Training

A look at lower leg injuries

Apr 7, 2020

Injuries in the lower leg are more common in runners. I prefer to include the knee with the area below the knee as my approach to most injuries is based on my methods of joint to joint complex mechanisms of movement. The explanation to prevalence of lower leg injury in runners is due to the linear loading on the lower leg joints. Running induces mechanical load through the leg, gravitational distribution in the upper leg and force production in the pelvic complex. The velocity initiated through force production plays a role in lower leg injuries because of the compressive force output created along with the rebounding forces of landing in that lower leg joint to joint complex.

Runner lower leg injury

Types of lower leg injuries

  • Patella tendonopathy
  • Patella malalignment
  • Bursitis
  • Compartment syndrome
  • Medial tibial stress syndrome (MTSS)
  • Stress fractures
  • Oschgood Schlattes
  • Calf strains/tears
  • Achilles tendonopathy
  • Ankle joint pathology
  • Plantar fasciitis
  • Bone spurs/calcification

The mechanics of running involve force absorption of your upper body weight into your SI Joint and pelvis. The drive phase distributes this force (force distribution plays a role in upper leg conditions i.e ITB syndrome, Pes anserinus pathology, quadriceps tendonopathy) creating the workload on the lower leg on landing which then creates a rebound force. Now this is critical in lower leg injuries. The magnitude of rebound force affects the knee and ankle joints. Excessive forces on these joints can cause stress fractures, wear and tear injuries of the knee and bone spurs or calcification. Incorrect biomechanics produces abnormal forces through the soft tissue structures causing patella malalignment, achilles tendonopathy, and bursitis.

The iliotibial band (ITB) functions to distribute force or load through joint to joint complex. If these forces are not distributed accordingly, it leads to patella tendonopahy, Oschgood Schlattes and MTSS (shin splints). There are various causes to shin splints such as footwear, changing running surfaces frequently, excessive force on landing especially on medial calcaneus, hypertrophied calves, poor footroll on take-off and weak muscles. If peroenei (muscles on the outside of your lower leg) and Tibialis anterior (muscle on the front of your shin bone) are weak, this affects force dissipation. The tibialis anterior is a major shock absorber. If it is adequately strong it takes load off the patella tendon. The peroneis are important for stabilisation and force dissipation. It also assists in acceleration. Highly toned peroneis can cause compartment syndrome.

For Shin splints and stress fractures, it is advisable to rest, ice for 10-12min per time 3 or 4 times a day.  Stretch your tibialis anterior muscle, foam roll medial calf, apply strapping (there are many ways to strap, hence see your physio). Compartment syndrome needs the intervention of a sport doctor where they will perform minor surgery to release the pressure in the compartment.

By understanding these mechanisms for injury, you arrive at a correct diagnosis resulting in correct and effective treatment which will promote quicker recovery.

To prevent lower leg injuries

  • Ensure proper running form
  • Soften your landing
  • Use correct footwear
  • Strengthen your tib ant and peronei
  • Add plyometrics to your training
  • Ensure sufficient intake of calcium
  • If you live at the coast, do a 400m run on beach sand regularly
  • Do mobility exercises for your ankles

Do not neglect symptoms in the lower leg compartment, however minor it may seem. These niggles could lead to severe injuries keeping you off from running for long periods. See your physiotherapist for adequate recovery because assisting circulation in these parts can be very helpful.

Below are some lower leg routines I have developed for base strengthening. All routines are performed in a superset manner. Start with 2 sets and increase to 3 sets after 2 weeks

Routine 1

  • Standing calf raises, toes pointed in x 20
  • Single leg balance, hold arms in front of you and reach forward to the point of almost tipping over x 8 on each leg
  • While sitting, loop band around top of foot, produce dorsiflexion movement (moving your foot up towards your shin) x 20

Routine 2

  • Pistol squats x 20
  • Single leg balance, arms up to side, reach side to side to the point of tipping over x 5 on each leg
  • While sitting, loop band around top of foot, perform eversion (outward) movement x 20

Routine 3

  • 1 legged squat, toes pointed in x 15
  • Single leg balance, arms above head, on tip toe reach as high as you can x 5 each leg
  • Long sitting, loop band around top of foot, perform inversion (inward) movement x 20

Walking on beach sand helps strengthen instrinsic muscles of the foot which can prevent plantar fasciitis. Do the little things, sometimes boring workouts which could go a long way in preventing injury and improving your performance. Wishing you Safe running.

Sumeshen Moodley


Sumeshen is a qualified physiotherapist in Durban who has worked with numerous international sports teams and athletes. He is passionate about running and has a special interest in human movement and biomechanics to optimise athletic/sport performance. Find out more about Sumeshen here

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