Pain guide · Leg pain

Lower leg pain: the shin, the calf, the Achilles, nerves, circulation or a clot, and what helps

Lower leg pain, anywhere between the knee and the ankle, usually comes from the shin, the calf or the Achilles, and the exact spot and when it hurts point to which: a strip along the inner shin, one sore spot on the bone, a tightness that builds in every run, or a sudden pull in the calf. Some causes aren't muscles or bones at all: narrowed arteries, a clot, veins or a nerve from the back. A National Health Service (NHS) physiotherapy leaflet says most new leg pain improves within 6 to 8 weeks, but a few causes need help the same day.

This guide starts with those signs, from 999 and accident and emergency (A&E) to a general practitioner (GP). Then it maps the causes and what helps each, from a graded running programme for shin splints to walking into the pain for narrowed arteries, and gives a three-stage plan with lanes for muscle and tendon, bone and circulation, with a 3D demo of every move.

3-stage exercise plan When to get help 53 sourcesUpdated 25 October 2026

When to get help first

Exercise is for pain that has been checked or is clearly mild and settling.

Get urgent medical help if

Call 999 or go to A&E: sudden, severe pain in a muscle, which may be worse when you stretch it, with swelling, numbness, weakness or pins and needles, or tightness or difficulty moving the leg. This can be acute compartment syndrome, which needs surgery as soon as possible. It usually follows an injury or a bandage or cast that is too tight, but rarely it can follow very hard exercise. Do not drive yourself to A&E.
Call 999: calf or leg pain or swelling with breathlessness or chest pain. It could be a clot that has reached the lungs. Do not drive yourself to A&E.
Same day (urgent GP appointment or NHS 111): throbbing pain in one leg (rarely both), usually the calf or thigh; swelling in one leg (rarely both); red, blue or darkened skin around the painful area, which may be harder to see on brown or black skin; or swollen veins. This can be a deep vein thrombosis (DVT). It is more likely after surgery, a hospital stay, 3 or more days in bed, a journey of over 4 hours, pregnancy or a recent birth, cancer, a previous clot, or oestrogen-containing contraception or HRT.
Call 999 or go to A&E: a leg that is suddenly cold, pale, numb, weak or very painful. A sudden loss of blood supply to a leg is a vascular emergency.
Contact a GP immediately (or NHS 111 if you can't): burning leg or foot pain that carries on at rest, pale skin, wounds on the feet or legs that do not heal, or toes that go cold, numb, then red or black. The Global Vascular Guidelines and the Circulation Foundation add that this rest pain is often worse lying down and at night, can wake you, and is often eased by hanging the foot down or getting out of bed.
Call 999 or go to A&E after an injury if the leg is twisted or bent, a bone is sticking out, there's a bad cut or wound, or there are signs of shock: cold, sweaty skin, a fast or weak pulse, fast or shallow breathing, or blue, grey, pale or blotchy skin or lips. While you wait, don't move the leg or put weight on it, and don't eat or drink in case you need surgery.
Same day (NHS 111): after an injury, the leg is very painful or the pain is getting worse, there's a lot of swelling or bruising, it hurts to put weight on it, or it's very stiff or hard to move.
Same day: a sudden snap, or a feeling of being hit in the back of the lower leg, then walking flat-footed and being unable to push off or stand on tiptoe. This can be an Achilles tendon rupture.
Get help from NHS 111: you have shin splints and the pain is severe, or you've injured your shin.
Ask for an urgent GP appointment or get help from NHS 111: the skin on your lower leg is painful, hot and swollen. It could be cellulitis, a skin infection, which is more common on the legs. With a very high temperature, a fast heartbeat or fast breathing, purple patches, dizziness, confusion, or cold, clammy or pale skin, call 999 or go to A&E.
Call 999 or go to A&E: a cut, a wound or a red or swollen area of skin that is much more painful than you would expect, or comes with a high temperature, headache, tiredness and aching muscles, or with black, purple or grey blotches or blisters near it. It could be a rare but serious skin infection (necrotising fasciitis).
Ask for an urgent GP appointment or get help from NHS 111: throbbing or cramping pain in your leg, sudden swelling, warm, red or darkened skin around the painful area, or swollen veins that are hard or sore when you touch them. It needs checking in case it's a clot.
Ask for an urgent GP appointment or get help from NHS 111 if you have severe pain in a joint, usually just 1, that started suddenly, swelling around a joint, skin around a joint that has changed colour, or difficulty moving a joint, or you have joint pain, feel generally unwell and have a high temperature or feel hot, cold or shivery. An infected joint needs treating straight away, usually in hospital.
Call 999, even if the symptoms stop: sudden weakness or numbness down one side of the body, a drooping face, an arm you can't lift, or slurred speech. These are signs of a stroke, and a sudden foot drop can be part of one.
Call 999 or go to A&E: leg pain with numbness around the genitals or bottom, new trouble starting or controlling peeing, not knowing when you need to poo or losing control of it, sciatica in both legs, or weakness or numbness in both legs that is severe or getting worse. These can be signs of cauda equina syndrome, which needs treating in hospital as soon as possible.
Call 999 or go to A&E: a child or teenager with sudden pain in the hip, knee or thigh, or who can't put any weight on their leg. Same day (urgent GP appointment or NHS 111): a child or teenager who is limping. Hip problems in children can sometimes be felt in the thigh or knee.
Same day: leg weakness that is getting worse; new leg pain with a history of cancer, HIV, TB or inflammatory arthritis; or leg pain with a fever, feeling unwell, loss of appetite, unexplained weight loss or night sweats.

