Calf Pain

Most runners experience calf pain at some point in their running career.  Often new runners report feelings of tightness in their calf during or after running.   Patients usually report feeling like they’ve been stabbed in their calf muscle if it is a more acute injury . Hopefully  after reading this you’ll have a little bit of a better understanding on how to avoid calf injuries and what to do if you do hurt them.

Firstly what are the calf muscles?

The calf complex (at the back of the lower leg), is composed of three muscles: gastrocnemius, soleus and plantaris.  These muscles come together as the achilles tendon and all three muscles insert into the heel. Gastrocnemius provides primarily plantar flexion (pointing toes)of the ankle joint and flexion at the knee joint.  This muscle provides the propelling force for locomotion. Although it spans over two joints, gastrocnemius is not able to exert its maximum power on both joints simultaneously. If the knee is flexed, gastrocnemius cannot produce maximum power at the ankle joint and vice versa.

Soleus is located beneath the gastrocnemius muscle in the superficial posterior compartment of the lower leg. Its main function is plantar flexion of the ankle and stabilising the tibia on the calcaneus limiting forward sway.

Plantaris is located in the posterosuperficial compartment of the calf. Functionally, plantaris is not a major contributor and acts with gastrocnemius as both a flexor of the knee and a plantarflexor of the ankle.

When you run the calf muscles are loaded up to 1500 times every mile.  They attach via the Achilles which acts like a spring to propel us forward with each stride.  Often poor running style and over use lead to the calf muscles being injured.

One of the most common is a calf strain.  This is when part of the muscle becomes damaged and the injury is graded depending on the severity

Grade 1 Calf Strain:

This is the least severe of calf injuries. A small number of muscle fibres have been damaged within the muscle. Signs and symptoms of this type of less serious strain may not be noticed until cessation of the activity. Tightness, cramping feelings and slight soreness are common when the muscle is stretched.

Grade 2 Calf Tear:

This is sometimes referred to as a partial calf tear. A greater number of muscle fibres have been torn, however the muscle remains largely intact. More immediate localised calf pain is present during activity, especially walking and running. Often the area is sore to touch.

Grade 3 Calf Rupture:

Total rupture. All the muscle fibres have been torn, losing continuity throughout the muscle. This is a serious injury and highly disabling. The athlete will be unable to walk pain free. Often bruising will appear below the tear site and there may well be a palpable bulge where the calf muscle has recoiled upon itself.

Recovery from a calf strain depends on the severity of the injury but usually it will take 3-6 weeks for even a grade 1 to start to feel better.  You may not be abe to perform high intensity activity but you can still continue to train.

If you are experiencing tightness or stiffness in your calf muscles its often the muscles telling you they can’t tolerate the load you are placing them under.  This may be due to poor running style or more often just too much running.  Runners will often read this tightness as stiff musces and one of their go to treatments is to stretch the calf muscles.  This may be detrimental to recovery as you could potentially be stretching muscle fibres that are trying to heal.  Its important to get the right advice so you have a good rehab plan and the right advice to follow.

Treatment of calf injuries

1- Acute injuries- Rest, Ice, Comression, Elevation.  This is fine for the first day or so but its also important that you begin gentle movement within what is tolerable.  Avoid high impact loading and you may find that once the initial swelling has gone down then heat to the belly of the muscle helps.  If its a more severe injury you may have to avoid weight bearing but its still important to keep the ankle moving to stimulate blood blow.  The body is very good at healing but it needs time, rest and most importantly fuel to repair.  Sleep and a good diet at this time of injury is paramount to the body healing optimally.

2- Work on range of movement (ROM) deficits.  Poor hip movement or ankle movement can lead to poor movement chains which can load the calf muscles beyond what they are happy with.  It can be really valuable to have your ROM assessed then you can work on the areas that may be lacking.  At KHPhysiotherapy I do a full movement assessment so we are guided as to which areas to improve.  Dynamic exercise is really imprtant to improve ROM where as static stretching has very little benefit. To find out more about which key areas you can improve have a look at my youtube videos.

3-Improve muscle strength- firstly you have to find out which muscles are weak.  At KHPhysiotherapy the Gait analysis session involves checking the important running muscles for their strength.  Once you know which ones need strengthening you can begin to target them.  Strength building only comes from including weights into any training programme and this is such an important element for runners but sadly often lacking.  As an S&C coach with a fully kitted gym I can work with the runner so they are getting the best out of their strength training. For 6 Key exercises that will benefit your running take a look at my youtube video

4- Improve running form- many runners overstride which causes excessive braking force when running. Your calf muscle then have to try and push the body up and over the foot instead of using the elastic energy that is already stored.  Improving form and cadence can help reduce the force on the calf muscles, thus making their job easier. There are a few simple areas you can work on to improve your running form

5- Ease back into running gently.  One of the biggest mistakes runners make is they go out to ‘test an injury’.  I see runners who were doing 10k runs, get injured, rest a few days then go out for a 10 k run.  At KHPhysiotherapy we will put together a return to running plan after a treadmill tolerance test.  The idea is to run for a time that doesn’t increase symptoms, that may be 8 x 1min.

So if you are experiencing calf pain during or after running its really important to get the right advice so you can begin to work on improving all the areas that need it. It may seem daunting but running is a skill; one we often lose as we age, that needs developing and nurturing.  Patience is a runners biggest challenge and virtue.  The body takes time to recover, it takes time to improve strength and ROM and it takes time to change poor running style.  If you need any help or advice or want to book an online assessment please get in touch.  Due to COVID 19 I can only do initial consultations via Skype/Zoom.  If you are not sure and just want some advice then please call me on the details on the web page.