Leg pain can strike anytime. Specific pain below the knee may be caused by factors such as anatomical weakness, daily activity and stress, and individual levels of fitness. The entire knee joint is susceptible to accidents and overuse, so knowing the exact cause of pain is helpful in controlling it.

Is This an Emergency?

If you are experiencing serious medical symptoms, seek emergency treatment immediately.


The area of the leg directly below the knee includes tendons, ligaments and bone. Because there are few stabilizing structures and relatively little subcutaneous fat in this area, the tissues can be easily injured. Directly below the knee cap are the thick patellar tendons and ligaments that attach to the heads of the two shinbones, the tibia and fibula. Small amounts of cartilage, including a moon-shaped meniscus slightly below and to the inside of each knee, provide cushioning. Add a bunch of blood vessels and nerves and you have lots of anatomical pieces that can get hit, twisted or pinched, with pain sometimes radiating down the leg.

Direct Forces and Twisting

Direct impact injuries include being struck in the knee or leg by an object such as a rock, you and a soccer teammate colliding at the knees, or a football player tackling another sideways at knee-level. Impact forces bruise and crack tissue, even bone, on a continuum from the tiniest strain or hairline crack to a full tearing of tissue or breakage of bone. Soccer, football, tennis and skiing also incur twisting forces that injure knee and leg tissue directly.

Running and Overuse

Running can either help or harm your lower legs 1. Studies reported by the New York Times have shown that running can actually protect your knees because it strengthens the leg's muscles, tendons and ligaments, stabilizing the knee joint and absorbing the repetitive pounding forces 1. Strong leg muscles and connective tissues protect your bones from stress fractures. However, when these protective structures tire from overuse, leg pain can quickly set in. Leg muscles can also become injured via sprains, strains, sudden increases in mileage or between running surfaces.

Swimming with Faulty Technique

Errors in training techniques account for most swimmers' lower leg pain. One injury in particular seems to befall breast-strokers: medial collateral ligament (MCL) tendinitis 2. Physio Advisor suggests that MCL tendinitis arises gradually from the frog-kick's repetitive propulsion, which requires the quadriceps and hamstring muscles to whip the lower legs backwards and together. This snapping action forces the knees to rotate in the water, stressing the MCL. If you frog-kick with too much snap and twist, you may get tendinitis. And if you fail to rest your legs after intense workouts, you risk injury from over-training.

Age and Deterioration

As you age, your legs lose strength, pains can become chronic and injuries take longer to heal. Arthritis, diabetes and nerve degeneration can lead to daily lower leg pain, so practice preventive measures such as regular exercise, good nutrition and sufficient sleep. According to American Family Physician, walking, running and cycling improve lower leg muscle tone, bone resilience and blood circulation. Adequate intake of protein and anti-inflammatory essential fatty acids found in fish, walnuts and olive oil can all potentially minimize muscle damage.