See a doctor or physiotherapist if

Pain in one spot on the shin or a foot bone that you can point to with a fingertip, worse with impact and later present at rest or at night: a possible stress fracture.
You keep getting pain, numbness, swelling or difficulty moving part of your leg when you exercise: see a GP, who can check whether it is compartment syndrome or something else.
Pain that comes on when you walk a set distance and goes after a few minutes' rest, especially if you smoke or have diabetes. Exercise treats it well, but it needs a diagnosis first.
Recurring leg pain when you walk or exercise: see a GP, even if you think it's just your age. The NHS says many people mistakenly think this is part of growing older.
Difficulty lifting the front part of your foot and toes: see a GP. The NHS says crossing your legs, kneeling or squatting for long periods can injure the nerve that lifts the foot. Sudden weakness with a drooping face, arm weakness or slurred speech, or with numbness around your genitals or bottom, is a 999 emergency.
Varicose veins that hurt, itch or make your legs swell, a sore on your leg that hasn't healed after 2 weeks, or veins that are getting worse: see a GP. A varicose vein that is bleeding needs an urgent GP appointment or NHS 111.
Pain, tingling or loss of feeling in your feet, loss of balance or weakness, or a cut or ulcer on your foot that isn't getting better: see a GP. These can be early signs of nerve damage (peripheral neuropathy).
Achilles pain that hasn't improved within 12 weeks of following this advice, or is getting worse: talk to a healthcare professional.
See a GP if your child has pain in 1 leg; leg pain in the morning, or when walking or taking part in activities; leg pain bad enough to stop them walking, or that makes them limp; or pain in 1 joint, such as the knee or ankle.
Pain that is not improving after a few weeks, is getting worse, or is stopping your normal activities.
Bone pain that is constant or worse at night, especially with a lump, unexplained weight loss, fever or tiredness, or a past history of cancer.

Where does it hurt?

Location narrows the likely causes; it does not diagnose.

A long sore strip along the inner edge of the shin, sore during and after running

Usually shin splints (medial tibial stress syndrome).

Read: Shin splints →Anywhere at the front of the shin

Our shin pain guide tells shin splints, a stress fracture and the muscles at the front apart.

Read: Shin pain →One spot on the bone you can cover with a fingertip, worse with each step or hop, later aching at rest or at night

A possible stress fracture: stop running and get it checked.

Read: Stress fracture →Tightness, aching or burning in the shin or calf that builds at the same point in every run and fades within minutes of stopping

Often in both legs, sometimes with numbness on the top of the foot: exertional compartment syndrome.

Read: Exertional compartment syndrome →A sudden pull, or a feeling of being hit in the calf, mid-stride or as you push off

Usually a calf strain. Our calf pain when running guide covers runners.

Read: Calf pain →Pain and stiffness in the cord above the heel, worst first thing in the morning or after rest

Usually Achilles tendinopathy, often after a sudden increase in running.

Read: Achilles tendinopathy →A snap, or a feeling of being kicked at the back of the ankle, then walking flat-footed and not being able to stand on tiptoe

A possible Achilles rupture: get help the same day.

Read: Achilles rupture →An ache, cramp or tiredness in the calf after walking a set distance, going within a few minutes of standing still

Can be narrowed leg arteries (claudication), which need a GP's diagnosis.

Read: Calf pain when walking →Leg pain on walking that eases only when you sit or bend forward

Can come from narrowing in the lower back (spinal stenosis).

Read: Lumbar spinal stenosis →Burning, tingling or numbness down the back or outer side of the lower leg, sometimes with back pain

Usually a nerve root in the back (sciatica).

Read: Sciatica →Numbness on the outer lower leg and top of the foot, or a foot that catches or slaps down

The nerve at the outer knee, which crossing your legs can squeeze, or a nerve root in the back: see a GP.

