Calf pain in Runners/ Marathon folk!

Here’s another gem from Tom Goom (www.therunning-physio.com).

The two injuries we see most commonly during this time of year is Runners knee and calf pain.

Here’s the article – any questions, do ask! Any injuries do call!

Calf pain after an injury is expected but runners often complain of calf soreness with no history of trauma to the area. In these cases, like many in running, the key is identifying the cause and rectifying it.

Non-traumatic calf pain usually follows a fairly predictable pattern – the pain develops when running and gradually worsens as the run continues. The calf may feel tight and even stop the runner from going any further. After running the pain subsides a little but the calf often continues to feel tight for a day or so. Commonly when not running symptoms are minimal.

There are a few potential diagnoses for this including superficial posterior compartment syndrome and ‘sciatica’ but the most common reason I see clinically is simply fatigue of the calf muscles. This leads to the question of why are my calf muscles becoming fatigued? Every muscle has it’s different level of strength and endurance, exceed that level and it will usually start to become painful and tight. The answer to why this happens usually has 2 parts to it;
1.The calf is being overloaded
2.The calf muscles are weak or lack endurance.

Overloading the calf

The first question here may be what’s changed recently that coincides with your calf problems?

Common causes can be introducing hill or speed work, increasing weekly mileage and increasing training intensity. It’s also very common for people transitioning to barefoot running to have calf pain. Running barefoot often involves landing on the forefoot and this usually loads the calf muscles and achilles tendon more than running in shoes. Another factor is exercise you do in addition to running – if you’ve started to introduce gym sessions and running on the same day, or the following day, the calf may already be somewhat fatigued before you start.

There is a cumulative effect to exercise that can be quite subtle. If you run regularly you might be quite accustomed to running on heavy tired legs. You can become unaware just how fatigued muscles are getting. I developed calf tightness in my marathon training and was amazed to discover I could hardly perform a calf raise on either leg even when there was no pain!

The first answer when you have been overloading your calf is often rest. The dreaded R-word! A few days rest, some stretching and a session or 2 with the foam roller will often work wonders. I would recommend this before you start thinking about addressing any calf weakness – adding more exercises to an already fatigued calf can add to the problem. Secondly, you may need to think about your training schedule. Are you doing too much with too little rest? Adding a rest day or reducing your mileage temporarily can help resolve symptoms, allowing you to progress again. Our article on training error can give you more guidance on this.

Assessing calf strength

The easiest way to do this is a single calf raise;
•Stand on 1 leg with your finger tips on a wall/ table for balance (not to push up from).
•Push up onto your toes and slowly down again
•Do as many as you can (going right up, not just lifting your heel a bit!)
•Count the repetitions and compared left and right side

You should be able to do the same amount left and right and it should feel as easy both sides. Clinically I like to see runners achieving 40+ reps on each leg, though I have no research to support this number. Below 30 might suggest a lack of endurance. You may find this test causes your symptoms, in which case stop, don’t push through pain.

The single calf raise is very effective to strengthen the calf. Do as many as comfortable, rest for 1-2 minutes and repeat for 2-3 sets. Aim to work up to 3 sets of 25-30 reps. Do this 2 or 3 days a week on days that you aren’t running. The exercise can also be done on the edge of a stair to allow for greater range of movement by letting the heel drop below the level of the step. (RunningPhysio will shortly be adding a detailed article on calf strengthening).

Addressing calf tightness

Calf flexibility is also important and not to be overlooked. Gently stretch the calf dynamically prior to running using mini squats, lunges, wall presses etc. anything that stretches the calf a little in a comfortable, controlled way. After running or doing strength work use your static calf stretches (as detailed on our previous article on calf injury) and as mentioned previously, the foam roller can help to release tight calves (although it is painful to do!).

Final thoughts: non-traumatic calf pain is often a case of doing too much or having weakness in the calf muscles (or a bit of both!). A combination of a little rest, some changes to your training and some strength work is usually enough to resolve the problem.

If you have any additional symptoms such as severe pain, swelling, skin redness, pins and needles or numbness consult your GP or health care professional. As ever on RunningPhysio if in doubt, get it checked out.