Exercise induced leg pain is a particularly important, common, and potentially debilitating problem for the athlete, especially those involved in running and ballistic sports. Because there are many causes of exercise induced leg pain, misdiagnosis is common with many controversies in relation to etiology and pathophysiology. Nomenclature has also confused the issue, with the ubiquitous “shin splints” now surely struck from the list of meaningful medical terminology. Clinical examination and diagnostic repertoire are critical in relation to exercise induced leg pain, and a thorough knowledge of when to investigate further with which investigative tools is essential. The bulk of exercise induced leg pain resolves uneventfully with either conservative or surgical intervention, however, some sources of exercise induced leg pain represent real medical emergencies, and as such thorough knowledge of this injury category is mandatory.