Calf Pain

Where are the Calf Muscles?

The calf muscles are located in the back of your lower leg, behind your shin bone. There are three muscles, which work together to support you when you stand, help you to walk, run, jump, stand on your toes, flex your foot (lift your toes up toward your knee), and "lock" your knee.

The calf consists of two main muscles — the Gastrocnemius and the Soleus. They come together above your heel forming and attaching to the Achilles tendon. In addition there is a small muscle called the Plantaris which runs between the Gastrocnemius and Soleus down the length of the lower leg. Interestingly not everyone has a Plantaris muscle; it is thought about 10% of people only have two larger muscles.

Causes of Calf Pain

• Cramps: Cramp is usually when the muscles suddenly tighten and contract. This might happen if you have been doing new exercises, if you are dehydrated, or if you are deficient in some minerals.
• Gastrocnemius (calf muscle) strain: This is an overuse (sprinting & jumping) injury of the largest calf muscle. The tendon that attaches the calf muscle to the back of the knee can be excessively worked or abruptly overstretched and gradually this can cause microscopic tears and inflammation within the tendon.
• Soleus muscle strain: This is a common overuse injury in endurance running. The soleus muscle plays an important role in lifting the heel off the ground. It also stabilises your posture as you walk or run, preventing you from falling forward.
• Calf muscle contusion: Otherwise known as a bruise, happens when blood vessels under the skin are torn or ruptured. As a result, the blood vessels leak into the muscle tissues. This type of injury often occurs after a person falls, bumps into something, or is struck on the calf.
• Plantaris muscle rupture: This can occur when a lot of weight is suddenly placed on the ankle while the knee is extended. This small, superficial muscle is situated behind the knee and runs between the gastrocnemius and soleus muscles.
• Baker's cyst: This is a fluid-filled sac that sits behind your knee that can develop if you have sustained a knee injury, causing your knee to become swollen and inflamed. If a Baker's cyst ruptures, the fluid may leak down into the calf region, causing an aching pain in the calf, along with swelling.
• Sciatica: This is when the Sciatic nerve becomes compressed and irritated at the lower part of the spine. The nerve travels down the back of the leg and calf, it sends nerve impulses and controls leg motion.

Calf Pain Symptoms

• Cramps: These are usually very sudden and very uncomfortable - the muscle clenches and tightens. After the cramp eases, the area might be sore for hours or days.
• Gastrocnemius (calf muscle) injuries/ tendonitis: Pain and tenderness at the back of the knee when pressing at the top of the calf. It can be painful to hop, stretch the car and lift up the heel whilst standing on a straight leg. Some people hear a "pop" when the injury occurs but feel no pain at that moment. If the strain is severe, there may be swelling and bruising, and the pain may be too intense to walk.
• Soleus muscle strain: This is deep soreness or tightness when you press on your Achilles tendon, walk on your tiptoes, or pull your toes toward your shin. Symptoms tend to develop over time, beginning with calf muscle fatigue. Swelling, bruising, and sharp pain may worsen until it is too difficult to run at all.
• Calf muscle contusion: This usually show with skin discolouration, swelling, bruising along with tenderness or severe pain. Swelling may also limit your ability to move as you normally would.
• Plantaris muscle rupture: This can cause a sudden, snapping pain in the back of your leg. Bruising, swelling, and pain may take a few minutes, hours, or even days to develop. Some people may also experience cramping.
• Sciatica: The pain can vary between a mild ache to a sharp, burning pain / pins and needles - it can even feel like an electrical current and sharp shock.

Calf Pain Treatment and Excercises

Early Advice - RICE

• Rest: Activity Modification - crutches may be useful if severe calf injury.
• Ice: If swollen and inflamed - apply a covered ice pack to the injury for up to 15 minutes 2 or 3 times a day.
• Compress: Use calf supports such as Tubigrip.
• Elevate: Elevation minimises swelling. Raise your leg up higher than your heart.

Progress

Improve lower leg biomechanics- wear cushioned and supportive footwear appropriate for the activity you are doing.

Do watch the PBG information class on calf pain and then try the QuickFix exercise class to learn how to safely mobilise and strenghten the calf and lower leg.