Read: Foot drop →

Burning, tingling or numb feet in both legs

Possibly nerve damage (peripheral neuropathy): see a GP.

Aching, heavy or swollen legs with visible, twisted veins

Varicose veins. A vein that is hard or sore to touch, with warm, red or darkened skin over it, needs an urgent GP appointment or NHS 111.

A sudden painful knot in the calf, often at night

Cramp.

Read: Leg cramps →Pain in both legs in a child, in the evening or at night, gone by the morning

Often growing pains. Pain in 1 leg, a limp or pain in the morning needs a GP.

Read: Growing pains →

One throbbing, swollen calf; hot, red, swollen skin; or burning pain at rest with a cold, pale foot

A possible clot, a skin infection or a severe loss of blood supply: see the urgent signs above.

Understand it

Where it hurts, and when, points to the causeEmerging evidence

Tenderness spread along the inner edge of the shin is typical of shin splints: a scoping review found it described in 95% of the papers on them. One spot you can cover with a fingertip is a stress fracture until it has been checked.

Timing helps too. Shin splints hurt during and after running and ease over days; a stress fracture hurts with every step, then at rest and at night; exertional compartment syndrome builds at the same point in every run and fades within minutes of stopping; and narrowed arteries bring on a calf ache after a set walking distance that goes within minutes of standing still. Leg pain that eases when you sit or bend forward points to narrowing in the spine (spinal stenosis): in a review of 4 studies, no pain when seated was the most useful sign.

Sources 1, 2, 3, 4, 5, 6

What's commonEmerging evidence

In a review of running injuries, the commonest new ones were Achilles tendinopathy (10.3%), shin splints (9.4%) and kneecap pain (6.3%). Of 150 athletes with leg pain on exercise at one centre, 33% had exertional compartment syndrome, 25% stress fractures, 13% shin splints and 10% a trapped nerve, a mix unlikely to match everyone's.

Shin splints affect 5% to 35% of runners; being female, a previous episode, fewer years of running, a higher body mass index (BMI) and using orthotics all go with a higher risk. For a calf strain, increasing age and a previous calf strain are the strongest risk factors, in a review of 10 studies of 5,397 athletes. Outside sport, other causes include narrowed arteries, a clot, varicose veins and nerves from the back.

Sources 7, 4, 8, 9, 5, 10, 11, 12

A stress fractureEmerging evidence

Health New Zealand describes pain in one spot you can point to with a fingertip, worse with activity, and later a constant ache, even at night; it usually takes 6 to 8 weeks to heal. Stress fractures often follow a sudden increase in activity, the American Academy of Orthopaedic Surgeons (AAOS) says. In a review of 2,974 bone stress injuries, return to sport averaged 44 days for the back-inner edge of the shin bone and 56 days for the thinner outer bone (the fibula), and more than 90% returned. The front of the shin bone is a high-risk site that needs protecting for longer.

Sources 3, 13, 14

Compartment syndrome: the exercise kind and the emergencyEmerging evidence

Exertional compartment syndrome is pain, tightness or burning that builds in one group of muscles with exercise and goes with rest. In a review, the front of the shin was the commonest site (45%), and both legs were affected in 85% to 95%. It's confirmed by measuring the pressure in the muscles before and after exercise.

Acute compartment syndrome is an emergency: severe pain, worse when the muscle is stretched and more than you'd expect from the injury, usually after an injury or a cast or bandage that's too tight. It needs surgery as soon as possible. Numbness and weakness are late signs, so don't wait for them.

Sources 4, 15, 16, 17

The calf and the AchillesEmerging evidence

A calf strain is a sudden pull mid-stride or as you push off, tender in one spot, and calf strains often come back. Achilles tendinopathy causes pain and stiffness in the cord above the heel, worst first thing in the morning or after rest, often after a sudden increase in running. An Achilles rupture feels like being hit or kicked at the back of the ankle, followed by walking flat-footed and not being able to stand on tiptoe: it needs help the same day.

Sources 9, 18, 19, 20

Narrowed arteries: claudication and rest painStrong evidence

An ache, cramp or tiredness in the calf, thigh or buttock on walking that goes after a few minutes' rest can be peripheral arterial disease (PAD), a narrowing of the leg arteries. The NHS says many people wrongly think it's just part of growing older, and it's checked by comparing the blood pressure at the ankle and the arm.

Most people with it don't get worse, and many improve with exercise and stopping smoking, the Circulation Foundation says, but 1 to 2 in 100 a year develop severe pain at rest. An international guideline says that pain is often worse lying down and at night and eased by hanging the foot down. It needs a GP immediately.

