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Exercise Related Lower Leg Pain in Runners


Exercise Related Lower Leg Pain (ERLLP) is a term used to describe a few different types of injuries. These injuries include medial tibial stress syndrome, tibial stress fractures, chronic exertional compartment syndrome, and tendinopathy of the anterior or posterior tibialis muscles. Since running is a popular form of physical activity–but nobody seems to have time to take care of themselves before or after a run–we tend to see ERLLP quite often.

A recent study looked at gait mechanics and differences in healthy and unhealthy runners to try and determine causes of ERLLP. The study measured differences in alignment, range of motion, and strength in the lab using wearable sensors to track running metrics. The runners used the sensors for a week, running at least three times during the week at a normal pace, in their usual training locations, and wearing their normal running shoes. During the week they were asked to record levels of pain before, during, and after the runs.

After the week was over they analyzed the data and found that the ERLLP group had increased contact times compared to the healthy group. Contact time is the time in contact with the ground during the stance phase of running. Increased contact time is correlated with an increase in loading forces of the lower legs, which will lead to an increased risk of ERLLP. The ERLLP runners also reported decreased strength, specifically in the ankle and hip regions.

Higher contact times are correlated with ERLLP in this study. Increasing your cadence (number of steps per minute) is the most common gait retraining cue used to reduce contact time. It is generally recommended to increase your cadence by 10% instead of focusing on a specific number. For example, if your cadence is 150, try running at 165 instead of the well-known 180 steps per minute. I would also strongly recommend a strength program focused on stability at the ankles and hips, to encourage better push-off as you stride from one leg to the other on a stable base.

Koldenhoven RM Viostek A DeJong AF Higgins M Hertel J. “Increased Contact Time and Strength Deficits in Runner With Exercise-Related Lower Leg Pain.” Journal of Athletic Training. 2020; 55(12):1247-1254.

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