Pain and muscle tension in the calves and shins is one of the most common problems I see in runners. On my website, the page "Calf Tightness When Running" gets almost twice as many views as any other page on the site.
The cause of such pains can be widespread.
Pain in the back of the lower leg can be:
- muscle tension in the calf
- a stress fracture
- cramp
- a calf muscle strain (tear)
- Achilles tendinopathy
- Achilles tendon tear
- deep vein thrombosis
- posterior compartment syndrome
Pain at the front of the lower leg may be:
- "shin splints" — medial tibial stress syndrome (MTTS)
- a stress fracture
- anterior compartment syndrome
- tibialis anterior muscle strain/tension
Pain at the side of the lower leg could be:
- a fibula stress fracture
- peroneal muscle strain/tension
- peroneal tendinopathy
While the treatment of each of these conditions varies considerably, there are several similarities in terms of common causes of the injury and ways runners can help themselves to recover more quickly and return to running.
1. Consider your running shoes
Running shoes are important to a runner. While the whole heel strike / forefoot strike / barefoot running debate rages on, at the end of the day what works for one person won't work for another. Sometimes, it is simply a case of trial and error.
If you're a new runner, make sure you get some advice regarding your running shoe choice. Make sure you have new, supportive running shoes that are comfortable and cushioned. Don't start running in your old tennis shoes from your college days!
If you're a seasoned pro and you've suddenly succumbed to lower leg pain for the first time, ask yourself if anything has changed. Have you changed shoes lately, maybe tried a different brand or model?
If not, is that the problem? Do you need some new running shoes? Remember the average lifespan of a pair of running shoes is 400 miles. That sounds a lot, but count up a rough total for your last month of running, and you'll see that 400 miles can soon come around.
In either case, getting a gait analysis is a great first step in treating your lower leg problems. Find a reputable running shop or physical therapist who offers this service. They can then recommend which shoes would best suit your foot and running style.
2. Stretch your calf muscles
The calf muscles (principally gastrocnemius and soleus) are vital to ankle function. If they are tight, this limits the range of dorsiflexion (pulling the foot upward) you can achieve.
If you can't move the ankle as much as your body would like, you start to compensate. One main way of doing this is to increase the range of eversion you utilize. Most people would see this as an increase in pronation at the foot — also called overpronation — where the foot rolls in and the arch collapses.
Excessive pronation can contribute to lower leg injuries such as MTTS, Achilles tendinopathy, compartment syndromes, and peroneal and posterior tibialis tendon issues. It can also contribute to other issues such as plantar fasciitis, knee pain, and hip and lower back issues, to name just a few.
The calf muscles can become tight for several reasons, the most common being past injuries and overuse. If you've previously pulled your calf, sprained your ankle or even fractured a bone in the lower leg, this may be the root cause of your problems.
Focus on stretching your calf muscles over a period of a couple of weeks. This should be done several times throughout the day, holding each stretch for 30 seconds and repeating three times on each leg. It takes quite a commitment to achieve an increase in muscle flexibility, so stick to it!
Try a run after the two-week period and see if anything has changed.
3. Strengthen your glutes
Strong glutes are key for any runner. They are the powerhouse of the body and have a multitude of functions when it comes to our running gait.
One of these functions is to propel us forward with every step. From the moment your foot hits the ground, your glutes should be working hard to powerfully extend the hip, move your upper body over the weight-bearing limb and on to the next step. If the glutes aren't working as they should, something else must happen for this propulsion to occur.
First, the hamstrings tend to overwork, so if you feel you have tight, tired hamstrings, this may well be you. Second, the calf muscles work harder to push you up and forward during the last part of the stance phase. I mentioned above that overuse is one reason that the calf muscles can become tight.
Weak or inhibited glutes is becoming a more common issue in physical therapy. This is more than likely due to the increased number of hours that many of us are spending sitting — at a desk, in the car or for any other reason.
4. Review your training schedule
Training load (frequency/duration/intensity) could be a cause of your lower leg pain. Many new runners suffer with these problems due to a sudden introduction to running and a load that their soft tissues and bones cannot deal with. It's all too easy when you’re getting into a new activity to overdo it.
New runners should not run on consecutive days and should not run more than three times a week. Overall weekly mileage should not increase by more than 10 percent for any runner.
If you're an experienced runner, consider the following: Have you started increasing your load lately? Have you added in hill running or changed to a route that now includes more hills? Do you get enough rest days?
Never run every day. Always have at least one rest day per week, with one to two easy/short runs (recovery runs) or cross training days in the middle.
5.Visit a professional
Consider all the above points. If either none seem to apply to you or you've addressed the points raised but are still getting pain, then it is definitely time to visit a sports injury professional.
They will be able to assess your injury, refer you for imaging (X-rays, MRIs, etc.) where necessary and develop a treatment plan to get you back on the road!