Sources 5, 21, 22

Nerves and veinsEmerging evidence

Sciatica often spreads from the buttock down the back of the leg into the calf or foot, with burning, tingling or numbness, and NHS inform says calf symptoms that come from the back are usually felt at the back of the calf. Crossing your legs, kneeling or squatting for long periods can injure the nerve at the outer knee that lifts the foot, the NHS says. Burning, tingling or numb feet in both legs can be nerve damage (peripheral neuropathy).

Varicose veins can make the legs ache, feel heavy and swell. A vein that is hard and sore to touch, with warm, red or darkened skin over it, can be phlebitis, which needs checking in case it's a clot.

Sources 12, 23, 24, 25, 11, 26

Tests and scans

Shin splints are diagnosed from the history and an examination: two clinicians examining 46 athletes agreed almost every time (a kappa of 0.89), and 11 of the 34 with shin splints had a second lower leg injury as well. For a suspected stress fracture, an early X-ray may look normal (in a review, it picked up as few as 1 in 10), with changes usually showing after 2 to 8 weeks, while a magnetic resonance imaging (MRI) scan shows bone swelling within about 3 days.

Exertional compartment syndrome is confirmed by measuring the pressure in the muscles before and after exercise. Narrowed arteries are checked by comparing the blood pressure at the ankle and the arm; the National Institute for Health and Care Excellence (NICE) says a normal result doesn't rule them out in people with diabetes. For a suspected clot, NICE's pathway is a clinical score and an ultrasound scan of the leg veins.

Sources 2, 4, 15, 5, 27, 28

How it usually goesEmerging evidence

An NHS physiotherapy leaflet says most new leg pain improves within 6 to 8 weeks, and NHS inform says most new calf problems begin to settle within 6 weeks. Some causes take longer. The NHS says shin splints usually get better within a few weeks, though that page is past its review date; in the Dutch trial below, athletes took a mean of 102 to 118 days to finish a graded running programme.

Stress fractures usually take 6 to 8 weeks to heal. Achilles tendinopathy usually takes several months or more to manage, and NHS inform suggests talking to a professional if it hasn't improved within 12 weeks. With claudication, the benefits of exercise lasted up to 2 years in trials. No one can promise a date.

Sources 29, 23, 30, 31, 3, 18, 32

What helps, and how strong the evidence is

Shin splints: graded running, from one trialEmerging evidence

In a Dutch trial of 74 athletes with shin splints, a graded running programme, three times a week with a day off between runs, did as well on its own as it did with added calf exercises or a compression stocking. Runners moved up a phase only if they finished it with pain below 4 out of 10. On average, they took 102 to 118 days to finish the programme in the three groups.

The limits are real: it's one trial, 18.9% dropped out because they weren't progressing, and there was no rest group, so it shows one way back to running rather than proving it beats rest. The NHS says shin splints usually get better within a few weeks, but that page is past its review date, and the trial's athletes took months.

Sources 31, 30

Nothing else is proven for shin splintsEmerging evidence

A systematic review of 11 trials found no treatment for shin splints free enough of bias to recommend, and a lower leg brace did no better than no brace when trials were pooled. The NHS advises gentler exercise such as swimming or cycling, softer ground, supportive trainers and not rushing back, and the AAOS several weeks off the activity that caused it. Running shoes chosen by foot posture didn't reduce injuries in a Cochrane review, and cushioned or minimalist shoes made little or no difference (low certainty).

Sources 33, 30, 34, 35

A stress fracture: protect the boneEmerging evidence

Stop the activity that hurts and let the bone heal, sometimes taking some weight off it, and never play through the pain, Health New Zealand says. Higher-risk sites, such as the front of the shin bone, need longer. An NHS sports medicine leaflet starts running again only once 30 minutes of fast walking is pain-free, then builds a walk-jog programme over 6 weeks. With any stress fracture, your clinician's plan comes first.

Sources 3, 14, 36

Narrowed arteries: walking into the pain is the treatmentStrong evidence

NICE recommends a supervised exercise programme for everyone with claudication: about 2 hours a week for 3 months, walking to the point of maximal pain. Across 32 trials of 1,835 people, exercise added about 82 metres of pain-free walking (9 studies, 391 people) and about 120 metres of maximum walking (10 studies, 500 people), on high-quality evidence, with benefits lasting up to 2 years. The NHS adds: aim to exercise daily for the rest of your life.

Stopping smoking matters too: the Circulation Foundation says people with PAD who stopped were twice as likely to be alive 5 years later.

Sources 27, 37, 32, 21

The calf and the Achilles: keep loading, within a pain ruleEmerging evidence

NHS inform says too much rest can slow recovery from a soft tissue injury, and that Achilles tendinopathy does not improve with rest, so keep up as much normal activity as you can, with discomfort that settles to your usual level within a few hours. In a trial of 38 people with Achilles pain, carrying on running and jumping while monitoring pain did no harm: both groups improved over a year. A 2024 US physiotherapy guideline lists several kinds of tendon-loading exercise as effective.

