Member Case Study: Mild Pain on Right Leg When Running

author : AMSSM

comments : 0

I've been having mild pain on my right leg when I run. The pain occurs when running and is present for a few hours afterwards, then is gone. Do you have any ideas?

Question from tpeterson02
I'm a 24year-old male, and have been running regularly for 14 months. I now run 2-3x/week at 3-9 miles per time. I've been having mild (~3-4/10) pain on my right leg when I run. The pain occurs when running and is present for a few hours afterwards, then is gone. However, if I push on this particular location, the pain is more severe (6-7/10) and pushing on the location elicits pain even if I have not run recently. It is a very localized pain, on the bone, about 1-2cm below the tibial tuberosity and on the lateral aspect of my tibia. I have no muscular pain at all. There is a slight bump at this location that gets slightly larger after running, but no swelling.

The pain began in December. I stopped running completely for 3-4 weeks, but it did not improve (there was no pain at rest, but still tender if I push on it). It really has not changed much at all since it showed up in early December. I don't recall banging/hitting my leg at this location. I had an x-ray taken in mid-January, which was negative for stress fracture. My general doctor didn't know what it was, he only suggested ice, anti-inflammatories, and suggested maybe an MRI in 6-8 weeks if it is still present; and he didn't see any reason I had to stop running.

Do you have any ideas? Do any other possible diagnoses come to mind? Do you think I should keep running?

Answer

Stress fracture is the first thought that comes to mind and even though plain radiographs can pick up stress fractures, more times than not, they can miss the stress fracture. Your mileage and frequency of running are quite variable- only "2-3 times per week, 3-9 miles per run". So if you run three miles only twice a week and advance to 9 miles three times per week, you could be setting yourself up for an overuse reaction such as a stress fracture.

The lateral displacement high on the tibia and the fact that it increases in size make it suspicious for possibly a herniated fascia with the exercising muscle getting engorged and pushing through. But then you indicate it is hard like bone and not soft and spongy.

A bone scan would certainly help to differentiate whether a stress reaction was present, but I am more inclined to recommend a dynamic MRI - meaning, go for a run just before the MRI and when you are most symptomatic, see what image is displayed on the MRI (good for stress reactions and soft tissue injury) especially when you tell the reading radiologist where to look for the pathology. One other thought would be a ganglion cyst which could be identified on MRI.

My thought regarding training is to consider cross training until this matter is cleared up. That is, getting on the bike or in the pool or on the rowing machine. The sooner a more definitive diagnosis is made the better you will be in terms of knowing what you can and cannot do and for how long. Indeed, if it is a stress fracture you may need more time off (from running, while still cross training). It is difficult to make an "email diagnosis" with what you have presented, but at least this points you in a direction to find an answer.

Ken Bielak MD
Member AMSSM

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date: April 2, 2006