Pain guide
Most leg pain is not serious. An NHS physiotherapy leaflet says most new leg pain improves within 6 to 8 weeks and that scans are not usually needed. That reassurance holds once the warning signs below have been ruled out, so read them first.
Then find where it hurts. If it points to a clear problem, such as sciatica, shin splints, the Achilles, a calf or hamstring strain, heel pain or cramps, go to that guide: each has a plan and a pain rule matched to the tissue. For ordinary aches with no clear cause, follow the plan on this page from stage 1.
Exercise is for pain that has been checked or is clearly mild and settling.
Location narrows the likely causes; it does not diagnose.
Often into the foot, sometimes with tingling or numbness. Usually sciatica: a nerve irritated in the lower back.
Read: Sciatica →Inner edge of the shinA long tender strip that hurts during and after running: shin splints (medial tibial stress syndrome).
Read: Shin splints →One fingertip-sized spot on a boneOn the shin or foot, worse with each step and later at rest or at night: a possible stress fracture. Get it checked; the shin splints guide shows how the two differ.
Read: Shin splints →Back of the heel or the cord above itSore and stiff, often worst first thing in the morning: Achilles tendinopathy.
Read: Achilles tendinopathy →Under the heelWorst on the first steps in the morning or after sitting: plantar heel pain (plantar fasciitis).
Read: Plantar fasciitis (heel pain) →Calf, sudden pain during sportA sharp pull mid-stride, tender in one spot: usually a calf strain.
Read: Calf pain →A possible deep vein thrombosis (DVT). Get a same-day check rather than exercising it.
Narrowed leg arteries (claudication), or, if sitting or bending forward eases it, narrowing in the lower spine (lumbar spinal stenosis). Both need a diagnosis; both are treated first with exercise.
A hamstring strain.
Read: Hamstring strain →Deep in the lower buttock, worse sittingHigh (proximal) hamstring tendinopathy, covered in the hamstring guide.
Read: Hamstring strain →Calf or foot, a sudden painful knotOften at night: a muscle cramp.
Read: Leg cramps →Usually in the evening or at night: restless legs syndrome (see below).
Worse after standing and eased by raising the legs: varicose veins (see below).
An NHS physiotherapy service tells patients that leg pain is rarely caused by anything serious, that most new leg pain improves within 6 to 8 weeks, and that scans are not usually needed. Its advice is to do a bit less for a short time, but not to rest completely.
Source 1
Claudication is a painful ache in the legs when you walk, which usually goes after a few minutes' rest. It comes from narrowed arteries, and smoking, diabetes and heart risk need medical care alongside exercise.
Lumbar spinal stenosis causes aching or cramping in the buttocks, thighs or calves with standing and walking, eased by sitting or bending forward. Telling the two apart at home is unreliable: narrowed arteries can cause leg symptoms like stenosis, so get it assessed.
Both are treated first with exercise, but with opposite pain rules. For claudication, NICE suggests about 2 hours of supervised exercise a week for 3 months and encourages exercising to the point of maximal pain. For stenosis, exercise such as progressive cycling, an adjusted walking program and stretching is first-line, with short pauses as needed. Neither rule applies to the muscle and tendon pain on the rest of this page.
Restless legs syndrome is an urge to move the legs at rest, usually in the evening or at night, sometimes with tingling or throbbing. NHS self-help advice is exercise during the day, a regular sleep routine, less caffeine and alcohol, and, when symptoms start, walking, stretching or massaging your legs.
In one small trial (23 people completed it), 12 weeks of aerobic and lower-body strength training 3 days a week improved symptoms. See a GP if it stops you sleeping: iron deficiency, pregnancy, kidney disease and some medicines are linked with it. Walking, calf raises and calf and hamstring stretches from the plan below are a reasonable daytime habit.
