Abstract
Leg pain in athletes has many aetiologies. The clinician must strive to specifically define the clinical problem in order to administer the appropriate treatment for the athlete’s condition. Clinical conditions in the leg causing symptoms in athletes include chronic exertional compartment syndrome (CECC), tendinitis, medial tibial stress syndrome, stress fractures, fascial defects, musculotendinous junction disruptions (tennis leg), popliteal artery entrapment syndrome, effort-induced venous thrombosis and nerve entrapment. Appropriate diagnostic studies are needed to allow accurate diagnosis. A work-up might include radiographs, bone scans and compartment pressure measurement. Many of these conditions relate to overuse and training errors. Conservative measures including rest, activity modification and rehabilitation will permit a gradual return to participation in sports. Some problems, such as CECC, popliteal artery entrapment syndrome and nerve entrapment may require surgical intervention to allow the resolution of symptoms. Clinicians should be familiar with the range of problems causing leg pain in order to prescribe specific treatment for each athlete.
Similar content being viewed by others
References
MacIntyre JG, Taunton JE, Clement DB, et al. Running injuries: a clinical study of 4,173 cases. Clin J Sport Med 1991; 1: 81–7
Clanton TO, Solcher BW. Chronic leg pain in the athlete. Clin Sports Med 1994; 13: 743–59
Hurschler C, Vanderby Jr R, Martinez DA, et al. Mechanical and biochemical analyses of tibial compartment fascia in chronic compartment syndrome. Ann Biomed Eng 1994; 22 (3): 272–9
Bourne RB, Rorabeck CH. Compartment syndromes of the lower leg. Clin Orthop 1989; 240: 97–104
Styf J. Diagnosis of exercise-induced pain in the anterior aspect of the lower leg. Am J Sports Med 1988; 16: 165–9
Martens MA, Backaert M, Vermaut G, et al. Chronic leg pain in athletes due to a recurrent compartment syndrome. Am J Sports Med 1984; 12: 148–51
Reneman RS. The anterior and the lateral compartmental syndrome of the leg due to intensive use of muscles. Clin Orthop 1975; 113: 69–80
Fronek J, Mubarak S, Hargens A, et al. Management of chronic exertional anterior compartment syndrome of the lower extremity. Clin Orthop 1987; 220: 217–27
Rorabeck CH, Bourne RB, Fowler PJ, et al. The role of tissue pressure measurement in diagnosing chronic anterior compartment syndrome. Am J Sports Med 1988; 16: 143–6
Pedowitz RA, Hargens AR, Mubarak SJ, et al. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med 1990; 18: 35–40
Mubarak SJ, et al. The medial tibial stress syndrome. Am J Sports Med 1982; 10 (4): 201–5
Beckham SG, Grana WA, Buckley P, et al. A comparison of anterior compartment pressures in competitive runners and cyclists. Am J Sports Med 1993; 21 (1): 36–40
Detmer DE, Sharpe K, Sufit RL, et al. Chronic compartment syndrome: diagnosis, management, and outcomes. Am J Sports Med 1985; 13: 162–70
Schepsis AA, Martini D, Corbett M. Surgical management of exertional compartment syndrome of the lower leg: long-term followup. Am J Sports Med 1993; 21 (6): 811–7
Rorabeck CH, Fowler PJ, Nott L. The results of fasciotomy in the management of chronic exertional compartment syndrome. Am J Sports Med 1988; 16: 224–7
Davey JR, Rorabeck CH, Fowler PJ. The tibialis posterior muscle compartment: an unrecognized cause of exertional compartment syndrome. Am J Sports Med 1984; 12: 391–7
Rorabeck CH. Exertional tibialis posterior compartment syndrome. Clin Orthop 1986; 208: 61–4
American Medical Association Subcommittee on Classification of Sports Injuries. Standard nomenclature of athletic injuries. Chicago (IL): American Medical Association, 1966
