibia.

The condition is an inflammation of the muscles, bone tissue, and tendons around the tibia.

Pain usually strikes along the inner border of the tibia, where muscles attach to the bone.

Symptoms

Often on the front side of the shin—or the anterior shin splints—or on the back inside of the shin—or the posterior medial shin splints.

You’ll feel tenderness around the lower two-quarters of the inner tibia.

The affected spot will be tender to touch.

You may also notice some mild swelling in the lower leg.

The Causes

The injury is caused by repetitive stress on the shinbone and the connective tissue that attach the muscles to the bone.

In most cases, shin splints develop when you suddenly increase your training volume, either with a new activity, intensity or by changing something in your running routine.

Even the skipping recovery section also takes part in this injury.

The Treatment

Treating shin splints involves taking a rest from high impact exercise, but you can maintain your fitness by doing low impact sports, such as swimming and cycling after the acute period.

Please be kind to yourself.

Don’t force your body during the acute period unless you want to prolong your injury.

Next, ice the affected limb, run in proper shoes or arch support, and change your running surfaces more regularly.

Wear insole or padding inside your shoes to minimize the impact.

For persistent cases, you may need to consult a physiotherapist to help you improve the mobility and strength of your Achilles tendon, ankle, and calf.

A chiropractor also a good help for those who need more physical adjustment by deep tissue massage.

Prevention

Assess your running routine to find anything that could be making the injury worse.

In most cases, doing too much too soon is the main culprit.

I’d also suggest that you improve strength in the muscles along the front and side of your lower leg and as well as improve the flexibility of your calf muscles.

Avoid hills and stick to softer surfaces like dirt paths and trails.

2. Stress Fractures

One of the most serious running injuries that can put you out of commission for weeks, often months, at a time.

Stress fractures consist of tiny cracks in a bone caused by repetitive trauma.

Fracture-prone sites in runners are the metatarsals (the long toe bones) and the inside edge of the tibia (shin bone).

Stress fractures are more common in female runners and are often linked to overtraining, osteoporosis, low body weight, and hormonal imbalances.

The Causes

Stress fractures are caused by repetitive stress—often from overuse—such as running long distances.

They’re often the result of increasing the intensity or amount of training too quickly.

Bad form can also be a factor.

Symptoms

Like shin splints, you may suffer pain during or after running, but with a stress fracture, the pain is sharp, gets worse, and persists longer with each run.

You’ll feel tenderness, pain, and sometimes swelling or bruising that will usually get worse the more miles you log in but may also hurt when not bearing weight on the affected limb, even at night.

The Treatment

Stop running and book an appointment with your doctor for a thorough diagnosis if you suspect a stress fracture.

Keep running through a stress fracture, and you’ll increase your risk of a full-blown fracture and a much longer recovery period.

An x-ray will show the fracture, and you’ll need to stop weight-bearing exercises for 6 to 8 months, often longer in serious cases.

Casting and elastic bandage should be worn in a certain amount of time.

Firm support is key.

You should do stop doing any form of high impact exercises, such as jump roping.

Prevention

Again, you’ll need to examine your running routine and make any key changes to your runs.

If you still feel intense pain while walking, a bandage, cast boot, or crutches may be required.

Use proper running shoes that fit well and suit your unique biomechanics.

If you have flat feet, look for shoes that support your arch, maybe insoles. You should also eat a well-balanced diet with enough vitamin D and calcium.

To keep your bones strong, make sure you’re getting enough calcium and vitamin D.

Both of these nutrients are key for bone health.

3. Achilles Tendinitis 

Tedinitis is a common issue in the lower leg that affects the Achilles tendon, the rope-like that connects to both the heel bone and calf muscles.

Causes

Achilles tendinitis is caused by overuse, stress, or strain on the Achilles tendon.

You can get it from running too much or overworking the calf muscle.

Symptoms

Achille tendonitis causes pain when the muscles is contracted or stretched.

The most telling warning sign that you’re dealing with Achilles tendons is pain in your lower calf, near the back of the heel, especially in the morning.

Other symptoms may include inflammation of the tendon, poor range of motion when flexing the affected limb, swelling, and/or pain in the back of the leg.

