Pain in the calf following an injury like a muscle tear can be expected but most of the time runners will complain of calf soreness with no obvious incident of an injury to the area. In these cases like with many running injuries, identifying the cause of calf pain is the key to rectifying it.

In our last blog, we discussed the causes and factors associated with Plantar Fasciitis and how we can provide a treatment program to reduce recurring pain.

Table of Contents

Identifying Calf Pain
Why does calf pain occur?
Factors related to Calf Pain in Runners
Why are my calf muscles becoming Fatigued?
1. The Calf is being overloaded
2. The calf muscles are weak or lack endurance
How can Physio help my Calf Pain?
Summary

“Calf pain usually occurs while running and can get more painful as the run continues. Your calf might begin to feel stiff and restrict your running movement.”

Identifying Calf Pain

Calf pain is one of those nigglly injuries, where you think ‘oh this will settle down over the next 1-2km; ill be fine’ another 800 meters and your limping home. Then each time you go to run the dull ache tenders to linger around, not fully developing or fully going away.

The msot common symptoms we find are the following:

A dull/achy pain develops as you run.
It worsens as the run continues.
The calf feels tight and may stop you from going any further.
The pain usually subsides a little when you stop running.

However, the calf will continue to feel tight for a day or so after. This becomes a frustrating cycle as you continue training, where the pain comes on much sooner with each run. Eventually you feel like you have to stop earlier in the run. The most common reason for this is fatigue of the calf muscles.

Why does calf pain occur?

Tight, aching calves are a common complaint amongst runners and are usually down to

Reduced foot and ankle strenght
Over training
Poor Mobility
Reduced quads strength (big muscles at the front of your thigh)

The calf muscles take up quite a lot of load when running and having stronger calf muscles is a great way to help reduce the chances of injury of both the calf and the achilles tendon. In the lower leg the peak loads on the muscles and joints are up to 7 times body weight at normal running speed.

People tend to think they have torn their calf when they have a deep ache but this is unlikely due to a number of factors that differentiate a muscle tear from an over use injury.

Tear

Sudden sharp on set of pain
usually occurs in push off phase when going to sprint or pushing heavy objects
Immediate swelling and painful to touch
Unable to get heel on ground when walking

Over use Calf pain

Gradual onset
Deep achey pain in nature
No sharp increase in pain
No significant swelling or painful to touch
Muscle tightness more so than sharp muscle pain

Factors related to Calf Pain in Runners

De-conditioned athletes aged 40-60
Reduced Achilles tendon Sitffness
Change in training load , increased pace or volume
Switch to forefoot running or minimalist shoe- increases calf work by 10% +
History of previous calf injury
Calf weakness
Reduced ankle mobility
Reduced big toe mobility
Not recovering enough in between sessions
Further weaknesses around Knee and Hip

Why are my calf muscles becoming Fatigued?

1. The Calf is being overloaded

Every muscle has its own level of strength and endurance. When we exceed that level the muscles become tight and painful. What has changed recently that has coincided with your calf problem? A common mistake many runners make is introducing lots of speed or hill work, increasing training intensity and weekly mileage too quickly.

A recent change to minimalist running shoe involves landing on the forefoot and loading the calf muscles and Achilles tendon even more.

Another factor is introducing gym exercises while you are running training. If you have introduced gym sessions and running on the same day, or the following day, the calf may already be tired before you start.

This all leads to a cumulative effect on the calf and the first thing that should be addressed is REST. The dreaded R word runners hate to hear. A few days rest, some stretching and a session or 2 with your physio can work a treat. I would recommend this before you start thinking about addressing any calf weakness – adding more exercises to an already fatigued calf can add to the problem.

Are you doing too much with too little rest?
A day or 2 rest or reducing your mileage temporarily can help resolve the symptoms.
Your training schedule also needs to be addressed.

2. The calf muscles are weak or lack endurance

The easiest way to assess your calf strength is to perform a single leg calf raise:

Stand on one leg with your fingertips on the wall for balance
Push up on your toes and slowly down again
Do as many as you can -lift the heel up as much as you can
Count the repetitions and compare left to right.

You should be able to do the same amount left and right. A number below 30 left or right may suggest a lack of endurance. You may find the test causes your symptoms, in which case stop.

This exercise is also an effective way to strengthen the calf. Do as many as you can comfortably, rest for 1-2 mins and repeat for 2-3 sets. Aim to work up to 3 sets of 25-30 reps.

You can do this 2-3 days a week on the days you are not running. This can also be done on the edge of a step to allow for greater range of movement by letting the heel drop below the level of the step.

How can Physio help my Calf Pain?

Soft tissue therapy: helps relieve soreness and tightness in the calf.
Improving Muscle Flexibility: reduced flexibility can overload the calves.
Improving Ankle Mobility: reduced ankle mobility restricted the calf muscles from lengthening
Guidance on Training Planning: design a progressive training plan that implements recovery strategies
Calf and Lower Limb Strengthening: getting that ankle complex stronger to improve your natural spring when running
Correcting Poor Bio mechanics : running is a skill that is learnt, correcting bio mechanics helps you reduced injury

Summary

Non-traumatic calf pain is often a case of doing too much or having weakness in the calf muscles. Usually a bit of both! A combination some rest, physiotherapy, strength work and changes in your training is usually enough to resolve the problem.

This Article was written by Diarmuid Hegarty, Clinical Director ReSync Physiotherapy, MICP MSc Physio, MSc Sports Med, NSCA. Our team are here to answer any questions or queries you may have about your pain/injury. We offer Free Consultation for people who are unsure if physiotherapy is right for them.