For a calf strain, NHS inform suggests cutting down your activity but moving as much as your symptoms allow, raising the leg when you rest, and heel raises sitting and then standing.

Sources 38, 18, 39, 40, 23, 41

How much pain is OK while you exercise?

Muscles and tendons: a mild ache that settles; running: under 4 out of 10; the bone: no pain; the arteries: walk into itEmerging evidence

A calf strain or a sore Achilles: mild discomfort that settles by the next morning is fine. NHS inform's calf exercises allow up to 5 out of 10 (0 to 3 minimal, 4 to 5 acceptable, 6 to 10 too much), and for Achilles pain, discomfort that returns to your normal level within a few hours. For the Achilles holds, the move page keeps pain at about 5 out of 10 or less, settling by the next morning. In trials of long-lasting muscle and joint pain, exercising into some pain did no worse than pain-free exercise.

Running with shin splints: in the Dutch trial, runners moved up a phase only if they finished it with pain below 4 out of 10; if pain reached 4 or more straight after or the next day, they stayed in that phase and ran 2 minutes less.

A sore spot on the bone (a possible stress fracture): no pain at all there, during, after or the next day. Health New Zealand says stop as soon as you feel pain and never play through it.

Narrowed arteries are the exception, once a GP has diagnosed them: walking into the pain is the treatment. The NHS says walk until the pain becomes intolerable, rest until it goes, then walk again; NICE's supervised programme encourages walking to the point of maximal pain.

Sources 41, 18, 42, 31, 3, 37, 27

The exercise plan: 3 stages

Start at the first stage. Each move opens a full guide with a 3D demo.

Stage 1

Settle and pin down the cause: keep moving

About weeks 0 to 2: keep the calf and ankle moving and your fitness up while the map above pins down the cause. Each move names its lane: muscle and tendon (a calf strain or the Achilles), shin (shin splints), bone (a possible stress fracture) or circulation (narrowed arteries, once a GP has diagnosed them). A sore spot on the bone, a possible clot or pain at rest needs checking before this plan.

Ankle circles demonstrated on the 3D figure

3D demoAnkle circlesBeginner · No equipment

10 slow circles each way with each foot · The move page's dose, an editorial starting point. In the first 24 to 48 hours after a calf injury, NHS inform says move the ankle and knee gently for 10 to 20 s every waking hour

Harder: Ankle CARs (controlled articular rotations)

Seated bent-knee calf raise (soleus raise) demonstrated on the 3D figure

3D demoSeated bent-knee calf raise (soleus raise)Beginner · A bench or box

2 to 3 at a time, building to sets of 8, 2 to 3 times a day, up to 2 sets of 15, if pain-free · NHS inform's seated heel raise, with its pacing

Harder: Slow calf raise

Isometric calf raise hold demonstrated on the 3D figure

3D demoIsometric calf raise holdBeginner · A wall

Achilles lane: 5 holds of 30 to 45 s, once or twice a day. Calf strain lane: 5 holds of 20 to 30 s, both legs, gentle effort · The move page's dose for the Achilles, an editorial starting point, with pain at about 5 out of 10 or less; our calf pain guide's holds for a strain

Easier: Seated bent-knee calf raise (soleus raise) · Harder: Slow calf raise

Tibialis raise demonstrated on the 3D figure

3D demoTibialis raiseBeginner · No equipment

Shin lane: 2 sets of 15 · As in our shin splints guide. Leave it out with soreness in the muscle at the front of the shin, or tightness that builds in every run, as our shin pain guide says

Harder: Single-leg tibialis raise

Stationary cycling demonstrated on the 3D figure

3D demoStationary cyclingBeginner · Cardio machine

Shin and bone lanes: 20 to 30 minutes, only if it's pain-free; or swim · As in our shin splints guide

Easier: Recumbent exercise bike · Harder: Air bike intervals

Treadmill walking demonstrated on the 3D figure

3D demoTreadmill walkingBeginner · Cardio machine

Circulation lane: walk-rest-walk until your walking adds up to at least 30 minutes, several times a week. Muscle lane: short walks as you can, with a shorter stride · Circulation lane: the NHS and the Circulation Foundation, as in our calf pain when walking guide; NICE's supervised programme is about 2 hours a week for 3 months. Muscle lane as in our calf pain guide

Harder: Treadmill jogging

Move on when: Walking is comfortable (muscle and shin lanes), the spot on the bone is pain-free (bone lane), or the time you can walk before the pain starts is rising (circulation lane).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 2

Build: calf and shin strength, and longer walks

About weeks 2 to 6: build the calf strength that walking, running, hopping and hills need. With shin splints, calf exercises added nothing to graded running in the Dutch trial, so do this stage alongside the running phases rather than waiting to finish it (our suggestion).

