Calf Muscle Pain
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The calf muscles work to lift the heel off the floor and propel you forwards when walking and running. Two muscles are attached to the Achilles tendon and the heel bone at one end. The deeper soleus muscle attaches below the knee, and the more superficial gastrocnemius is attached above the knee. Therefore, the gastrocnemius will work more when the knee is straight and the soleus when the knee is bent. In this article, we will explore what causes calf pain running.
The most common cause of calf pain is when the calf muscles are overloaded, and the demand is greater than the capacity of the muscle. When running, the calf muscles may not be strong enough for the intensity or duration of the run. The calf muscle will start to feel progressively more tight and painful. As this progresses, this can trigger a cramp, a strain or a tear.
Injuries can occur in the main belly of the muscle, in the junction between the muscles and the tendon, or in the tendon itself. As well as feeling where the pain is, common patterns are seen when a muscle or tendon is injured.
Tendon injuries can cause pain at the start or end of the activity. They often feel better after warming up and before it has worked too much. Sometimes these will cause delayed pain, which You might feel after being sat still for a while after exercise or even the next day.
Muscles tend to be more consistently painful when the muscle is used and worsens the longer it is used and the greater the work intensity. It will then gradually get better with rest.
Differentiating between the two calf muscles can be difficult. Still, pain specific to the soleus is usually more pronounced when a heel raise is done with a bent knee and the gastrocnemius when the knee is straight. The soleus can also give a more vague pain as it is a deeper lying muscle, and often the individual might find it hard to pinpoint the area of pain.
Determining the injury’s extent is essential to direct the most appropriate rehabilitation for recovery. The history of the onset of
the pain, sudden or gradual, the intensity of the pain, and how the muscle can function are all helpful indicators to diagnose the severity of the injury. Swelling and especially bruising can take several days to appear after the injury, which is a poor indicator of injury in the acute phase.
Based on the British Athletics muscle injury classification, muscle and tendon injuries are graded 0-4. 0 being a strain and 4 being a rupture or complete separation of the two ends of the muscle or tendon. A letter is now attached to the grading, which will indicate the location of the injury with (A) referring to an extension from the fascia, (B) muscle or muscle tendon junction and (C) tendon involvement.
Muscle strain, soreness after exercise, no sign on MRI.
Small muscle tears, & <10% cross-sectional area, pain but no loss of strength, haematoma
seen on MRI.
2 = Moderate muscle tears, 10-50% cross-sectional area, pain with loss of strength, high
signal changes on MRI.
Extensive muscle tears, >50% cross-sectional area, pain with loss of strength and
function, high signal changes on MRI.
Complete muscle tears, 100% cross-sectional area, noticeable gap, defect seen on MRI.
Your calves might hurt when running as you may have an injury such as a strain or tear. However, many other reasons you might experience pain when running are less common.
Other less common causes include compartment syndrome. This results from restricted blood flow to the calf muscle, known as claudication, restriction of blood to the nerves of the leg, neurological claudication or blood clots, also referred to as deep vein thrombosis (DVT).
Compartment syndrome is a condition where fluid can build up under a band of tissue. The skin will usually look pale, and the individual will feel pins and needles or numbness on the skin as well as pain. Often the muscle will be affected and may not feel as strong, or it might not be able to function at all.
A DVT is usually felt as extreme tightness and pain in the calf that worsens as the intensity and duration of the activity increases. This is most common when an individual has been inactive for an extended period, such as a long-haul flight or following surgery. There is usually a change in colour of the calf, making it look red or dark on the skin, and it will be swollen.
Other causes include issues with blood clotting, smoking, being overweight, severe dehydration, varicose veins, taking contraceptive pill or HRT, cancer or heart failure.
It does not help recover a calf injury if the demand for the recovering tissue is too high. Therefore the severity of the injury will guide what is good to do in terms of activity.
In a less severe injury in a strong individual, it may be okay to have calf pain running slowly on flat, level ground but not to run fast or uphill. Someone less well conditioned or with a more severe injury may be better off not running.
In some cases, it is best to rest the muscle completely, and a Physical Therapist might advise you to use crutches for some time.
A good rule to follow is not to run if you don’t know what exactly is hurt or why. Without knowing this, you won’t know if you are doing more harm or not. It is best to see your physiotherapist, doctor or physician to assess this and ensure that you follow the best treatment to recover.