Calf Pain

There are many different reasons why we develop pain in the calf. The most simple being muscular injury and this can be caused by trauma to the muscle or overuse resulting in a tear. There are other conditions in the body which mean our nerves or blood supply can be causing the pain. This section will run through the anatomy of what may be causing the calf region to be painful before looking at more specific types of calf pain.

Muscle

There are 2 muscles within the calf called the gastrocnemius and the soleus. The 2 visible heads you can usually see are the gastrocnemius – this is the muscle that helps to point your foot downwards when your leg is in a straight position. The soleus sits underneath the gastrocnemius and operates the pointing downwards of the foot when the knee is in a flexed position.

Tendon

There are 2 tendons which help to feed the calf region. There is the tibialis posterior tendon which sits in the foot and ankle and runs in to the calf region on the inside of the achilles and assists with downwards pointing of the foot.

This can be a common misdiagnosis of calf/achilles pain due to how it presents. Then there is the main calf tendon which is the achilles. This is a thick, strong tendon responsible for the explosive movement and shock absorption going through the calf region. The gastrocnemius and soleus blend in to the achilles and attach down at the end of the heel bone.

Bone

The less common cause of calf pain is from the bones of the lower leg but they cannot be ruled out. The shin bone – tibia and lateral shin bone fibula can become sore from conditions such as shin pain which may refer in to the calf at times.

Nerves

Referred pain from the lumbar spine from problems such as sciatica and also nerve claudication in the back when nerves become strangled produce irritation in the lower limbs.

Blood Supply

Blood supply which can be affected can cause aching in to the calves, this commonly occurs in problems such as claudication and deep vein thrombosis – these are both very specific and also less common causes of calf pain.

Calf Strain 

Tearing of the muscle fibres within the calf can produce pain and dysfunction. This is common in very active people, especially with sudden movements or explosive sports. Big changes to a training regime where the amount a person is doing can cause muscle injury. Inadequate rest and recovery can contribute to calf tears developing.

If there is weakness within the muscle this will make a tear more likely to happen if it is subjected to repetitive load and force. Calf tears can be painful when walking, more painful when running or jumping and can often make someone limp. Really bad tears will produce swelling within the calf and potentially even visible bleeding when worse.

Achilles Tendonitis

This is when the achilles tendon is not tolerating the demands it is being placed under and becomes painful and sore. This can then cause development of pain within the calf. The tendon will become sore to touch, reduce function but also reduce the power you are able to generate from the tendon. Its tolerance to exercise may not be as good.

Achilles Rupture

A rupture of the achilles is a serious injury involving tearing of the main body of the tendon, this will result in a big loss of function within the lower limb and may require surgery in most cases – as a result of this being the main way the calf muscle is used – the calf is likely to develop pain due to the rupture.

Limping

If you start limping for any reason, a typical style will be to place more wright through the tip toe. This engages the calf muscle and it becomes overworked and it may develop a tight feeling. If you have injured yourself – great advice is that you walk slower and take smaller steps and make sure you contact your full foot to the ground and walk as normally as possible.

Cramp

This a common calf pain source. Cramp can occur in 2 ways – if the muscle has been overworked and you are dehydrated and depleted, the muscle does not have enough of the required electrolytes and fuel to contract – this causing it to cramp. Another reason for cramp can be if the calf is weak and becomes overworked then it will go in to cramp when it is not capable of working anymore.

Tibialis Posterior Tendonitis

As discussed earlier, this is a common misdiagnosis due to its close proximity to the achilles tendon. Tibialis posterior helps us to point our foot downwards and in, when it is worse it can cause calf pain as it assists the calf and also attaches close to the mid-calf region.

So what can we do about our calf pain? Luckily we have all the treatment and exercise advice you should need. Read on.

Always take advice from a health professional if you have a calf injury before attempting any exercises. Here are our top 5 exercises which can help to reduce and prevent calf pain.

Standing Calf Raises

This is the most common calf exercise you will see. This can be performed with bodyweight by standing with straight legs and raising up to your toes. You may need the support of something if you haven’t got good balance.

To progress these exercises you will need weight or a machine to add weight to. If you haven’t got weight you can do a single leg calf raise or even slow down the speed of your exercises in order to place the calf muscle under more tension for longer.

Seated Calf Raises

This variation helps to strengthen the soleus muscle which is only worked by having a flexed knee.

If you go to a gym there are seated calf raise machines which can do this job easily for you but if you don’t, simply sitting down and placing a weight on your knees as you raise your heels off the ground and keep your toes on the ground is a great way to perform this.

Tip Toe Walking

Walking on the tip toes is a great challenge for the calf muscles. Because your foot is pointed downwards all the time it will activate your calf muscles.

Walking in this position helps to strengthen your calf muscles but also your foot and ankle muscles which help to support your calves.

Skipping

This is probably the number one way to build calf muscle and strength. Skipping is used a lot in sports such as boxing for endurance training but it also helps to develop calf strength, power and resilience.

There are many different ways to perform skipping, but beginning with a standard double foot skip is a great starting point and perform for 30 seconds to 1 minute per round. Progressing to longer times and different types of skipping over time will help to build your calves up. Skipping translates really well to improved running and sporting performance.

Box Jumps / Landing

Using a plyometric box which is stable and safe enough to jump on to – repeated jumping up and soft landing practice is a great way to strengthen your calf muscles and achilles during the rehabilitation phase.

The jumping motion helps you to develop power in the calves and the landing practice helps you to absorb force through the lower limb. This is great way to develop calf power and also prevent injuries.

Calf Stretch

This one should not be done following a calf injury – an injured muscle does not need to be stretched as it has been torn and further stretching will aggravate it.

Stretching is only advised if a muscle feels tight and you need some immediate relief. Stretch the muscle for 20-30 seconds at a time.

A calf stretch is performed by placing a towel round the bottom of your foot with your leg out straight and pulling the foot up so that the calf stretches.

When standing, place both hands on a wall and place the leg you wish to stretch out behind you and push the heel in to the floor to stretch the calf – get to an intensity you are comfortable with and do not make it painful.

Calf pain is pretty easy to identify but what is causing the issue may have you stumped if you have not had a clear injury. Go and see a health professional such as a physio who can help to diagnose the issue properly. Depending on the cause of the problem they will recommend a treatment plan which is designed to reduce pain and restore function.

If you have a soft tissue injury then techniques such as:

Soft tissue therapy

This could be a combination of things which include, massage, cupping, myofascial release. To simplify, if you have had a soft tissue injury then there will be torn and strained fibres of muscle. Soft tissue therapies help to move and separate muscle fibres in order to aid the healing process by increasing blood flow and helping tissue to remodel. It can be quite common the calf will develop tightness and pain and soft tissue therapies really help to reduce these symptoms and aid recovery.

Shockwave therapy

This is a technology which helps to deliver mechanically generated shockwaves in to the tissue via specialist machine. There is great research on these machines which show that it can accelerate healing by up to 40%. The shockwaves help to ignite a healing response and increase blood flow in to the tissue which then helps the muscle to heal more quickly. Another benefit of the shockwave treatment is that it can give great pain relief following treatment.

Acupuncture

This is a traditional treatment where needles are inserted in to the skin to help with pain control but also can help with muscle tension. Dry needling is a more western approach which involves the needles being worked in to the muscle belly and helping it to relax.

A good physio will also provide you with the right exercises at the right time in order to help your calf recover. Strength exercises should always be implemented with a calf injury as they help to support the muscle and repair it so that it can function properly again. If the calf is not strengthened then it may be susceptible to re injury or the pain not reducing.