Slow calf raise demonstrated on the 3D figure

3D demoSlow calf raiseBeginner · A wall

Holding a support: 2 to 3 at a time, building to sets of 8, up to 2 sets of 15 · NHS inform's standing heel raise, with its pacing

Easier: Seated bent-knee calf raise (soleus raise) · Harder: Standing dumbbell calf raise

Single-leg calf raise from a step demonstrated on the 3D figure

3D demoSingle-leg calf raise from a stepIntermediate · A step + A wall

Build towards 3 sets of 15 to 20 slow reps each leg, on the floor first · As in our shin splints guide. Start on the floor, then face the step with a hand on a rail, and get a painful Achilles assessed before lowering below step level, as the move page says

Easier: Slow calf raise · Harder: Single-leg pogo hops

Soleus wall stretch demonstrated on the 3D figure

3D demoSoleus wall stretchBeginner · A wall

2 to 3 holds of 30 s each side, for comfort · As in our shin splints guide; NHS inform builds stretch holds to 20 to 30 s. Stretching hasn't been shown to treat shin splints

Easier: Seated calf stretch with a towel · Harder: Toes-tucked kneeling (toe squat)

Single-leg stand demonstrated on the 3D figure

3D demoSingle-leg standBeginner · A wall

3 holds of 30 s each leg · As in our shin splints guide. With numb feet, keep a hand on a counter or wall, as the move page says

Easier: Tandem stance and heel-to-toe walk · Harder: Single-leg reach matrix

Glute bridge demonstrated on the 3D figure

3D demoGlute bridgeBeginner · No equipment

3 sets of 12 · As in our shin splints guide

Easier: Pelvic tilt into bridge · Harder: Single-leg glute bridge

3D demoTreadmill walkingBeginner · Cardio machine

Circulation lane: walk-rest-walk, a little faster or up a gentle slope every 1 to 2 weeks · As in our calf pain when walking guide, with a diary of the time to pain and the total time

Harder: Treadmill jogging

Move on when: Single-leg calf raises are comfortable within the pain rule, and 30 minutes of fast walking is pain-free, the NHS sports medicine service's starting point for running (all but the circulation lane).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 3

Hop, then run, then sport; keep walking for life

From about week 6, and only once any sore spot on the bone is pain-free: bring impact back in small steps, then running and sport, by the written steps below. With narrowed arteries, keep walking for good.

Ankle bounces (mini pogo) demonstrated on the 3D figure

3D demoAnkle bounces (mini pogo)Beginner · No equipment

3 sets of 20, landing quietly · As in our shin splints guide; leave it out until any bone pain has gone, as the move page says

Harder: Pogo hops

3D demoPogo hopsIntermediate · No equipment

3 sets of 20 · As in our shin splints guide, once ankle bounces are easy, as the move page says

Easier: Ankle bounces (mini pogo) · Harder: Single-leg pogo hops

Single-leg hop and stick demonstrated on the 3D figure

3D demoSingle-leg hop and stickIntermediate · No equipment

3 sets of 5 each leg · As in our shin splints guide, as a control check, not a test for a fracture

Easier: Standing broad jump with stuck landing · Harder: Alternate-leg bounding

Treadmill jogging demonstrated on the 3D figure

3D demoTreadmill joggingIntermediate · Cardio machine

Shin splints: the Dutch trial's six phases (below), three times a week with a day off between. After a stress fracture: the walk-jog weeks instead · The Dutch trial's graded running programme, or the NHS sports medicine service's programme after a stress fracture; a road or path counts

Easier: Treadmill walking · Harder: Sprint intervals

3D demoTreadmill walkingBeginner · Cardio machine

Circulation lane: most days, for the long term · The NHS: with claudication, aim to exercise daily for the rest of your life

Harder: Treadmill jogging

Move on when: Our suggestion: your usual running, sport or walking stays within the pain rule, and the leg is no worse the next day.

Follow along: a timer, a cue and the next move, one step at a time.

What to change for now

What to change for now (written steps)

Our 3D figure can't show these changes. They come from the NHS, NHS inform, the AAOS, Health New Zealand, a Cochrane review and an NHS sports medicine leaflet, unless marked as our suggestion.

