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External Factors to Consider for Lower Leg Pain in Runners


Lower leg pain is incredibly common in runners, both new and experienced. And right now, in this year of unusual and different training for so many, new aches and pains are creeping up. This leads to a lot of unhappy runners!

A lot of lower leg pain in runners comes from some sort of imbalance when the body is under load. An imbalance is typically compensation for an ache, pain, instability, lack of mobility, or muscle weakness from one side to the other. This could happen for a number of reasons: type of running surface, the camber of the road, old shoes, and change in work lifestyle.

You should always be aware of the surface you are running on. Let’s look at the actual surface first. Surfaces can vary from soft surfaces, like grass or dirt, to the concrete jungle of NYC. If you are on a softer surface, injuries tend to be more muscular due to a lack of stability from the soft surface. If you are on a harder surface, it’s more stable, but there is more loading through the body with less return from the ground. This results in more bone injuries compared to soft surface running.

In addition to the actual surface, assess the camber of the road, path, or trail you are on. If you are constantly running on one side of the road, your hips will be off-balance because one leg will be landing lower than the other. If you are constantly running on a track you will always be turning left. Consider switching upsides of the road (as long as it is safe!) and running in the opposite direction on the track.

Once you’ve assessed your running surface, consider your shoes. Some runners are doing more right now and some are doing less, but in both cases, runners are out of their typical routine. This means you need to pay closer attention to the mileage on your shoes because they might be wearing out faster than they have in the past.

Lastly, has your day-to-day work life changed? Are you sitting at a desk for a prolonged period of time, creating hip tightness? This is very common for a lot of runners here in NYC. It’s even worse right now, with most people working from home due to Covid. They are moving less and less throughout the day. We are seeing a subtle increase in hip tightness leading to slight changes in running mechanics. This change will lead to different muscle firing patterns, which could create some new aches and pains.

Each runner needs to be considered as an individual. Even internal factors that can be measured (i.e. leg length, foot posture, tibial torsion, Q angle, and hip tilt) can vary quite a bit between individuals. When you break down your basic movement patterns, you may start to understand an imbalance that’s been causing pain.

When assessing lower leg pain, consider the external factors that are easy to adjust: surface, road camber, shoes, and work lifestyle. Through trial and error, you might be able to clear up some nagging aches and pains.

Koldenhoven RM, Virostek A, DeJong AF, Higgins M, Hertel J. “Increased Contact Time and Strength Deficits in Runners with Exercise-Related Lower Leg Pain”. J Athl Train. 2020; 55 (12): 1247–1254.

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