Varicose veins can cause pain, aching or a feeling of heaviness, worse after standing and eased by raising the legs. The NHS advises raising your legs, exercising regularly, such as walking, to improve blood flow, and avoiding standing or sitting for long periods. NICE advises light to moderate physical activity.
Evidence that exercise changes vein disease is very low quality: a Cochrane review found only 2 small trials. Walking and calf raises are sensible, low-risk habits. A bleeding vein needs urgent help; skin changes, hard painful veins or a leg ulcer that has not healed in 2 weeks need a GP.
For leg pain without warning signs, the NHS leaflet advises doing a bit less for a short time rather than resting completely: short walks, heat, staying at work and gentle exercises. As a rule for all leg pain this rests on clinical advice more than trials.
For sciatica and Achilles tendinopathy it is guideline-level advice: the NHS says that even if moving hurts, it is not harmful, NICE encourages people with sciatica to keep up normal activities, and the Achilles guideline says complete rest is not indicated.
The 2024 Achilles guideline makes calf loading, as heavy as you can tolerate, the first-line treatment, and exercise beat wait-and-see by about 20 points on a 100-point Achilles score at 3 months. The 2023 heel pain guideline gives its top grade to plantar fascia and calf stretching, and recommends strengthening the foot and ankle a grade lower.
A systematic review found no shin splints treatment free enough of bias to recommend. In a trial of 74 athletes, a graded running program did as well on its own as with added calf exercises or a compression stocking. A gradual return to running is the backbone.
NICE says to offer a supervised exercise program to everyone with claudication. A Cochrane review found high-quality evidence that exercise programs increase pain-free walking distance, by about 82 metres on average, and maximum walking distance, by about 120 metres. They did not change the ankle blood pressure test, and there was no evidence of an effect on amputation or death.
This site's default for ordinary leg aches: mild discomfort during exercise is acceptable if it settles within a day and the trend over the weeks is improving. Sharp pain, pain that keeps building, or pain at night means stop and get it checked.
Each tissue has its own rule, given in its guide. Tendons tolerate a little more (in an Achilles trial, up to 5 out of 10). Nerve glides should feel like a pull, not pain. A suspected stress fracture should not be pushed through pain at all.
Start at the first stage. Each move opens a full guide with a 3D demo.
The first days to 2 weeks. Keep blood moving and use the leg without flaring it. The NHS advises getting up and moving every hour or so when you sit for long spells.
3D demoTreadmill walkingBeginner · Cardio machine5 to 10 min, 2 to 3 times a day · Any easy walking counts
Harder: Treadmill jogging
3D demoAnkle CirclesBeginner · Other / check instructions10 circles each way, every hour you sit
Harder: Peroneals Stretch
3D demoSeated bent-knee calf raise (soleus raise)Beginner · A bench or box2 sets of 10 to 15
Harder: Slow calf raise
3D demoGlute bridgeBeginner · No equipment2 sets of 10
Easier: Pelvic tilt into bridge · Harder: Glute kickback (quadruped hip extension)
3D demoSupine hamstring stretch with a strapBeginner · No equipment3 holds of 20 to 30 s each side · Only if comfortable
Easier: Leg-up hamstring stretch · Harder: Contract-relax hamstring stretch (PNF)
Move on when: You can walk for 20 minutes and do daily tasks, and the leg is no worse the next morning.
About weeks 2 to 6.
3D demoSlow calf raiseBeginner · A wall3 sets of 10 to 15
Easier: Seated bent-knee calf raise (soleus raise) · Harder: Standing dumbbell calf raise
3D demoSingle-leg standBeginner · A wall3 holds of 20 to 30 s each leg
Easier: Tandem stance and heel-to-toe walk · Harder: Single Leg Reach Matrix
Move on when: These feel moderate, and the pain is settling week by week.
From about week 6. Single-leg strength and springy impact, back to your usual activity.
