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I am training for a half-marathon (my first) but I'm having problems with my left lower leg. I can't quite put my finger on it but the pain is steady and increasing over time. I don't want to stop training but I'm worried I'll make whatever the problem is worse. What do you suggest?

Lower leg (below the knee) pain accounts for more leg problems than anything else (other than knee problems) in both competitive and recreational athletes. What starts out as an acute (short-term) problem can become chronic (long-lasting) without the proper diagnosis and treatment. A recent study from the Vanderbilt Orthopaedic Institute in Tennesse reported five common causes of lower leg pain in athletes. These conditions include 1) medial tibial stress syndrome, 2) chronic exertional compartment syndrome, 3) stress fracture, 4) nerve entrapment, and 5) popliteal artery entrapment syndrome. Long-distance runners and military personnel seem to have the most lower leg injuries. All five of these chronic lower leg pain problems are caused by weight bearing, repetitive or compressive forces, and overexertion or overuse from activities such as running. Continuing activities that bring on leg pain or make leg pain worse is an important risk factor for acute pain becoming chronic. Other risk factors for these conditions include female sex, anatomy (e.g., flat feet, hip internal rotation), and previous injuries. Eating disorders and loss of bone density are additional risk factors for bone fractures. And being overweight contributes to delays in recovery. Continued exercise and overtraining resulting in increased muscle bulk can lead to impingement (pinching) of a nerve or blood vessel (entrapment). As we mentioned, before treatment can be determined, an accurate diagnosis must be made. The physician starts with a good patient history including training history (number of sessions per week, length of each session, intensity of sporting activity), training surface, and footwear. Any recent changes in any of these variables may be an important part of the history. Depending on your symptoms, diagnostic imaging can include X-rays, bone scans, and/or MRIs. For more specific identification of problems involving compartment syndromes, pressure testing can be done. To test for nerve compression, electrodiagnostic studies can be ordered. The diagnosis helps direct treatment. Most often, conservative (nonoperative) care is the first line of treatment. Recommendations for conservative care include rest, the use of ice, antiinflammatory medications, and possibly taping, splinting or casting the lower leg. Physical therapy is an important part of the recovery and rehabilitation for these conditions. The therapist will address posture and alignment, flexibility and stretching, activity modification, and strengthening. The therapist is also integral in guiding the athlete in selecting proper shoe wear and getting back into an appropriate and effective training schedule. Some conditions such as stress fractures, requires rest before rehab. The athlete is put on crutches and a nonweight-bearing status. Load is taken off the bone until healing can take place. This means no sports or recreational activities until cleared by the physician. But don't panic or jump to conclusions about yourself. These are just some of the most common possibilities for lower leg pain. The first step is to see your primary care physician, orthopedic surgeon, or physical therapist for an evaluation. It could be something as simple as shoe wear or training technique.

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