Whether you’re a long-time runner or you’re new to running and are still learning the ins and outs, there’s one thing that can have a massive impact to your running – and your life: Calf pain.
While some may have the privilege of knowing the moment that it all went wrong and they heard that painful *snap*, for others, the pain will feel like it came out of nowhere with no particular run or exercise to blame.
Knowing exactly what’s going on and why is key when it comes to managing (and even preventing) calf pain, so today we thought we’d share with you the four most common causes of calf pain in runners that we see and treat here at Thrive Health.
But First, Anatomy
To best understand how the calves are affected in each of the following four causes, it’s always helpful to have a general understanding of the anatomy and function of the muscles in question.
Three muscles make up the calves, the:
They are a collective group, and although they originate in slightly different places, they all come together as the achilles tendon which inserts into the back of your heel. To be specific, the gastrocs and plantaris start at the bottom of your thigh bone and cross the knee, and the soleus begins at the top of your shin bone. As the gastrocs and plantaris cross both the knee and ankle joints, they power and help the knee to bend and the foot to point down.
When we run, these muscles are working tirelessly to propel us forward, push off the ground and help stabilise the knee and ankle. Just think of the power required when we jump that they deliver! Now that we’ve got a basic understanding of the important role of the calves, we can talk about the four ways they can become painful and wreak havoc and your day.
1. Overloading Your Calf Muscles
Despite their strength and power, your calf muscles very much have a ‘line’ or ‘breaking point’. This is the point beyond which the job that you’re asking your calf muscles to do gets too much and exceeds what they can safely perform without sustaining an injury. This ‘line’ is determined by numerous factors including the strength and flexibility of the calves. As strength and flexibility can change, your ‘line’ will also change as you keep training and grow stronger – or vice versa.
You may exceed the line from:
- Going for a very long run that you don’t usually do
- Completing a short but intense uphill training session which puts a large load on the calves – more than you normally do
- Switching from joggers with a 4cm pitch to completely flat ‘bare’ shoes, requiring you to engage and work your calf muscles harder to perform the same movements you previously were
- Generally increasing your duration of exercise (without having the adequate strength to handle it)
Whatever the cause, when the line is exceeded, damage begins. It doesn’t have to be a sudden ‘snap’ either! Most runners will experience a gradual onset of pain that will feel worse during exercise as you continue to engage your damaged and vulnerable calves. Before you know it, you’ll have a tendinopathy (meaning a damaged muscle/tendon) and will need tailored rehab to get it back to its healthy, functional and pain-free state – before it gets worse.
2. Calf Muscle Weakness (+ Flexibility)
This one is very much related to the first point. When your calves are weak, the load that they can bear before they reach their ‘line’ and damage begins is significantly less. That’s why, for most of us anyway, we can’t just ‘jump’ into a marathon without the months of training and the strength development – we’d reach the ‘line’ on all our muscles even before we reached the halfway line.
Thankfully, the solution to this one isn’t complicated: work on developing your strength. Don’t just do ad-hoc calf raises either. Get a programme (we can help!), work on it daily (or at least four times per week) and gradually build up the base strength that will help power you through the exercises and activities you want – which will help build that strength even faster.
This is also a good time to quickly mention that your flexibility matters, too. When your calves are tight, you are more likely to strain the muscles because of the constant pull that inflexibility creates. It can also alter the biomechanical movement of your feet and legs.
For example, think of the pull that a tight achilles tendon creates at the back of the heel. It can change your gait and the way you take steps. Your heel will start to lift up off the ground earlier, putting more pressure on your forefoot for longer. This can predispose you to forefoot injuries, pain, developing bunions (depending on your foot type) and the like.
Your calf pain may not always be due to problems with the calves – it may be due to other conditions and we’ll touch on two of these quickly:
3. Chronic exertional compartment syndrome
If you’ve ever experienced it, you’ll know that chronic exertional compartment syndrome (CECS) is not a condition to be taken lightly. CECS describes the swelling of one of the four muscle compartments in your lower leg. We say ‘compartments’ because the muscles in your lower legs are actually enclosed by a soft tissue (fascia) that keeps them in these four separate compartments. In CECS, the fascia doesn’t expand as your muscles do, so you only have a limited amount of space within the compartment. So if you have significant swelling, whether it’s natural from exercise and greater blood flow to the area, or from injury, it can quickly cause a great deal of pain and stop you in your tracks.
As a runner, you have a higher risk of developing CECS. If you think you may have this, you must seek help immediately. That’s because if your blood flow is limited into and out of the compartment, oxygen may not be able to reach your tissues. In some cases, surgery may be required to relieve the compartmental pressure.
If you’ve had any back or neural problems, then you may also suspect sciatica. Sciatica is damage to your sciatic nerve, which starts at your spinal cord and runs down through the hip, buttocks and down the leg. It’s very long – and damage at any point along this nerve can cause pain in the leg (particularly below the knee) – even damage in your lower back!
This pain may feel like burning or shooting, and you may experience other neural symptoms like numbness, tingling and pins and needles along the leg. The pain can be quite intense in the lower leg around the calves. The best way to find out if you have sciatica is to seek professional help – which is important to do because the pain can last for months and definitely keep you off the road or treadmill!
What if I have calf pain?
With all this said and all the conditions explained, if you do have calf pain, our experienced physiotherapists at Thrive Health would love to help you feel great again and keep you running well. You can book an appointment online or call us on 2522 6972 .