Exertional Leg Pain in Marathon Runners

As marathon day draws nearer, unfortunately the number of injuries we see often increases. In this blog, Dr Mike Burdon will discuss three common marathon related injuries in more depth.

As marathon day draws nearer, thousands of runners will be looking to complete their training programs in preparation for the big day. Having previously completed three London Marathons and an Ultra-Marathon myself, I am aware of the need to increase the mileage in training in order to tackle the distance on race day.

Unfortunately injuries may happen around this time and a group of such injuries are often referred to as "Exertional Leg Pain". This usually refers to 3 conditions that I will discuss; namely Medial Tibial Stress Syndrome (Shin Splints), Stress Fractures and Compartment Syndrome.

  1. Medial Tibial Stress Syndrome (MTSS) is usually referred to as " Shin Splints". Runners often feel pain on the inside (medial) part of their shin bone (tibia) - hence the name. The stress is usually on the inside of the bone where the muscles attach. The pain often comes on early into a run, and sometimes the pain reduces as the run progresses. It may allow the run to be completed but then produce some pain the next day, with a similar pattern occurring. Usually, there is no significant pain at rest or night.  Icing the affected area can help to reduce inflammation and a course of anti imflammatories can also help.
  2. Stress Fractures usually present with more significant pain and often this can be present at rest or in bed. Trying to run through the pain in training will usually lead to worsening pain and the inability to complete a run. Stress fractures can be a serious problem and lead to a full fracture with complications if ignored. They may be seen when there has been a sudden increase in the long run distance or total weekly mileage.
  3. Compartment Syndrome refers to pain in the shin or calf muscles within a specific muscle group or compartment. One or more groups can be affected and this leads to pain that worsens as a run progresses. Often a feeling of tightness and numbness in the foot can develop. Pain may be felt in the front or side of the shin and can affect the calf muscles also. This is a rarer cause of leg pain in runners but needs to be considered as a possible cause. 

In addition there are other but rarer causes of exertional leg pain in runners, so it's important to seek the advice of a clinician if you are worried.

As ever, diagnosis is very important. Following this, the correct management can be offered. If needed, Sports Doctors can use ultrasound on site, or refer you for tests such as MRI scans before offering more specific treatment.

If in doubt, it is always best to let a professional assess your injury and help you achieve your running goals. Happy running!