1. Shin splints: stop the exercise that caused them, switch to gentler exercise such as swimming or cycling, use softer ground when you go back, and don't rush back (the NHS). The AAOS suggests several weeks off the activity, with lower-impact exercise instead.
2. One sore spot on the bone: stop the activity that hurts, get it checked, and never play through the pain (Health New Zealand).
3. A calf strain: cut down your activity but keep moving as much as your symptoms allow, raise the leg when you rest, and avoid long periods on your feet at first (NHS inform).
4. Achilles pain: keep up as much of your normal activity as you can, with discomfort that settles within a few hours (NHS inform).
5. Shoes: supportive trainers (the NHS), renewed when they're worn (the NHS sports medicine leaflet). Shoes chosen for your foot type didn't prevent injuries in a Cochrane review, so a special shoe isn't the fix.
6. Long journeys: get up and walk about every hour or so when you can, and do the NHS's seated ankle exercises when you can't (the NHS).

Sources 30, 34, 3, 23, 18, 35, 36, 10, 43

Running and walking come back (written steps)

The running phases are one Dutch trial's programme for shin splints, run three times a week with a day off between. Move up a phase only if you finish it with pain below 4 out of 10; if pain reaches 4 or more straight after or the next day, stay in the phase and run 2 minutes less. The trial chose each runner's starting phase with a treadmill test; starting at phase 1 is our suggestion, and our shin pain guide gives the trial's speeds.

1. Phases 1 and 2: 4 rounds of 2 minutes' running and 2 minutes' walking (16 minutes), the second a little faster.
2. Phases 3 and 4: 4 rounds of 3 minutes' running and 2 minutes' walking (20 minutes), from an easy pace to one where talking gets hard.
3. Phases 5 and 6: 16, then 18 minutes of continuous running.
4. After a stress fracture, your clinician's plan comes first. The NHS sports medicine leaflet starts once 30 minutes of fast walking is pain-free: 1 minute's jogging and 1 minute's walking for 30 minutes, every other day, building over 6 weeks to 30 minutes' jogging.
5. Once you're back to 30 minutes, add no more than about 10% a week (the NHS sports medicine leaflet).
6. Narrowed arteries: walk until the pain becomes intolerable, rest until it goes, and repeat until you've walked at least 30 minutes in all, several times a week (the NHS; the Circulation Foundation). Keep it up for life.
7. Hills, sprints and jumping sports: once flat running is comfortable, one change at a time (our suggestion).

Sources 31, 36, 37, 21

Positions to swap, and why

Habit or position	Why it matters	Instead
Running or hopping on a sore spot on the bone	It may be a stress fracture, and Health New Zealand says never play through the pain; the ankle bounce and hop-and-stick pages say bone pain should be gone before you hop.	Cycling or swimming, only if the bone is pain-free.Try: Stationary cycling
Building running time or speed quickly	The NHS says don't rush back, and the NHS sports medicine leaflet adds no more than about 10% a week once you're back to 30 minutes.	The Dutch trial's phases, or the walk-jog weeks.Try: Treadmill jogging
Going straight back to hills, sprints and hard surfaces	The NHS suggests softer ground and not rushing back.	Flat, softer surfaces first, then hills (our suggestion).
Resting completely until a calf or Achilles stops hurting	NHS inform says too much rest can slow recovery, and carrying on running with pain monitoring did no harm in a trial of Achilles pain.	Keep moving within the pain rule, with heel raises.Try: Seated bent-knee calf raise (soleus raise)
Stretching hard into a fresh calf strain or a sore Achilles	The move page says go gently with a recent Achilles tear and build depth over weeks rather than forcing it, and our calf pain guide keeps its stretches gentle after a strain.	Calf raise holds first, then gentle stretches.Try: Isometric calf raise hold
Buying compression stockings or a special shoe to fix shin splints	A compression stocking added nothing to graded running in a trial, and shoes chosen by foot posture didn't reduce injuries.	The graded running programme.Try: Treadmill jogging
Stopping walking because the calf aches, once narrowed arteries are diagnosed	Walking into the pain is the treatment, and in trials it added distance before the pain started.	Walk-rest-walk, at least 30 minutes in all, several times a week.Try: Treadmill walking
Smoking, with poor circulation	People with PAD who stopped smoking were twice as likely to be alive 5 years later, the Circulation Foundation says.	Ask your GP or a pharmacist about stop-smoking support.
Carrying on with one throbbing, swollen calf	It could be a clot.	A same-day check first: an urgent GP appointment or NHS 111.

Routines to follow

Calf workout: straight-knee and bent-knee raises with a step

A 25-minute calf workout with a step and a dumbbell: single-leg raises for the big calf muscle, then seated raises for the soleus, with gym swaps for each move.

25 minIntermediate7 movesA wall, A step

Foot and ankle strengthening routine: toes, arches, calves and balance

A 15-minute barefoot routine for stronger toes, arches, calves and ankles, finishing with balance. You need only a towel, a wall and a resistance band.

