Ask The ST Run Expert

Stretch out the pressure, take small steps to go far

Q. I am in my teens and I seem to have a problem running for anything longer than 15 minutes. I would get a fast-growing, aching cramp over the front and outer part of both my legs and calves. The pain disappears after I stop and rest for about five to 10 minutes, but would come back if I start running again.

My friends and relatives also notice that my knees are slightly bowed and some of them claim that I have knee arthritis as a result of my deformity. How can that be, when I have no pain in my knees and I am so young? Do I really have arthritis? How can I run beyond that 15-minute mark?

A. While knee pain and ankle pain are common complaints among runners, pain around the calves and legs is certainly not as common.

Your complaint brings to mind a few conditions, the most likely of which is chronic exertional compartment syndrome (CECS) of the leg. It is essentially the build-up of pressure in the muscle compartments of your legs between the knee and ankle joint, as a result of increased usage and hence exertion of the muscles.

This abnormal build-up of compartment pressure results in lack of blood supply and therefore oxygen to the involved muscles, which are in need of increased oxygen supply to allow you to continue running. CECS typically gives rise to pain in one or both legs after a period of exertion of the leg and calf muscles. The pain often feels like a cramp, which gets worse with continued exertion. This pain resolves quite rapidly the moment the inciting activity ceases.


Engaging in stretching exercises prior to running is a way of minimising the onset of pain and to improve your running distance. ST FILE PHOTO

The first step you can do is to start running a shorter distance that does not bring on the pain, and gradually increase your running distance and intensity to allow the muscles to slowly "accommodate" to the increased compartment pressure.

  • Brought to you by

Engaging in stretching exercises prior to running is another simple way of minimising the onset of pain and to improve the running distance. If the pain does not improve, a consultation with an orthopaedic surgeon is prudent.

Compartment pressure measurement and possible surgical release of the fascia (covering layer) of the affected muscle compartment may be required if non-operative measures fail to improve the pain.

Bowing of the knees on its own, a condition called primary genu varus, does not always need treatment. There is no need for active surgical treatment to correct this deformity unless it gives rise to significant pain.

In your case, your deformity is mild and you have no knee pain. I would not be too concerned unless you start noticing pain localised to the inner aspect of your knee. Should you require a consult with an orthopaedic surgeon for your leg and calf pain, he can evaluate your knee at the same time.

Dr Andy Wee

Orthopaedic surgeon at Mount Elizabeth Novena Hospital

A version of this article appeared in the print edition of The Sunday Times on May 01, 2016, with the headline 'Stretch out the pressure, take small steps to go far'. Print Edition | Subscribe