Lower leg pain...what is it?

Ok, I have been to the doctor, he says shin splints. I am just worried he is incorrect, and I am considering going to see another doctor or possibly a PT.

Here are the details:
Location: Lower leg, 3 inches above the bone on the inside of the ankle. It hurts on the back inside part of my leg.

When: This varies a bit, and I am overly sensitive to the area now, so I will be as general as possible. It does not hurt when walking or resting. It only slightly hurts when running. No pain cycling or swimming. It really doesn’t hurt at all unless I press on the area. However, there is a slight dull pain that comes and goes, nothing bad at all. When I run, it does sometimes feel a little tight, but not that bad. I first noticed it when massaging my lower legs with “the stick”, and this is the most common way for me to cause the pain. The pain only occurs with pressure, and immediately goes away after.

How Long: I have had this issue since the first part of November. I quit running after the first week of November, and did not run at all until just after Christmas, when I tried a couple of days, still felt pain, so called the doc. Went in two weeks ago, He told me it was shin splints, and that if I didn’t feel pain while running I should be fine, so I started running again last week. I have done 4 days so far, and the pain was back after the second run. My runs were 2, 3, 3, 4 miles in that order, basically every other day. I ran all runs at marathon pace or slower. I never felt that I was pushing it at all.

I am concerned because I feel that shin splints should have probably gone away after all of that rest. I mentioned this to my doctor, and he kind of shrugged it off, said it can take a really long time to get over. I am not saying he is wrong, I am just hoping that some has had, or knows someone who has dealt with this same thing. At one point I was sure I had a stress fracture, but the doc says no way, though no xrays or anything were done.

What caused it: This injury occurred during a 16 week marathon build, somewhere around week 14/15. I stopped running after the event. I had a very good base going into the build, full season of racing/training, and built slowly. I never did more than 60 miles in one week. My usual in season volume is around 25 when I am riding and swimming as well. During the build I did an occasional swim or ride, but 95% just running. My guess was simply over training as the cause. Possibly too much of an increase of effort and mileage during one of the later weeks, though I am not certain.

Some other info: I am 6’4" 215 lbs., 30 years old. I have been back to running for a couple of years now. I have had no other running injuries anywhere in the past. I have shoes that have been professionally fit to me, and I change them every 200-250 miles. I typically rotate between two pairs of shoes, though I am not methodical about it, I just keep two pairs, and toss both somewhere around 450 miles. I try to use them evenly. I have been using the same model of trainer for the last two years, Saucony Grid Propel NxGen.

Any help is appreciated.

Sounds like you need to rule out a stress fracture … might even show up on plain film X-ray at this point. Was your doc a general practitioner?

Honestly it sounds like a stress fracture to me. The location sounds like it is lower than the bottom of the gastrox, and not at a typical location for a soleus injury either. It’s possible that you have a torn soleus…but there’s a bunch of other small muscles in that area also. The key is whether the stick causes a definite muscular-type pain or not. Bone issues “feel” different…

Hey,
As mentioned you should rule out a stress fracture via x-ray or bone scan with a competent doc. Prior to imaging, a good clinical exam should also help guide the diagnosis.
If cleared from a stress fracture, look up Medial Tibial Stress Syndrome (MTSS) , a prevelent condition in runners, usually lower 1/3 of medial lower leg.
MTSS is usually a recurring dull pain in that area during running, and palpable tenderness.

rroof,

Yes, GP. You responded to another post when I thought I had a stress fracture, and yours along with several others on ST as well as my wife and friends convinced me I needed to go to a doctor. I hadn’t been to a doctor since 1990, so it was probably time anyway. I had a physical done, and we talked a bit about this problem. He told me there is no way I have a stress fracture because I don’t feel pain in my daily activities (other than after runs). He said I have shin splints, and that I need to do some stretching, and then showed me what types of stretches to do. I told him that I was already doing all of those on a very regular basis, in addition to some others, and he said I just need to do them more. I am a sales rep, and spend hours and hours a day driving, so I am usually pretty tight. Because of that I have started a regular stretching and self massage (with “the stick”) routine that I do at least every other day. I also do some Yoga, usually not more than once per week.

My doctor told me that getting an Xray would be a waste of time and money (I have to pay for the first $5k with my insurance), and that he was confident it is just shin splints. He is the medical professional, so I decided to listen to him. However, because the pain is exactly the same, and has not improved over a couple of months of no running, I am skeptical. Maybe I shouldn’t be, but I am.

Sorry if this is a dumb question, but I haven’t dealt much with the medical system, who do I call about and Xray? Should I call my doc again, or contact someone else?

Also, I know you are some sort of doctor/medical professional, do you have anyone in the Chattanooga, TN area you could recommend? I didn’t know if you have some kind of network or something.

Thanks for the advice. I feel that you are correct, in order for me to feel better, I need to rule out the stress fracture. I am worried on every run that I am prolonging my situation, or even making it worse. I need that to go away.

Scott

triguy42,

Thanks for the response. It definitely feels like it could be a muscle injury. It doesn’t really feel all that different from any normal muscle problem when you massage it, it just has stuck around for a lot longer (2 months).

I have never broken a bone, so I don’t really know what “bone pain” would feel like. It is very localized, which was one of the reasons I thought it might not be a muscle, but I guess there could be a really small muscle in that area? I have to admit I am completely clueless on detailed anatomy. I am nearing the edge of my limit with “lower leg”. I have no idea what a soleus or gastrox would be.

Thanks again for the help,

Funny that a GP doesn’t order a simple test (since they are famous for that). Since I have an X-ray (and ultrasound) in the office, it is pretty easy. They cost $45 cash for a patient and many insurance companies pay less than $28 for an X-ray exam (3 views), so I’d hardly call the test expensive! Having said that, stress fractures do not show well on plain film X-rays, but it is a good initial scout test since if it does - bingo you are done - no question and no further tests needed. This is even more important in one who continues to try and run as this can linger in a subclinical state for a long time. Other simple clinical exams (like a 128 Hz tuning fork test, single leg hop test, etc.) should also be done. An MRI is most sensitive to differentiate a focal cortical fracture from typical medial tibial stress syndrome (shin splints) or “pre stress fracture”, but they are definitely costly (about $1100 around here).

Don’t know anyone in Chattanooga (specialist). I generally would not suggest to step over your PCPs recommendation, but pressing for an X-ray order or referral to someone since it has not improved despite following orders would be appropriate.

rroof,

Once again, thanks for the advice.

I will call my doctor back and just ask him if he would order and Xray to ease my mind. His office is in a hospital, I am sure there is an Xray machine around there somewhere. I had no idea they were that cheap. I would gladly pay that just in case.

I may be over simplifying this, but I can jump on one foot with no pain, I am assuming that is the “single leg hop test”, but it seemed like it might be.

I am not impressed with my GP, this was my first visit, but he just didn’t seem all that concerned about what I see as a serious problem. He is quite obviously not an athlete, and I sort of got the feeling he doesn’t understand how important being able to run without pain is to me. I have been asking around with some friends to see if anyone has a GP that is more focused on athletes, or maybe is an athlete themselves. I just feel that they might understand what I am dealing with better.

Thanks again. I really appreciate you sharing your expertise.
Scott