Many runners experience lower leg pain at some point in their running life. Exercise Induced Compartment Syndrome, Tenoperiostitis (Shin splints) and Stress Fractures are three common causes of this pain. Although all involve the lower leg, each has distinct features and should be dealt with accordingly. This eReport will focus on Exercise Induced Compartment Syndrome and Tenoperiostitis.

Exercise Induced Compartment Syndrome is caused by the increase of pressure in a muscle compartment, usually due to tight surrounding tissue layers called fascia (much like the orange peel around the orange). As exercise progresses, blood flow into the muscle increases in order to supply the muscle with oxygen and nutrients. To accommodate this extra blood flow, the muscle swells, a normal response. However, if the fascia around the muscle compartment is too tight, pressure will start to rise inside the muscle, leading to leg pain, possible numbness in the foot, as well as weakness.

The symptoms for Exercise Induced Compartment syndrome are typically only present during activity, with resolution of leg pain once the activity stops. Typically, tightness or cramping pain in the lower leg(s) begins and escalates as running progresses, corresponding to increasing pressure inside the affected muscle(s). Rest relieves the pain, which reoccurs once activity begins again.

Compartment pressure testing is the gold standard test to aid in the diagnosis of this condition.  Toronto SEMI is one of few facilities in Ontario that routinely do this testing. There are several other tests that may be needed to rule out other possibilities, including x-rays and bone scans to rule out stress fractures.


Orthotics will be beneficial in correcting any biomechanical imbalances. Often a decrease in activity or load to the affected compartment, with a gradual return to activity accompanied by stretching, manual fascial release techniques, lymphatic drainage and trigger point therapy may be beneficial. Surgical release of the affected compartment(s) is the definitive course if conservative approaches do not help.

Tenoperiostitis (Shin splints)

Pain in this syndrome is most often experienced along the inside part of the tibia (shin bone), and is due to inflammation along this part of the tibia where several muscles attach. This is a complex syndrome with many factors thought to be related, including foot type, leg alignment, shoe selection, training surface and training volume, among others. Often there will be a history of overtraining, improper footwear and poor warm up.

Diagnostic testing may need to be done to rule out stress fractures and other potential problems if symptoms persist.


  •     Rest and apply ice. Modify training volume
  •     Anti-inflammatory medication
  •     Taping the foot or orthotics for support
  •     Analyze running style for over pronation &/or incorrect mechanics
  •     Various therapeutic interventions are possible and potentially helpful, including Sport Massage techniques on the affected muscles, avoiding the inflamed part of the tibia
  •     Anti-inflammatory drugs along with rest and ice can help reduce inflammation, particularly in the early stages. However, if the underlying causes are not treated then the likelihood of the injury returning is higher.

References:    Wheeless’ Textbook of Orthopedics, (C)1996
D. Stoddard, MD Toronto SEMI

Rishi D. Ramkissoon  BPHE, RMT, SIM (y3)
Sport Massage Therapist
Stretch Therapist
Medical Exercise Trainer  Printed: November 2003
Copyright ©2003 SEMI