15 minBeginner11 movesA wall, Other / check instructions

Runner's warm-up

An 8-minute dynamic warm-up for runners: ankle and hip mobility, lunges, skips and pogo hops.

8 minIntermediate8 movesA wall

Strength workout for runners at home

A 40-minute strength workout for runners at home: hops, Bulgarian split squats, single-leg deadlifts, step-ups, calf raises and side planks.

40 minIntermediate15 movesA wall, A bench or box

Claudication walking workout: walk-rest-walk

The walk-rest-walk session for leg pain from narrowed arteries: walk until the pain is close to the most you can bear, rest until it goes, repeat to 30 minutes.

45 minBeginner8 movesA wall, Cardio machine

Calf pump exercises for varicose veins and heavy legs

A 15-minute calf pump routine for varicose veins and heavy, swollen legs: ankle pumps, calf raises, a brisk walk, calf stretches and legs up to finish.

15 minBeginner10 movesA bench or box, A wall

More moves for this area

Questions people ask

What causes pain in the lower leg?

In runners, the commonest causes are Achilles tendinopathy, shin splints, stress fractures and compartment syndrome, and calf strains become more likely with age and after a previous strain. Other causes include narrowed arteries (an ache on walking that goes with rest), a nerve from the back, varicose veins, cramp and a clot. The exact spot and when it hurts point to which, as the map on this page shows.

Is it shin splints or a stress fracture?

Shin splints hurt along a strip of the inner edge of the shin, during and after running. A stress fracture hurts at one spot you can point to with a fingertip, worse with every step, and later aches at rest or at night. An X-ray can be normal early on, so stop running and get a spot like that checked.

Why does my lower leg hurt when I walk?

A calf strain usually follows a sudden injury in sport or a fall, and walking hurts from the start. An ache in the calf after a set distance that goes within minutes of standing still can be narrowed arteries, which the NHS says shouldn't be put down to getting older. Pain that eases when you sit or bend forward can come from the spine, and shin pain with every step can be a stress fracture.

Why does my lower leg hurt at night?

Cramp is a common cause, and our leg pain at night guide covers it and restless legs. Severe burning pain in the foot or leg at rest, worse lying flat and eased by hanging the foot down, can mean the arteries are badly narrowed and needs a GP immediately. Bone pain that is worse at night needs a GP too.

Could pain in my lower leg be a blood clot?

It could, if it's throbbing pain in one calf with swelling and red, blue or darkened skin, especially after surgery, a long journey, pregnancy or a spell in bed. Ask for an urgent GP appointment or call NHS 111, and call 999 if you're breathless or have chest pain.

Why does my lower leg hurt after running?

Shin splints, stress fractures, compartment syndrome, calf strains and the Achilles are the usual causes, and a sudden increase in running is a common trigger. Build up gradually, by no more than about 10% a week once you're back to 30 minutes. A sore spot on the bone means stop running and get it checked.

Why does the outside of my lower leg hurt?

Burning or tingling down the outer leg is usually a nerve, either from the back or squeezed at the outer knee, for example by crossing your legs for long periods. Tightness that builds in every run can be compartment syndrome, which can affect the outer muscles, and a sore spot on the thinner outer bone (the fibula) can be a stress fracture.

Can sciatica cause lower leg pain?

Yes. Sciatica often spreads from the buttock down the back of the leg into the calf or foot, with burning, tingling or numbness, and calf symptoms from the back are usually felt at the back of the calf. Our sciatica guide covers what helps.

Is leg pain on walking just part of getting older?

No. The NHS says many people mistakenly put it down to age, when it can be narrowed arteries (peripheral arterial disease). If it comes on with walking and goes with rest, see a GP: once it's diagnosed, it responds well to walking exercise.

Should I rest my lower leg until it stops hurting?

Mostly no: too much rest can slow recovery, shin splints are managed with graded running, and walking into the pain is the treatment for narrowed arteries. The exception is a sore spot on a bone, which needs pain-free activity until it heals.

What exercises help lower leg pain?

Heel raises, sitting and then standing, build calf strength; graded running is the best-studied way back for shin splints; and walk-rest-walk helps narrowed arteries. The plan on this page has lanes for each, with a 3D demo of every move.

When should I worry about lower leg pain?

Call 999 or go to A&E for sudden, severe pain in the calf or shin after an injury or in a tight cast, a leg that's twisted or bent, or a leg that's suddenly cold and pale. Get same-day help for one throbbing, swollen calf, a sudden snap at the back of the ankle, or hot, red, swollen skin. Contact a GP immediately for burning pain at rest with pale skin or wounds that won't heal.

Related exercise guides

Other pain guides

Sources

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.