BACKGROUND: Musculoskeletal injuries result from physical activity and seem to have a dose-response relationship to the amount of that activity. The more exposure to training or sport the greater the risk of injury. OBJECTIVE: This article examines the common causes of chronic exertional leg pain in the community. DISCUSSION: The common presentations include muscle injury, medial tibial stress syndrome, stress fractures of the lower limb, chronic exertional compartment syndromes as well as nerve entrapments. A description of these and an algorithm to assist in the diagnostic dilemma are presented.