A Leg To Stand On: Exercise Related Leg Pain in High School Athletes

There are many causes of ERLP but the 3 most common causes are medial tibial stress syndrome (a.k.a. shin splints), stress fractures, and exercise induced compartment syndrome. Athletes who perform high impact, repetitive sports which involve running, are especially at risk for developing this type of leg pain. The symptoms can occur in one or both legs and the greatest risk factor for getting ERLP during a season is having had pain during a previous season.

Medial tibial stress syndrome is more commonly referred to as shin splints. People suffering from shin splints usually complain of pain on the inner, posterior aspects of their lower legs. Numbness and changes in sensation are rare. Pain is usually worse with activity and improves with rest. Initially, pain often occurs only while running but sometimes symptoms can get so bad that it can occur with every day walking.

Shin splints occur because the muscles that attach to the inner, posterior aspect of the leg are overworked and are pulling so strongly against the bone (i.e. the tibia) that the lining of the bone (i.e. the periosteum) becomes very inflamed. This process is called periostitis, or inflammation of the periosteum. This usually occurs after suddenly increasing the frequency, intensity, or duration of athletic training. Being flat footed increases the likelihood of developing this condition.

Stress Fractures

Stress fractures can occur in any bone in the leg, ankle or foot but the tibia is the most common site in the running athlete. Stress fractures occur when there is an imbalance between bone production and bone break down. Again, a sudden increase in the duration, intensity, and frequency of a training program is often noted by patients suffering from this condition. Increasing activity before the muscles are strong enough puts too much stress on the bones. This causes tiny microscopic cracks in the bone. If your activities produce these cracks faster than your body can repair them, they accumulate and cause a true fracture. Bone pain and swelling are the hallmarks of this condition.

Female athletes are particularly at risk for developing stress fractures. Estrogen plays a major role in bone healing. Poor nutrition and being underweight leads to low levels of estrogen. A common sign that this may be occurring is having irregular periods. To reduce the risk of developing stress fractures all athletes but especially female athletes should practice proper nutrition and consult their doctor if their periods are irregular.

The muscles in the legs are covered in thick tissue called fascia. When muscles do work during exercise they swell. For most people there is plenty of room inside this fascia to allow for this swelling. For some people though, the fascia does not allow for this swelling and the pressure inside the muscle increases. In exercise induced compartment syndrome, the pressure increases so much during exercise that it decreases the blood flow to the muscles and nerves inside the fascia. This causes significant pain and often numbness and tingling with exercise. Rest usually relieves all symptoms but symptoms recur when exercise is resumed.

Treatment for ERLP is dependant on the cause. These are just a few examples of the most common reasons for ERLP. In order to prevent missed time from sports, an early and accurate diagnosis is necessary. Consult your physician or orthopedic surgeon if you suffer from this condition. Properly treating ERLP will give you "a leg to stand on" as you train and compete throughout your athletic career.