Calf pain when running has a number of causes. These include calf strain, compartment syndromes, cramp, stress fractures and DVT (Deep vein thrombosis).
Chronic calf pain when running
Chronic calf pain develops gradually over time. You may or may not notice a specific point in time when your calf pain occurred. Chronic injuries can also follow an acute injury that has not healed or been treated correctly. The most common include Posterior deep compartment syndrome and tight calf muscles
Acute calf pain from running
Acute injuries occur suddenly. You will know the exact time your injury occurred and often be unable to continue playing or training. These include Calf strains, Contusions, and Cramp.
Most common causes of running calf pain
The following are some of the more common causes of calf pain in runners:
A torn calf muscle/calf strain is probably the most common cause of sudden onset calf pain when running. Symptoms include:
- Sudden sharp pain at the back of your lower leg
- Often in the middle of your muscle at the point where the big gastrocnemius muscle connects to the Achilles tendon
- Tenderness at the point of injury.
- Swelling and/or bruising, depending on the type and severity of your injury.
Treatment consists of applying immediate cold therapy and compression and rest followed by a full calf strain rehabilitation program.
A cramp is a powerful and painful involuntary contraction of the muscle, which can cause calf pain when running or after.
Symptoms of cramp in the calf muscles consist of:
- Sudden, involuntary contraction of your muscle
- It usually occurs towards the end of a particularly hard training session, or possibly a few hours later
Potential causes include dehydration and low carbohydrate levels so taking on fluids and energy may help.
Immediate treatment is to try and stretch the muscles gently to release the spasm, often the help of a partner is needed.
Chronic Posterior compartment syndrome occurs when the muscle swells up too big for the sheath surrounding it. This is a gradual onset cause of calf pain when running. Symptoms include:
- Deep aching pain or tightness in the back of the lower leg that develops during a run, but eases off with rest.
- Experienced runners may find the pain comes on at exactly the same point during a run becoming progressively worse until they have to stop.
Compartment syndromes can be acute, that occur suddenly. These may occur following direct trauma or impact causing bleeding within the muscle sheath. Acute compartment syndromes are medical emergencies as they can lead to permanent tissue damage.
Treatment consists of the following:
- Rest or relative rest such as reducing running mileage to 50% of normal or switching to cycling or swimming
- Apply ice or cold therapy and compression for up to 20 minutes at a time
- Cross friction massage to stretch the fascia
- Gait analysis with corrective orthotic foot insoles
- Surgery to decompress the compartment
Tight calf muscles
Although not specifically an injury itself, tight calf muscles can lead to other injuries as well as discomfort when running.
A physical sign of tight calf muscles is a gradual tightening of the muscles over time. It may get worse whilst running, or improve while running only to tighten up later. If you palpate (feel) the muscles you may identify tight lumps and bumps. These are areas of spasm where the muscle fibres have tightened up.
Your physio may do specific tests to measure if you have tight calf muscles.
There are various ways to stretch your calf muscles including:
- Stretching exercises
- Deep tissue massage
- Wearing a night splint or sock
Fibula stress fracture
A Fibula stress fracture is a rare cause of calf pain in runners. It is an overuse injury resulting in a hairline fracture of the fibula on the outside of the lower leg. The calf muscles attach to the fibula bone, so the traction and twisting forces of the muscles can cause a stress fracture. Symptoms consist of:
- Pain at the back of the lower leg, which may be more towards the outside
- Weight-bearing is painful
- Calf pain increases when running.
Deep vein thrombosis
Deep vein thrombosis (DVT) should always be considered a possible cause of calf pain. Although it is a common injury overlooking it may cause serious injury or worse!
It is a blood clot in the veins and is most likely to happen in the calf area, especially after long flights and surgery. This is a serious condition and medical help is needed if this is suspected.
Symptoms consist of:
- Constant pain, usually in the calf muscle at the back of the lower leg
- Tenderness deep within the muscle
- You may have swelling in the calf muscle area
- Skin temperature may seem hot to the touch
- Sometimes a red area is visible on the skin
If you suspect a DVT then seek professional advice from your Doctor. Do not attempt to run with calf pain.