Whether you’re new to running or have been running for years, at some point you’ve probably developed calf pain from running. While most calf pain is fairly self-limited and doesn’t need much in the way of treatment or time off running, every once in a while, you may find yourself sidelined with calf pain that prevents you from running.
What causes calf pain in runners?
The most common reason for calf pain in runners is due to a calf muscle strain or calf muscle injury. Usually, these calf muscle injuries are acute, meaning there’s an identifiable injury that you can recall, either slipping while running on a trail (been there, done that) or a sudden pain or cramping of the calf while running. In other cases, you may not notice the calf strain until the next morning when you try to get out of bed and have that excruciating pain and cramping in the calf when you try to take those first steps in the morning.
Muscle cramps while running can be another cause of calf pain from running. Muscle cramps are most likely due to muscle fatigue and not electrolyte issues, so the prevention for muscle cramping is to improve muscle strength and endurance so the muscle doesn’t fatigue as quickly from running. 1
Trigger points or chronic muscle spasms are another cause of leg and calf pain from running. Trigger points are hard and taut “knots” or nodules in a muscle that can cause referred pain in another part of the body 2 First described by Travell and Simon in the 1960s, I’ve found that undiagnosed trigger points can be a frequent cause of calf pain in runners and other athletes that don’t respond to rest and ice as for typical calf strain treatment.
The picture above shows the relation between trigger points (TP#) in the calf and its pain distribution (yellow dots). A trigger point (TP1) in the upper inner calf can cause pain to be felt in the middle calf, down the back of the leg into the heel, and even into the arch of the foot.
Other causes of calf pain in runners
Tight calf muscles or poor flexibility in the foot, ankle or lower leg can place increased stress on the calf muscles during the stance and push-off phase of the running stride. If you have limited range of motion at the ankle, then working on stretching of both the soleus and gastrocnemius calf muscles can help.
Running gait and foot strike can also overload the calf muscles and either cause calf pain or calf tightness. Runners that are either heavy heel-strikers or runners that run on their toes can stress the calf, leading to pain and injury. Because of these altered running mechanics, these toe or heel runners may be more likely to have calf muscle injuries. Focusing on a more neutral running stride with either a mid-foot strike or allowing the foot to land underneath your body instead of out in front like many heel-strike runners can help decrease the stress on the calf muscles and Achilles tendon.
Muscles of the calf
There are two main muscles in the calf, the gastrocs (or gastrocnemius) and the soleus muscles. Both muscles originate from the Achilles tendon on the back of the ankle and run up to the knee. The soleus sits deeper while the gastrocs is more superficial. The gastrocs makes up the bulk of the calf and is divided into two “heads” as the muscle splits before it attaches to the femur.
The soleus muscles ends before the knee joint while the gastrocs muscle crossed the back of the knee and attaches to the lower part of the femur.
Both calf muscles help plantarflex (point your toes downward) the foot and are important in running since they help with pushing off the ground. So you can imagine that an injury to either calf muscle can limit your ability to run and cut into your training.
What to do when you first have calf pain from running
The first step of dealing with calf pain from running is to figure out the cause of the pain. You may need to back down on either your running mileage or intensity as you let the calf muscle heal.
Ice can be helpful in the first 24 to 48 hours of an acute calf injury to help decrease swelling and to help with the pain. A compression sleeve while running also helps some runners.
Follow up treatment for runners with calf pain
As your calf pain begins to improve, slowly increase your running mileage and intensity while being careful to keep assessing for any recurrence of calf pain. If you notice that the calf pain is worse when you are running, back down the mileage and intensity because the calf hasn’t fully healed.
Preventing calf pain from running
An ounce of prevention is worth a pound of cure is the famous saying and holds true with calf strains. Most calf strains and calf injuries in runners are due to overuse and under-recovery. It’s important to listen to your body and know when you’re reaching your training limits.
Recovery as well s making sure you take care of your body are all important for preventing leg injuries. Making sure you follow a well-planned out strength training program for runners as well as trigger point work on the calf muscles can help prevent recurrence. I usually recommend using a massage ball or foam roller several times a week to help prevent trigger points in the calf muscles from becoming painful or debilitating.
A trigger point massage ball is inexpensive and allows better direct pressure on the trigger points of the calf muscles than a foam roller does. These massage balls are an invaluable tool for any runner and can prevent time away from running.
Strength Training for Calf Pain
Strength training not only for the calf but strength training of the entire leg, as well as the glutes, can also help decrease stress on the calf muscles. If there is a weakness in the glutes or conversely, tight hip flexors that result in inhibition of the glutes, then a strength-training program specifically for runners can be helpful. Single leg glute bridges can improve gluteal strength and hip stability when running.
How to properly stretch your calf muscles
There are two different muscles that make up the calf and each muscle has a different attachment on the upper leg, which means there are two different ways to stretch each muscle.
The soleus attaches to the proximal tibia or shin bone while the gastrocnemius crosses the back of the knee joint and attaches to the lower part of the femur.
Most people will stretch their calf muscles by keeping their foot firmly on the floor and then leaning forward with a straight knee until they begin to feel a stretch in the back of the calf. Or maybe you sit on the ground with the legs out straight and lean forward until you can touch your toes.
Both of these stretches actually one stretch one of the calf muscles – the gastrocnemius. In order to stretch the soleus, you need to bend your knee, which relaxes the gastrocs, since it crosses the back of the knee joint and the soleus doesn’t.
When to see a sports medicine professional for your calf pain
If you’ve tried stretching, ice and trigger point massage with no improvement over a week or two, its probably time to see your sports medicine doctor or physical therapist to get an accurate diagnosis.
The most concerning diagnosis NOT to miss in the calf would be a blood clot or deep venous thrombosis (DVT). If you have significant swelling of the calf, it’s important to rule out a DVT quickly since the clot can break off and end up in the lungs causing a pulmonary embolism.
Sciatica (herniated disc) is another cause of calf pain that may mimic a calf strain. Usually the pain from sciatic runs down the entire leg and into the foot.
Other medical problems that can cause calf pain in runners include poor blood flow into the leg due to blockage or occlusion of the arteries of the leg. Another rare problem that could cause leg pain in a runner would be chronic exertional compartment syndrome, where the lower leg muscles swell and constrict blood flow into the lower leg.
Looking to stay injury-free?
Read our strength exercises for runners articles.Research