Bachner EJ, Friedman MJ. Injuries to the leg. In: Nicholas JA, Hershman EB, editors. The lower extremity and spine in sports medicine. St Louis (MO): CV Mosby, 1995: 523–80
D’Ambrosia RD, Zelis RF, Chuinard RG, et al. Interstitial pressure measurements in the anterior and posterior compartments in athletes with shin splints. Am J Sports Med 1977; 5 (3): 127–31
Richie DH, DeVries HA, Endo CK. Shin muscle activity and sports surfaces: an electromyographic study. J Am Podiatr Med Assoc 1993; 83 (4): 181–90
Michael RH, Holder LE. The soleus syndrome: a cause of medial tibial stress (shin splints). Am J Sports Med 1985; 13: 87–94
Viitasalo JT, Kvist M. Some biomechanical aspects of the foot and ankle in athletes with and without shin splints. Am J Sports Med 1983; 11: 125–30
Andrish JT, Bergfeld JH, Walheim J. A prospective study on the management of shin splints. J Bone Joint Surg Am 1974; 56 (8): 1697–700
McKenzie DC, Clement DB, Tauton JE. Running shoes, orthotics and injuries. Sports Med 1985; 2: 334–47
Cook SD, Kester MA, Brunet MA. Shock absorption characteristics of running shoes. Am J Sports Med 1985; 13 (4): 248–53
Detmer DE. Chronic shin splints: classification and management of medial tibial stress syndrome. Sports Med 1986; 3: 436–46
Jones DC, James SL. Overuse injuries of the lower extremity: shin splints, iliotibial band friction syndrome and exertional compartment syndromes. Clin Sports Med 1987; 6: 273–90
Ekenman I, Tsai-Fellander L, Johansson C, et al. The plantar flexor muscle attachments on the tibia: a cadaver study. Scand J Med Sci Sports 1995; 5 (3): 160–4
Fredericson M, Bergman AG, Hoffman KL, et al. Tibial stress reaction in runners: correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995; 23 (4): 472–81
Beck BR. Tibial stress injuries: an aetiological review for the purposes of guiding management. Sports Med 1998; 26 (4): 265–79
Shwayhat AF, Linenger JM, Hofherr LK, et al. Profiles of exercise history and overuse injuries among United States navy, sea, air, and land (SEAL) recruits. Am J Sports Med 1994; 22 (6): 835–40
Markey KL. Stress fractures. Clin Sports Med 1987; 6: 405–25
Sullivan D, Warren RF, Pavlow H. Stress fractures in 51 runners. Clin Orthop 1984; 187: 188–92
Kadel NJ, Teitz CC, Krommal RA. Stress fractures in ballet dancers. Am J Sports Med 1992; 20: 445–9
McBryde AM. Stress fractures in runners. Clin Sports Med 1985; 4: 737–52
Matheson GO, Clement DB, McKenzie DC, et al. Stress fractures in athletes: a study of 320 cases. Am J Sports Med 1987; 15: 46–58
Bennell KL, Malcolm SA, Thomas SA, et al. Risk factors for stress fractures in female track-and-field athletes: a retrospective analysis. Clin J Sport Med 1995; 5 (4): 229–35
Whitelow GP, Wetzler MJ, Levy AS, et al. A pneumatic leg brace for the treatment of tibial stress fractures. Clin Orthop 1991; 270: 301–5
Green NE, Rogers RA, Lipscomb AB. Nonunions of stress fractures of the tibia. Am J Sports Med 1985; 13: 171–6
Rettig AC, Shelbourne KD, McCarroll JR, et al. The natural history and treatment of delayed union stress fractures of the anterior cortex of the tibia. Am J Sports Med 1988; 16: 250–5
Blank S. Transverse tibial stress fracture: a special problem. Am J Sports Med 1987; 15: 597–602
Barrick EF, Jackson CB. Prophylactic intramedullary nailing of the tibia for stress fracture in a professional athlete. J Orthop Trauma 1992; 6: 241–4
Mubarak S, Hargens S. Exertional compartment syndromes. In: Mack R, editor. AAOS symposium on the foot and leg in running sports. St Louis (MO): Mosby, 1982
Styf J. Chronic exercise-induced pain in the anterior aspect of the lower leg: an overview of diagnosis. Sports Med 1989; 7: 331–9
