Running Calf Injuries

May 18, 2011   //   by James Dunne   //   Strength And Rehab For Endurance Athletes  //  12 Comments

One of the more common running injuries is a calf strain or a tear resulting in calf pain. The biggest of the calf muscles, “Gastrocenemius” to use its correct name, is the largest and most superficial of the muscles in the lower leg and is loaded repetitively and heavily during running sports.

With every stride we take when running, the calf gets loaded, firstly to absorb the shock of our body weight landing, then to help propel us forward into the next stride. Now take into account that for every mile we run we take about 1500 of these strides. Looking at it like this makes it easier to see that if there is a weakness in the calf complex, or a fault elsewhere in the kinetic chain or running technique which leads to more stress going on the area, calf pain through injury is almost inevitable.

The calf is classified as a global mobilizer muscle, meaning that its main anatomical function is to absorb and then create large motions and forces. It is accompanied above and below by stabiliser muscles which are responsible for keeping the joints crossed by the calf stable – so that it can carry out its main function. However, if stability is compromised, particularly at the foot and ankle complex, leading to excessive pronation, the calf will begin to try and take on a stabilising role also – leading to loading it is not positioned well to cope with.

Click here for more information on Calf Pain associated with Forefoot, Midfoot or Barefoot Running,

Often a poor warm-up is cited as a reason why athletes suffer calf pain through injury. Most of us appreciate the necessity for a thorough warm-up. Let us consider why in the case of the calf complex particularly, a good warm us is important in avoiding injury: The calf runs down from its medial and lateral attachments above the knee and blends with the achilles tendon – which in turn attaches at the base of the heel. The calf and the achilles tendon act as one dynamic structure during motion. As the calf complex is loaded, a portion of the load is taken by the elastic properties of the achilles tendon, sharing the load with the calf muscles. If the achilles tendon is not warmed up sufficiently, these elastic properties of the achilles tendon will not be displayed and more of the load will have to be taken by the calf.

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It is also important to note that as we age, these elastic properties of the tendons in general diminish – thus accounting for the increased occurrence of calf strains in the more senior of our athletic population.

Grades of strain or tear:

Muscular strains are classified according to their severity in terms of how many fibres have been disrupted or ruptured

Grade 1:

This is the least severe of calf injuries. A small number of muscle fibres have been damaged within the muscle. Signs and symptoms of this type of less serious strain may not be noticed until cessation of the activity. Tightness, cramping feelings and slight soreness are common when the muscle is stretched.

Grade 2:

This is sometimes referred to as a partial calf tear. A greater number of muscle fibres have been torn, however the muscle remains largely intact. More immediate localised calf pain is present during activity, especially walking and running. Often the area is sore to touch.

Grade 3:

Total rupture. All the muscle fibres have been torn, losing continuity throughout the muscle. This is a serious injury and highly disabling. The athlete will be unable to walk pain free. Often bruising will appear below the tear site and there may well be a palpable bulge where the calf muscle has recoiled upon itself.

Calf Pain – Treatment and Rehabilitation:

Treatment of most calf injuries is initially much the same as that of any soft tissue injury. The Rest, Ice, Compression, Elevation (R.I.C.E) principal should be followed. Then a gradual return to exercise undertaken. Sports massage is also good once the initial acute phase has passed. In terms of timescales for rest, a good rule of thumb is 3 weeks for a grade 1 strain and 4-6 weeks for a grade 2 strain. A grade 3 tear will most likely require surgery followed by a 12 week rehabilitation programme.

As with any injury, on the road to recovery, progressive and comprehensive exercise based rehabilitation is key to avoiding recurrence or secondary injuries. These often occur through compensatory movements which may have become habit during the injured period.

As with any injury, the rehabilitation phase is an ideal opportunity to target those areas we all ignore in our weekly training routine. The core muscles and glute muscles are a great place to turn focus to when you are restricted in terms of activity. The stronger these muscles can become, the more likely a successful outcome is to be reached both in terms of injury recovery and subsequent performance.

Particularly after any injury to the leg, the first step in the rehabilitation process is to correct any limp that may remain after the pain has gone. These limps become habitual both in running and in walking and can cause problems in areas such as the lower back.

Specific single-leg exercises are important to build the strength in the injured limb and take away the temptation to use the other leg to bear an uneven portion of the load. These exercises also enable the body to regain its sense of balance which will have been lost on the injured side during the injury period.

Once improvements have been made in single leg strength and balance, low level plyometric exercises may be re-introduced as a precursor to running. Jumping, hopping and skipping are all useful to re-introduce the muscle to the dynamic loading needed for running.

Once successfully progressed through the multidirectional plyometric exercises, running may be re-introduced in short bursts. A sure way to re-injure the muscle is to do too much too soon at this stage. Running is to be approached with a methodical approach in terms of progressing from session to session. Keep a watchful eye on running technique – especially foot position on contact.

