Struggling with tight calves or calf pain when running?

The #UKRunChat feed has at least one person a day complaining about sore or tight calves while running and at SIP we often get asked for advice regarding this. The problem is that there are several reasons why your calves may be sore or tight during or after sport and every one of them requires a slightly different treatment approach.

Needless to say, I cannot cover this on Twitter and its 140 characters, so I thought I’d try and answer your questions in this blog post.

Some of the most common reasons why people get painful or tight calves from exercise are:

• Training errors/changes

• Change of shoes

• You’re a tight arse (or back)

• You’ve upset a nerve

• Muscle tears

• Medial tibial stress (shin splints)

Training errors that may cause tight or painful calves

Any change in your training routine that will cause a sudden increase in load on the calf muscles may cause them to tighten up or hurt. The two best examples are speed work and hilly runs – both of these training sessions force you to run more on your toes, which will increase the load on the calf muscles.

For the same reason, changing your running style to running more on your mid foot or forefoot can cause trouble if you introduce it too quickly.

Interestingly, a study of 1500 recreational runners have found that running less than 40km per week and being a member of an athletics club appears to protect you against calf injuries! One could argue that being a member of a club may give you access to better training advice, but the researchers did not investigate this further.

I would advise “relative rest” if you suspect that training errors may have caused your calf issues. Relative rest means that you don’t have to cease all exercise, but just choose sessions that will allow the injured or aggravated body part to recover e.g. cycle, swim or do a shorter easy run on grass. Introduce speed work, hills or changes in running style gradually to prevent calf pain and injury.

Shoes that may cause calf pain

Most runners these days know about “minimalist” shoes that claim to make you run more naturally. However, I find that a lot of the runners I see in practice have never heard of or considered the heel-to-toe-drop (offset) when buying a new trainer.

The heel-to-toe-drop basically tells you how much higher your heel is than your toes when you’re wearing the shoe. Standard running shoes usually have a drop of around 12 degrees, but you can get 8, 6, 4 and 0 degrees as well. Minimalist shoes typically have a 0 degree heel-toe-drop (your foot is essentially flat).

A flatter shoe will force most people to change their running style to run more on their toes. As mentioned in the section above, this will increase the load on the calf muscles. Your calves may become overworked and sore if you transition too quickly from a regular trainer to a flatter one.

If you want to make a transition to flatter shoes, I would suggest that you:

• Transition slowly by initially doing only shorter runs in your new shoes or do some walk/run sessions.

• Strengthen your calf muscles.

• Walk in flat shoes most of the day.

You’re a tight arse (or back)

No, it’s not the money you keep in your pockets that weigh you down and stress your calves. :-) Your tight calves or calf pain may be caused by something called “increased neural tension”.  Don’t worry, it’s not nearly as serious as it sounds.

What is increased neural tension?

Your nervous system is continuous from your brain to the tips of your toes (and fingers). When you walk and move the nerves slide happily in their sheaths. Tight muscles or other structures can sometimes hold on to or press on the nerves and prevent them from sliding, causing increased neural tension and symptoms lower down in the limbs.

A very common culprit is the piriformis muscle in the buttocks. In some people the sciatic nerve runs through or under the piriformis and gets squashed when this muscle becomes very tight. Tight buttocks often go hand in hand with a tight lower back and I find it most effective if you improve the flexibility in both areas.

Why do people get tight in these areas? It may just be lifestyle. I often find that my runners who spend most of their day sitting or driving end up with very stiff lower backs and buttock. They often have associated increased neural tension when I test them.

There is also some evidence that sports people tend to suffer a bit more wear and tear in the lower lumbar spine (especially in contact sport) over time and that older athletes tend to suffer more injuries to the muscles that are supplied by the nerves that originate from this area (sciatic nerve).

Both of these cases can easily be improved/fixed by following a regular flexibility programme. In cases that do not respond to conservative treatment, a cortisone injection into the lumbosacral canal can produce good results.

You can download an example of a flexibility programme if you follow the button below. Please be careful with the hamstring stretches since it can make your symptoms worse if you stretch them too aggressively while the nerve is still stuck. I would suggest to stretch the glutes and back first and then gently stretch the hamstrings.

You’ve upset a nerve

This is a bit more serious than the cases described above. If you experience tingling, numbness, very sharp pain or a lot of pain at night, chances are that you have injured a nerve in your back. Now, before you say “But I don’t have back pain!” – you often don’t feel back pain when you experience pain in your leg.

This is because the pain/sensation in the leg is often too strong and blocks the pain signals from the back. As the nerve pain or funny sensations in the leg calms down, people usually start experiencing more pain in their backs.

I would suggest that you consult a physiotherapist if you are experiencing any of these symptoms.

Some muscle tears can feel like tight calves

It’s usually easy to tell when you tear a muscle – you feel a sharp sudden pulling or pain and you can often see some swelling or bruising. But some muscle tears may not be this obvious. The soleus muscle, which can be found mostly in the lower 2 thirds of the calf, often just feels like it’s just very stiff when you first tear it. This stiffness then increases as you continue to exercise on it (this may take several sessions) until you are usually forced to stop due to pain.

If you suspect that you have torn a muscle, you should use a combination of rest and strengthening exercises until it is strong enough to run again. You may be able to cycle or swim to maintain your fitness. A physio will be able to provide you with a rehab programme that is right for your injury and takes your sporting goals into consideration. This is also something that we can easily help you with via an online video consultation.

Medial tibial stress (shin splints)

Medial tibial stress syndrome (shin splints) may initially feel just like very stiff or tight calves. People usually experience some discomfort along the inside of the shin bone – where the muscle attaches to the bone. In the beginning people usually only experiences pain in this area when exercising, but as the condition worsens they also feel pain with walking and in severe cases at rest.

You should not neglect this condition as it can easily develop into stress fractures if left unchecked. It is also a notoriously stubborn injury and may take several months to resolve (depending on how bad you allowed it to get). You should definitely consult a physiotherapist if you have pain along the inside of the shin bone (where the muscle attaches to the bone).

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn, ResearchGate.

References:

1. Bryan Dixon J. Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Current Reviews in Musculoskeletal Medicine 2009;2(2):74-77. doi: 10.1007/s12178-009-9045-8

2. Orchard JW, Farhart P, Leopold C. Lumbar spine region pathology and hamstring and calf injuries in athletes: is there a connection? British Journal of Sports Medicine 2004;38(4):502-04. doi: 10.1136/bjsm.2003.011346

3. Van Gent, R. N., et al. "Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review." British journal of sports medicine 41.8 (2007): 469-480.