You may experience inflammation on the peroneal (the outer aspect of the ankle) and the posterior tibialis (the inner aspect of the ankle).

Treatment

Treating Achilles tendonitis involves the RICE (rest, ice, compress, and elevate) method.

Start by taking a break from running.

Use ice therapy to reduce inflammation, especially after your runs.

Consult a doctor if home treatment doesn’t work, or your symptoms don’t improve.

Prevention

Stretch your calves regularly but avoid eccentric calf stretches (dropping your heel off a step) for as long as you have pain.

You should also avoid running hills and speedwork.

4. Posterior Tibial Tendonitis

Also known as a posterior tibialis syndrome, this not-so-common injury is, just like shin splints, an inflammation injury in the same muscle-tendon structure.

It strikes the tendon that wraps around the inside of the ankle and attaches the muscle to the navicular bone at the midfoot.

The posterior tibialis muscles (see image) is a key running muscle used when pointing the ankle and toes downward (ankle plantar flexion) as well as when rolling the ankle inward (ankle inversion).

The muscle also supports the arch of the foot.

The condition can also develop into a tibialis posterior tendon insufficiency, which may result in a fallen arch.

Symptoms

If you’re suffering from tendonitis, you’ll experience tenderness, swelling, and pain around the inside of the ankle and often down to the navicular bone (see image).

The affected area is often warm to touch, red, and swollen thanks to the inflammatory process.

The Causes

The injury is caused by overuse of the posterior tibial tendon from a drastic increase in training intensity or volume.

It can also be caused by a specific incident such as a fall or vehicle accident.

The Treatment

Your first course of treatment is to RICE the affected limb.

Additionally, consider using an ankle-compression sleeve to help soothe pain and prevent re-injury or relapse when you return to running.

Please avoid painkillers without getting the green light from your doctor.

These may blur or mask the symptoms, making your condition worse.

Prevention

Consider adding arch support (Custom foot orthotics)to your (preferably well-cushioned) running shoes, though this will reduce the space inside of the shoe.

First, consult to expert as not everyone in need of orthotics.

To avoid compressing your neuroma, loosen the laces near the toes.

You should also strengthen your ankle muscles.

Try This exercise

And oh! You may hate me because of this.

Avoid barefoot walking, flip-flops, and flat.

It might be comfortable but will continuously support the progress of a fallen arch.

5. Muscle Strains

Another common culprit behind lower leg pain in runners is an injury to the calf muscles.

If you suffer from a  sudden calf pain, especially running sprints or doing ballistic exercises, you’re likely strained a calf.

Symptoms 

A telling sign of a calf muscle strain is mild to serious pain in the lower leg.

You’ll know if you strained a calf muscle as you’ll feel it “go” or “give way.” Many runners may mistake it with tightness.

You’ll also feel a lot of pain in the muscle, especially on resisted movement—and a limited range of movement.

Pain may subside during a run but come back after.

The Causes

Calf strains are often the result of excessive strained from too much training, changes in running technique, or drastic increases in increasing running distance/intensity.

For example, when you start running for the first time or increase your training intensity, all of a sudden can strain your calf muscle.

Treating

Mild cases of calf strains can be dealt with at home with the RICE method.

However, severe tears or strains may need medical attention.

Keep running if it does not hurt do so.

You should also stretch and massage the right area regularly.

Don’t wait until you feel too much hurt, because when you start to feel it, the other muscle starts to compensate—more damage.

Prevention

Take time to warm up for your run with a 10-minute jog to increase blood flow and core temperatures before hard training.

A good warm-up should consist of 5 to 10 minutes of low intensity running then performing a series of dynamic movements to mildly stress all of the muscles about to be used.

Ideal exercises include lunges, butt kicks, side shuffles, squats, and inchworms.

You should also strengthen your calf muscles and prepare them properly for hard training.

Isometric can be one of your helping hand!

Conclusion

The above injuries and conditions are some of the most common causes of lower leg pain in runners, but by no means is it an exhaustive list.

For more in-depth articles on running injuries and prevention, make sure to check my page here.

You can also check how to relieve foot pain from running article.

I’d love to hear from you in the comments section below.

Thank you for dropping by.

Keep training strong.

David D

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