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A calf strain is probably the most common cause of calf pain or pain at the back of the lower leg. However there are a number of other potential causes of calf pain which we outline below.
We outline the most common causes of calf pain as well as some of the less common calf injuries. We also explain some important more serious conditions resulting in calf pain not to be missed such as deep vein thrombosis.
Common causes of calf pain
Calf strain is a strain or tear to either gastrocnemius or the soleus muscles which together make up the calf muscles. Symptoms include a sudden sharp pain at the back of the lower leg. A calf strain can range in severity from mild where the athlete can continue exercise although in some discomfort right up to a full tear of the muscle resulting in lots of pain and in ability to walk. We explain the different types of calf strain as well as a full rehabilitation program to get back to full fitness and avoid the calf injury recurring in the future.
Calf muscle contusion results from a direct blow to the back of the lower leg. The muscles is crushed against the bone and will bleed causing pain and swelling. Again these calf injuries can be very mild or quite severe and disabling. It is important to treat a calf contusion correctly as complications such as myositis ossificans (bone growth within a muscle) can occur causing long term problems from may initially be a minor injury. Treatment and rehabilitation is similar to that of a calf strain with rest, ice, stretching and strengthening exercises.
Cramp in the calf muscle is a sudden sustained, involuntary contraction of the calf muscle which can be very painful. Cramp is common after or towards the end of an exceptionally hard or long period of exercise. The exact cause of cramp is not known but is thought to include dehydration, low salt levels, tight muscles and low carbohydrate levels.
DOMS or delayed onset muscle soreness is muscle soreness that typically comes on hours after exercise or even a couple of days after. It is more likely after extreme or unaccustomed levels of exercise particularly plyometric or explosive type exercise. We examine the causes of DOMS and treatment methods although time is probably the most important element here.
Referred pain is where a problem or injury elsewhere can refer pain into the back of the lower leg making the athlete think they have a calf injury. Calf pain can be referred from the lower back via pressure on the sciatic nerve as in sciatica or slipped disc. Pain calf also be referred into the calf from a Bakers cyst or swelling at the back of the knee.
Less common calf pain causes
Posterior deep compartment syndrome is where the muscles in the posterior superficial compartment becomes too large for the sheath surrounding it. This can be acute following a direct blow or contusion where the muscle bleeds within the sheath. Or it can come on very gradually and be chronic where the muscle has simply grown too big for the sheath that surrounds it. Typically the pain would come on at a certain point into the run and get worse until the athlete has to stop. After a period of rest the symptoms will go only to return again once the athlete returns to training. We examine the potential causes of a compartment syndrome as well as treatment options available.
Stress fracture of the fibula is a hairline crack in the bone due to over use or repetitive stress. It is less common than a stress fracture of the larger tibia bone in the shin as its function is muscle attachment rather than weight bearing. Symptoms include pain at a point on the fibula bone deep within the calf muscles.
Poor circulation can be caused by pressure or entrapment of the Popliteal artery or the external iliac artery resulting in calf pain. Popliteal artery entrapment is often misdiagnosed as a compartment syndrome because symptoms can come on during exercise as blood pressure increases.
Endofibrosis of the external iliac artery can cause exercise related calf pain, particularly in rowers, cyclists and triathletes. Damage to the arteries in the groin and hip area causes them to stretch or narrow restricting blood flow resulting in pain which comes on during exercise.
Stress fracture of the tibia is a hairline fracture in the large weight bearing tibia bone of the shin caused by overuse. It is more likely to cause shin pain, particularly in the lower third of the inside of the shin as in shin splints but may also be a cause of pain in the calf.
Varicose veins can also be a cause of calf pain.
Do not miss..
DVT or deep vein thrombosis is a blood clot in a vein. It is most common in the calf muscle area, particularly following surgery and long-haul flights. Symptoms include tenderness and pain at the site of the clot. It is very important to treat these calf injuries correctly and not apply massage as the clot can dislodge and travel up towards the heart where the effects can be very series, even fetal.
Poor circulation from constricted arteries can cause calf pain. Symptoms will be exercise related as blood pressure increases as heart rates increases.