What is a calf strain in runners, and how do you rehab them?

If you are a runner, you may have experienced a calf strain in the past. You may have been lucky enough to get over it very quickly, but a particular cohort of people find it extremely difficult to resolve this issue.

Continue reading this article if these points relate to you

• You have pain in your Calf running
• you have rested your Calf, but the pain comes back
• You have gone to the physio for your calf pain, but they have not been able to resolve it.
• You are getting frustrated with the lack of progress and want the answer to your problem.

If this sounds like you, then you are in the right place to get the correct information.

My name is Diarmuid, and I’m the Clinical Director here at Resync Physiotherapy. Over the years, calf strains have been increasingly challenging to treat if you are only looking at the Calf. So we tend to take a bird’s eye view of how your body functions as one unit and get to the root cause of why your Calf is becoming overloaded and painful all of a sudden.

What is a calf strain?

A Calf strain, put very simply, is an overload of the muscle fibres within the Calf. Your muscles are made up of tiny myofibrils and muscle fibres that form the larger muscles. What we need to note here is that the forces have attachments to the bone via tendons. Tendons are located at both ends of the muscle and slowly become tightly packed together and change morphology as they get closer to the bone. The area where the muscle begins to turn to the tendon is called the Musculotendionous Junction or MTJ. This is the most common area where a calf strain can occur as this is the weakest point of the muscle.

Is a calf strain serious?

No. Calf strains are not severe, but sometimes calf strains can be mistaken for other medical conditions. Simple questions you can ask, and if all answers are yes, then it is unlikely there is a serious medical condition you need to get checked

1. Can you remember the time of injury? (calf pain did not start gradually)
2. Was it sore, but it is beginning to improve?
3. My leg IS NOT discoloured
4. My Calf DOES NOT have a shiny glare on it, or is it not very painful to touch?

What causes a Calf Strain?

As mentioned, a calf strain can be caused by an overload of the muscle fibres. Muscle fibres can be overloaded in 2 ways.

1.) Excess forces ( ground reaction forces) can be placed on the muscles during sprinting or repeated jumping that exceeds the muscle fibres’ capability, and tiny fibres become strained.

2.) Through prolonged running, your calf muscle is exposed to repeated low-level forces that fatigue the muscle fibres. The body can cope with a small level of strained muscle fibres, but once that number increases, the body will perceive this as a threat and produce a pain response to protect the muscle.

This is a basic knowledge given by every physio on the planet to patients who experience Calf strain. But, unfortunately, while they can explain a calf strain, they do not understand calf strains.

Allow me to explain.

Your body works as a system when running. Biomechanics has shown us that your body absorbs and produces force through muscles and tendons. But what happens when there is a weak link? What happens when one part of the system ( like the knee) begins to take more load than another. Or is it not capable of distributing that load evenly across the rest of the limb? Your hip might start to get sore running then.

What happens is that muscle produces pain to let you know that something is wrong.

People who rest calf strain but don’t try to correct the imbalance that causes the strain in the first place end up having this ongoing calf pain for months.

Why is my Calf Strain not healing?

Why is my calf strain not healing? It is a million-dollar question, and to answer it, we need to look further away from the Calf and ask these questions.

 Is my Calf weak?

Is my foot not absorbing enough force as I run? Therefore my Calf is taking the load?

How is my running technique?

Do I run on my toes?

Do I have land heavy on my feet (Plod)?

Are my quads taking all the load and my glutes and hamstrings not helping?

Do I have enough range in my Ankle to help my muscles absorb the forces more efficiently?

This is where a detailed assessment comes in. But we can’t do that as you are only reading a blog, so read on, and I will continue to explain. 

Why your calf strain has not healed comes down to 2 points.

1.) Have you allowed enough healing time to take place, and have you progressed your training back to pre-injury levels gradually?

2.) Have you investigated the underlying biomechanical causes that may have contributed to the calf strain

If you have answered yes to these questions, then there is only one other logical explanation.

You didn’t look at the biomechanical issues deep enough.

Focusing on the finer details can reap massive rewards.

What are the finer details?

• Foot posture
• Intrinsic Foot strength
• Midfoot stance endurance
• Soleus Strenght & endurance
• Gastroc Strength & Endurance
• Running Gait- Forefoot/midfoot/heel strike
• Quad strength – excessive knee flexion on landing affected lengthening at the soleus
• Quads Hamstring Co Contraction
• Ipsilateral/ contralateral hip stability
• Core Strength
• Torso rotation
• Shoulder level
• Arm drive

This is just a snapshot of what we look for when we see a person with calf issues running. We then look for the most significant strength and endurance deficits in the foot, Calf, and further up the kinetic chain.

Why do I have calf pain running slow?

People can have calf pain running slow due to strength deficits, endurance deficits, or biomechanical issues. What we see in the clinic differs from male to female.

Males:

Males generally have a weak foot, and if they are seated a lot for work, this, combined with more ailing hamstring and glutes, can cause an overload in the Calf.

Females:

Females generally have weaker glutes, less stable ankles and a reduced plyometric ability (natural spring/bounce) unless they have specific training to target these qualities.

Each person is different, so there is no blueprint to resolving a calf issue, just better assessments and experience knowing where to look for the deficits

Ultimately, it would be best to focus on why the Calf is taking on too much strain and what exercises are best “bang for your buck” to resolve the biomechanic issues leading to this overload.

Please take a look at this photo of a runner we had recently with calf pain.

Let us break this down.

1.) Ankle

There is a lot of bend in the Ankle, which is lengthening the calf muscles Soleus)

2.)Knee bend is excess, and also her knee is out over her toes. (Knee over toes is not always bad, but in this instance, it is).

Overall her body weight is not being absorbed by muscles and tendons in her lower limb. If the forces are not being absorbed evenly, her calf is taking the load in this instance. In another person, her knee may have taken the extra load?

Are we following?

So, in conclusion, when you experience calf pain, understand it is not necessarily the calf that is the issue. Still, the overall strength of the lower limb and its ability to dissipate the forces from running that has the most influence on recovery.

Diarmuid Hegarty, MISCP, MSc. Physio, MSc. Sports Med, S&C Coach NSCA

Clinical Director