Calf Pain - 4 questions answered

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Do you have calf pain when you run that gets worse the longer you run? The calf feels tight and might even stop you from running forcing you to walk home?
 
This is a fairly common problem we see in runners and usually is a not caused by an acute injury  but  often the result of fatigue of the muscle.

Other potential causes of calf pain are compartment syndrome or sciatic nerve impingement.
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But lets save them for another post....in the mean time if you have any numbness , tingling or loss of muscle function - get thee to a doctor!

Which calf muscle is it?
There are a heap of muscles in the back of the lower leg. (feel free to glaze over as we go through the anatomy) The "calf" muscle is the medial and lateral head of the gastrocnemius and the lower portion of the "calf"  is the soleus. 

Lying deep beneath the gastrocnemius and the soleus are the toe flexors and the tibialis posterior muscle.

So which one is causing you pain? That's a tricky question - most commonly it is the medial head of the gastrocnemius but I have certainly seen calf pain that has been caused by the Flexor Hallucis Longus - which is latin for the muscle that pulls your big toe down. The Flexor Hallucis Longus  can get overworked, fatigued  and stressed if your big toe is stiff - result is pain in the "calf"

Ok -  why does the calf fatigue?
Well that’s a great question! Is it a problem of the calf or is it a problem up or down stream of the calf? 

Is your calf muscle "tight" or is it "weak" or is it trying to do the job of something else?
 
If you have weakness or inhibition in your gluteus maximus it’s tricky to get into hip extension at propulsion, which is an important part of running. The result is we either compensate by using our hamstrings as hip extensors (say hello to proximal hamstring issues) or by using an ankle strategy and end up overloading the calf.
 
The other potential cause is restriction at the ankle joint called an equinus ( latin for an ankle that functions like a horses)  which makes the life of the calf muscle that much harder
 
Also a sudden change in volume, intensity or frequency of running can also stress out the calf muscle. Sprinting and hills repeats are often the culprits.

​The other potential cause of calf strain is a changing to a lower profile running shoe, racing flat or “barefoot” shoe. This can change the foot strike pattern of running and increase the demands of the calf muscle.
 
Well my calf is sore. Maybe I should take some anti-inflammatories then?
Ah…. The answer would be whoah Nelly! . NSAIDs or anti-inflammatories aren't that flash when it comes to helping muscle injury. There has been a truck load of research over the last 20 years or so that shows anti inflammatories impair muscle healing. Recently  the Journal of Applied Physiology published research in 2013 that showed Anti-inflammatories actually slow down repair of muscle after injury which will delay your return to running. This is the last thing we want to do!!
 
So what do I do?
Well if the calf pain is significant it might be worth having a few rest days and let the calf settle. I know that sucks, ideally we want to start strengthening the calf muscle but there is no point adding load to an already overloaded muscle.
 
Once the pain has settled isometric calf raises are a fantastic place to start a strengthening program. Double legged, heels slightly off the ground, toes pointing straight ahead and hold for 15-30 seconds. As muscle endurance improves you can progress to single leg, heavy slow repeats and then even some plyometrics. But start with calf raise and hold.

Some gentle, slow foam rolling to improve mobility of the calf is useful too. Don't go deep into the pain cave when foam rolling, we don't want to further damage the calf muscle - we just want to give it some love. As Chrissie Amplett said 
"There's a fine line between pleasure and pain" so don't overdo it!
 
Also address any glute strength and ankle mobility issues and make sure your shoes aren’t completely trashed.

Cheers Daina