Lower Leg Pain

I used to be a long distance runner, and stopped for a few YEARS. Now that I've gained weight and got back into running about a mile a day I get horrible lower leg pain, on the outside of my shins.

Not shin splints, because when I touch the muscle it is hard, and a light massage makes it perfectly normal in a few minutes.

I thought it was the weight gain, but some days its not bad and others i can't make it 1/2 a mile.

I believe I overpronate but don't know how to fix it, I want to run more!! Help!

– Amy, Tampa, FL

Answer by Dom: Hi Amy, thanks for your question. Whatever we call it, your pain is almost certainly an overload problem — your muscles and bones are being asked to do more than they have adapted to. Rest, a gentle restart and a few simple strengthening exercises will usually sort it out.

1. Rest first, then restart with run/walk
2. Why the pain comes and goes
3. Shoes, surfaces and overpronation
4. Strengthen the front of your lower leg
5. Stress fracture warning signs

Rest first, then restart with run/walk

"Shin splints" is a bit of an abused term. These days it seems to cover any lower leg pain. Whatever the name, the first treatment is the same: rest and ice. Take a week off running, and ice the sore area for 10–15 minutes a few times a day. Walking, swimming or cycling is fine as long as it doesn't hurt. My shin splints-page lists some products you can use.

Once you can walk briskly pain-free, restart with run/walk. Run easy for 2 minutes, walk for 1, and repeat for 15–20 minutes. Do this every other day, not every day. A mile a day sounds modest, but for a body that has been off for years it is a lot of repeated impact — and your shins get no recovery.

Build up slowly. Add a minute or two of running per session, and let your total weekly mileage rise by no more than 10% a week. Every fourth week, hold steady or drop back — a consolidation week. The trick is being patient now, so you can run for years instead of weeks.

Why the pain comes and goes

You mention some days are fine and others you can't manage half a mile. That is typical of overload. Your muscles, tendons and bones don't adapt at the same speed, and a bad day often reflects the build-up of the last few days rather than that day's run.

Here is the thing: your brain still knows you were able to do 20-milers, your body doesn't. Your lungs and heart come back fairly quickly. Your tendons and bones take months. So you feel fit enough to run further, while the lower legs quietly fall behind. Running too much, too soon is the most likely cause here.

Extra body weight adds to this. Every step puts more load through your legs, and that load is repeated thousands of times per run. It isn't a reason to stop — it is a reason to be extra sensible with the build-up. Your light massage working so well also suggests the muscle at the front of the shin is tight and tired from overworking. Treat that as a signal to ease off, not a green light to push on.

Shoes, surfaces and overpronation

Other possible reasons are your running shoes or hard surfaces. Check your shoes first. Most running shoes wear out somewhere between 300 and 500 miles (500–800 km). If yours are older, or you have been running in an old pair from your racing days, replace them. Look at the soles too — heavy wear on one side tells you something.

You say you believe you overpronate, meaning your foot rolls inwards a lot as it lands. I wouldn't assume that without evidence, Amy. Plenty of runners think they do and don't. Go to a proper running shop and have your gait looked at while you run on a treadmill. They can then suggest suitable shoes. I'd put that ahead of buying insoles or anything fancy.

Then look at where you run. Concrete and pavement are the hardest surfaces. Switch to a park path, a trail, grass or a running track where you can. Keep your steps short and quick rather than reaching forward with your foot — overstriding puts extra strain on the front of the shin.

Strengthen the front of your lower leg

The muscles on the front and outside of your shin work hard every time your foot lands, and yours are probably weak after the break. Strengthening them is simple, and you can do it at home while you recover.

• Toe raises: stand with your heels against a wall, lift your toes up, lower slowly. Three sets of 15.
• Heel walks: walk on your heels, toes lifted, for 20 metres, three times.
• Calf raises: rise onto your toes, lower slowly. Three sets of 15 — strong calves share the load.

Do these three or four times a week, on the days you don't run. Stay pain-free, and give it six weeks before judging whether it helps.

Stress fracture warning signs

I'm a running coach, not a doctor, so here is a clear line. If there is absolutely no positive response to rest and treatment, it is time to see a doctor. You may have a (developing) stress fracture — a tiny crack in the bone caused by repeated impact. It can slumber in the background and get worse with every run.

Stop running and book an appointment if you notice any of these:

• pain at one small spot on the bone that hurts when you press it;
• pain at rest or at night;
• pain that gets worse with each run, or hurts when you hop on the leg.

Muscle tightness that eases with massage is much less worrying. Bone pain that stays put is not.

Amy, you clearly love running, and that is half the battle. Be patient with your legs for the next couple of months and you will be running further than you think. Best of luck with the treatment.

Kind regards,
Dom

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