Miller WA. Rupture of the musculotendinous junction of the medial head of the gastrocnemius muscle. Am J Sports Med 1977; 5: 191–3
Slawski DP. Deep venous thrombosis complicating rupture of the medial head of the gastrocnemius muscle. J Orthop Trauma 1994; 8 (3): 263–4
Froimson AI. Tennis leg. JAMA 1969; 209: 415–6
Millar AP. Strains of the posterior calf musculature (‘tennis leg’). Am J Sports Med 1979; 7: 172–4
Delaney TA, Gonzalez LL. Occlusion of the popliteal artery due to muscular entrapment. Surgery 1971; 69: 97–101
McDonald PT, Easterbrook JA, Rick NM, et al. Popliteal artery entrapment syndrome: clinical, noninvasive and angiographic diagnosis. Am J Surg 1980; 139: 318–25
Collins PS, McDonald PT, Lim RC. Popliteal artery entrapment: an evolving syndrome. J Vasc Surg 1989; 10: 484–90
Cummings RJ, Webb HW, Lovell WW, et al. The popliteal artery entrapment syndrome in children. J Pediatr Orthop 1992; 12 (4): 539–41
Lysens RJ, Renson LM, Ostyn MS, et al. Intermittent claudication in young athletes: popliteal artery entrapment syndrome. Am J Sports Med 1983; 11: 177–9
Rudo ND, Noble HB, Conn Jr J, et al. Popliteal artery entrapment syndrome in athletes. Physician Sports Med 1982; 10: 105–14
Erdoes LS, Devine JJ, Bernhard VM, et al. Popliteal vascular compression in a normal population. J Vasc Surg 1994; 20 (6): 978–86
Chernoff DM, Walker AT, Khorasani R, et al. Asymptomatic functional popliteal artery entrapment: demonstration at MR imaging. Radiology 1995; 195 (1): 176–80
Di Marzo L, Cavallaro A, Sciacca V, et al. Natural history of entrapment of the popliteal artery. J Am Coll Surg 1994; 178 (6): 553–6
Darling RS, Buckley CJ, Abbott WM, et al. Intermittent claudication in young athletes: popliteal artery entrapment syndrome. J Trauma 1974; 14: 543–52
Duwelius PJ, Kelbel JM, Jardon OM, et al. Popliteal artery entrapment in a high school athlete: a case report. Am J Sports Med 1987; 15: 371–3
Harvey JS Jr. Effort thrombosis of the lower extremity of a runner. Am J Sports Med 1978; 6: 400–2
Zigun JR, Schneider SM. ‘Effort’ thrombosis (Paget Schroetter’s syndrome) secondary to martial arts training. Am J Sports Med 1988; 16: 189–90
Gerkin TM, Beebe HG, Williams DM, et al. Popliteal vein entrapment presenting as deep venous thrombosis and chronic venous insufficiency. J Vasc Surg 1993; 18 (5): 760–6
Gorard DA. Effort thrombosis in an American football player. Br J Sports Med 1990; 24 (1): 15
Schobi R, Kocher F, Vorburger C. Deep leg vein thrombosis during skiing: a case report. Schweiz Med Wochenschr 1983; 113 (39): 1402–3
Massey EW, Pleet AB. Neuropathy in joggers. Am J Sports Med J 1978; 6: 209–11
McAuliffe TB, Fiddian NJ, Browett JP. Entrapment neuropathy of the superficial peroneal nerve: a bilateral case. J Bone Joint Surg Br 1985; 67: 62–3
Mitra A, Stern JD, Perrotta VJ, et al. Peroneal nerve entrapment in athletes. Ann Plast Surg 1995; 35 (4): 366–8
Styf J. Entrapment of the superficial peroneal nerve: diagnosis and results of decompression. J Bone Joint Surg Br 1989; 71: 131–5
Mozes M, Ouaknine G, Nathan H. Saphanous nerve entrapment simulating vascular disorder. Surgery 1975; 77: 299–303
Schon LC, Baxter DE. Neuropathies of the foot and ankle in athletes. Clin Sports Med 1990; 9: 489–509
Vastamaki M. Decompression for peroneal nerve entrapment. Acta Orthop Scand 1986; 57: 551–4
Marti B, Vader JP, Minder CE, et al. On the epidemiology of running injuries: the Bern Gran-Prix study. Am J Sports Med 1988; 16: 285–94
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Touliopolous, S., Hershman, E.B. Lower Leg Pain. Sports Med 27, 193–204 (1999). https://doi.org/10.2165/00007256-199927030-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00007256-199927030-00005