3D demoSingle-leg calf raise from a stepIntermediate · A step + A wall3 sets of 10 to 15 each leg
Easier: Slow calf raise · Harder: Single-leg pogo hops
3D demoSplit squatIntermediate · No equipment3 sets of 8 each leg
Easier: Bodyweight squat · Harder: Reverse lunge
3D demoSingle-leg Romanian deadliftAdvanced · A dumbbell3 sets of 8 each leg, bodyweight first
Easier: Dumbbell Romanian deadlift · Harder: Full Nordic curl
3D demoPogo hopsIntermediate · No equipment3 sets of 20 · Once ankle bounces are easy
Easier: Ankle bounces (mini pogo) · Harder: Single-leg pogo hops
3D demoTreadmill joggingIntermediate · Cardio machineWalk-jog intervals · If running is your goal
Easier: Treadmill walking · Harder: Sprint intervals
Move on when: Hopping and your usual activity feel normal. Add running time before speed.
Cut back the activity that brings the pain on, such as distance, speed, hills or jumping, for a short time, and keep walking and gentle exercise going.
Break up long spells of sitting. The NHS advises getting up and moving every hour or so to help prevent clots, especially on journeys of over 4 hours.
If you can point to the sore spot on a bone with a fingertip, or it hurts at night or with every step, stop the impact activity and get it checked. Health New Zealand's advice for stress fractures is plain: do not keep pushing through the pain.
Source 9
Stay active, try gentle stretches and nerve glides, then build strength. What NICE and the trials support, with 3D demos and the warning signs.
Pain guideShin splints or stress fracture? How to tell, what to stop, calf and shin strength work, and a walk-run return plan. Evidence graded, 3D demos.
Pain guideThe 2024 guideline says load the calf as heavily as you can tolerate. A staged plan for mid-tendon and heel-end pain, with a pain rule and 3D demos.
Pain guideOne swollen, warm calf needs a same-day check. For a strained calf, start gentle loading within days. Staged plan with 3D demos and graded evidence.
Pain guideLengthening exercises got footballers back sooner, and the Nordic curl halves hamstring injuries. A staged plan with 3D demos, plus high hamstring pain.
Pain guidePlantar fascia and calf stretches, heel raises with a towel under the toes, and what else helps heel pain. Graded evidence and 3D demos.
Pain guideNightly calf and hamstring stretches eased cramps in one trial of older adults. What to do mid-cramp, what the evidence says, and when to get checked.
A gentle leg strength routine with no jumping: sit-to-stands, step-ups, wall sits, bridges and calf raises.
20 minBeginner7 movesA bench or box, A stepSeven stretches for after a run: calves, soleus, quads, hip flexors, hamstrings and glutes.
10 minBeginner7 movesA wallWhen it comes with a warning sign: one swollen, warm or discoloured calf, breathlessness or chest pain, a suddenly cold and pale leg, numbness around the genitals or bottom, or a change in bladder or bowel control. These need urgent help. The full list is at the top of this page.
A strain usually starts during activity and is tender in one spot. A clot tends to bring swelling in one leg, throbbing pain and a change in skin colour. They can feel alike, so if in doubt get a same-day check.
Usually keep moving and do a bit less for a short time; complete rest is rarely the answer. The exception is bone pain: if you suspect a stress fracture, stop the impact activity and get it checked.
Walking, calf raises, bridges, sit-to-stands and step-ups, built up gradually, as in the plan above. For a specific problem, the condition guides give a plan and a pain rule matched to it.
Most new leg pain improves within 6 to 8 weeks. Sciatica usually settles in a few weeks to a few months; Achilles tendinopathy often takes months, sometimes up to a year.
Usually narrowed leg arteries (claudication) or narrowing in the lower spine (spinal stenosis); stenosis tends to ease when you sit or bend forward. Both are treated first with exercise, after a diagnosis, so see a GP.
Usually not. Most leg pain is diagnosed from your history and an examination. Scans are for when something does not fit, such as a suspected stress fracture.
Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.
