Calf Pain

Calf pain

Calf pain refers to pain at the back of the lower leg. Here we explain the common causes of calf pain, as well as more serious conditions which should not be missed when diagnosing calf injuries.

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Sudden onset/acute calf pain | Gradual onset (chronic) calf pain | Rehabilitation Programs

Sudden onset (acute) calf pain

The following injuries are common causes of sudden onset or acute calf pain:

Calf strain

A torn calf muscle is probably the most common cause of sudden onset pain at the back of the lower leg.

  • You will feel a sudden sharp pain at the back of your lower leg.
  • Pain is usually in the middle of your muscle at the point where the big gastrocnemius muscle connects to the Achilles tendon.
  • Your leg will be tender to touch at the point of injury.
  • You may have swelling and/or bruising, depending on the type and severity of your injury.
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Calf contusion

Calf contusion

A contusion occurs following a direct impact or trauma to the calf muscles. Symptoms include:

  • Sudden calf pain resulting from direct trauma to the muscle.
  • Pain may be mild, or so severe you will be unable to walk properly.
  • Your leg will be tender to touch and swollen.
  • Bruising may, or may not appear depending on the type, and how bad your injury is.


Lower leg cramp

Cramp is a powerful and painful involuntary contraction of the muscle. Symptoms consist of:

  • A sudden, involuntary contraction of your muscle.
  • It usually occurs towards the end of a particularly hard training session, or possibly a few hours later.
  • Immediate treatment is to try and stretch the muscles gently to release the spasm, often the help of a partner is needed.
  • Potential causes include dehydration and low carbohydrate levels so taking on fluids and energy may help.

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Gradual onset (chronic) calf pain

The following are common causes or gradual onset or chronic calf pain:

Posterior compartment syndrome

Posterior compartment calf pain

Posterior compartment syndrome occurs when the muscle swells up too big for the sheath surrounding it. Compartment syndromes can be acute, which occur suddenly, or chronic, which have developed gradually over time.

Acute symptoms:

  • Acute compartment syndrome occurs suddenly and may develop following a contusion (direct trauma to the muscle).
  • The muscle bleeds within the muscle sheath causing increased pressure within the muscle sheath.
  • An acute compartment syndrome needs urgent medical attention, especially if the pain becomes progressively worse as it can result in long-term damage.

Chronic symptoms:

  • Chronic compartment syndrome occurs because your muscle gradually grows too big for the sheath surrounding it.
  • Deep aching pain or tightness in the back of the lower leg occurs gradually during a run but then eases off with rest.
  • Experienced runners may find the pain comes on at the same point in a run consistently.
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Lateral compartment syndrome

  • Lateral compartment syndrome can be acute or chronic the same as posterior compartment syndrome, only the pain is over the outside of the calf muscles.
  • It is probably more common as a chronic injury in long-distance runners.

Tight calf muscles

Although not a specific injury, tight muscles at the back of the lower leg is a widely seen problem among athletes and can lead to other related injuries. Tight calf muscles may be caused by:

  • Poor foot biomechanics
  • Lack of stretching
  • Wearing high-heeled shoes.

If your calf muscles are partially contracted, or in spasm, the blood and nutrients cannot flow so easily, which may cause discomfort and pain. If left untreated, this can increase the risk of suffering from a more severe and acute injury.

Deep vein thrombosis

Deep vein thrombosis (DVT) is a possible cause of calf pain that should always be considered. Although it is not as likely as the injuries above, it is a condition that should not be missed or overlooked.

  • 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.

Fibula stress fracture

Fibula stress fracture may cause calf pain. 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.
  • This injury would make putting weight on the leg pain, and the calf pain is likely to increase with exercise.
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Other causes of calf pain:

Calf pain may be referred from other body parts and produce pain in the calf.

It may originate from injuries to the spine, the knee (including Baker’s cyst and PCL injuries), and myofascial tissue structures (particularly in the gluteal muscles).

Calf pain may also be caused by trapped arteries or vessels, such as the popliteal artery.

Trapped tibial and sural nerves in the calf may also make the lower leg area painful.

Immediate first aid for calf pain

Calf pain should be treated using the P.R.I.C.E. principles (protection, rest, ice, compression & elevation).

  • Protection – Stop training or playing immediately to prevent the calf injury from getting worse.
  • Rest – Resting the calf is important and vital for recovery. Try to reduce the demands of your daily activity and stop doing any sports that exacerbate the pain. Continuing to train with a calf injury and not allowing it time to heal can result in a more serious injury.
  • Ice – Apply ice or cold therapy to the calf to help reduce the symptoms of pain and any inflammation. Apply for 10 minutes every hour for the first 24 to 48 hours after injury, reducing to 3 or 4 times a day as symptoms improve. Do not apply ice directly to the skin as it may burn. Use a commercially available cold pack or wrap ice in a wet tea towel.
  • Compression – Wearing compression support or compression bandages on the calf can reduce swelling.
  • Elevation – Keeping the lower leg elevated above heart level can help to reduce swelling, due to the effects of gravity.

Read more on PRICE principles.

Rehabilitation programs

We have the following step by step rehabilitation programs available:

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References & further reading

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