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.
Did your calf pain occur suddenly or develop gradually over time?
Sudden onset (acute) calf pain
The following injuries are common causes of sudden onset or acute calf pain:
A torn calf muscle is probably the most common cause of sudden onset pain at the back of the lower leg.
- A calf strain is a tear in either the gastrocnemius muscle or the soleus muscle which together make up the calf muscle group.
- Sudden sharp pain is felt, usually in the middle of the calf muscle area at the point where the gastrocnemius muscle connects to the Achilles tendon.
- The muscle will often be tender to touch at the point of injury.
- Swelling and bruising may appear depending on the type and severity of your injury.
- A calf muscle strains are graded from 1 to 3, with grade 3 being the most severe.
Read more on Calf strain
A contusion occurs following a direct impact or trauma to the calf muscles. For example, being kicked in the back of the leg in a game. Symptoms of a calf muscle contusion include:
- Sudden pain resulting from a direct trauma to the muscle.
- Pain may be mild, or so severe you will be unable to walk properly.
- The area will be tender and swollen.
- Bruising may, or may not appear depending on the type, and how bad your injury is.
Although contusions may not at first appear serious it is essential they are treated with as soon as possible with cold therapy PRICE principles (protection, rest, ice, compression, and elevation).
More on calf contusion
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.
More on Cramp
Gradual onset (chronic) calf pain
The following are common causes or gradual onset or chronic calf pain:
Posterior compartment syndrome
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 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 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.
More on Posterior compartment syndrome
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.
More on Lateral compartment syndrome
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.
More on Tight calf muscles
Deep vein thrombosis
Deep vein thrombosis (DVT) is a possible cause of calf pain which 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.
More on Deep vein thrombosis
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.
More on Fibula stress fracture
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.
References & further reading
- Ekstrand J, Hägglund M, Walden M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 2011;39(6):1226–32.