Begin with straight line runs with gradual acceleration and deceleration. Then slowly introduce changes of direction and more aggressive changes of pace.

Calf Pain – Rehabilitation Exercises:

Single Leg Squat

Balancing on one leg, flex at the hip, knee and the ankle performing a mini squat keeping the knee aligned with the first two toes, then return to the standing position. Repeat this maintaining alignment of the knee.

Calf Raise

Start standing with the heels hanging off a step, with your bodyweight supported on the balls of the feet. Slowly allow the heels to drop towards the ground, coming below the height of the toes, then rise up using the calves so that the heels come higher than the toes.

Calf Stretches

With one foot far in front of the other, and hands pushing on the wall, keep the rear leg straight and flex the front knee. Pushing the rear heel into the ground, a stretch should be felt in the calf.

Wobble Cushion Balance

Balancing in a single leg stance on any unstable surface. Begin with a reasonably stable surface, and progress by increasing time or decreasing stability.

Jumps

Staying ‘light’ and landing on the forefoot, jumps are a great way of re-introducing the calf complex to more dynamic loading. Begin with a set of 10 jumps on the spot. Then progress to doing as many jumps between one spot and another for 20 seconds. Further progression entails adding multidirectional jumps in all planes of motion.

Hops

Following the same methodology as that used when progressing through the jumps program: perform these dynamic motions as hops – preventing the body from compensating through using the uninvolved leg.

About The Author

James has an academic background in Sport Rehabilitation and a special interest in Applied Biomechanics. He currently coaches a large number of Runners and Triathletes across all levels of ability and performance. He's grown a strong reputation for enabling athletes to improve their running performance and overcome running injuries through improving their Running Technique and developing Running Specific Strength.

 

12 Comments

  • After a few runs I always get a massive ache down the inside of my left calf, running along my shin bone. Extremely painful to touch, and puts me out of running for at least a few weeks, and then simply repeat the process! No idea why it happens. I assume it’s that my left calf is weaker than my right. Any idea how to fix it?

  • I repeatedly suffer calf muscle injuries. I am trying to figure out why. I have noticed that when I walk the outside of my foot touches the ground first and also that my kneecaps will naturally point inwards when I squat. Would either of those be related to the calf inury? If so what exercises could I do to correct these habits?

  • [...] within a day or two. Finally tonight I turned to Google. Self diagnosis from WebMD, Wikipedia and an actual running injury source says I have a muscle strain in my calves which is comparable to a sprained [...]

  • I have been suffering from a repetitive calf injury for a number of years now and it is really getting me down ,just the thought of another triathlon season getting closer and not being able to complete any sort of regular running is a nightmare. I have been seen by a number of sports therapists and followed their plans with no joy and I have even managed to get an MRI scan on my calf that shows no sign of damage? I have stopped running for the last month and 3 times a week I have been performing squats, lunges and a series of other stretches and exercises to help loosen my gluteus up too. I have been doing calf raises on the stairs 3 times a day for the last 2 weeks and my calfs do feel a touch stronger. On quite a few occasions over the last years I have experienced a stabbing pain in the same spot during a run and again many times I have felt a tightening coming on and have had to pull up short and had to limp home which tends to last a few days. I have had a few periods of a couple of months rest with no running and it’s the same story on returning. I have a constant point top left of my left calf that feels like a knot that is sore when pressure is applied and hasn’t disappeared for over a year now. I am looking for advice from some body I can trust to help or the names of people that I can maybe speak to for help. Have you any ideas or can you help? I really feel I am running out of options and dream about being able to run pain free again. Thanks, Marc.

    • I had been a casual runner and duathlete for several years when I suffered a Grade 2 calf strain. I saw my primary care, had an MRI, and had this diagnosis given. I went through the recommended period of rest, 6 weeks, and then began some stretching and strengthening for a few weeks, before I started doing some walking with interspersed light jogging. I quickly re-injured it despite my attempts to be as gradual as possible. This cycle repeated for about a year and a half. I thought my running life was over. I changed to a new job and 2 of my new co-workers were triathletes, in my same age range, 35-45, and had suffered calf injuries in the past themselves. Both swore that massage therapy had been the key to their recovery. A few months ago, I located a therapist near my residence and it has been absolutely amazing. I run 10-15 miles per week now and just finished my first sprint distance duathlon. I still have some soreness, especially after the duathlon, but I go and see her and by the next day the difference is unbelievable. I do focus a lot more on warmup, stretching, and strengthening of my calves as well. I try not to run 2 consecutive days, and take at least 2 days off per week. Cycling does not generally appear to aggravate the calf, so I do more cycling than I did in the past as well.

      Good luck

    • Marc,
      I am recovering from my annual calf strain. Usually it’s the left leg. It occurs in February or March after I’ve had a layoff and then start running again. I am a particularly active triathlete and 53. This time it occurred after a 10 mile run outdoors. I had been treadmill running for 2 months. I have a few theories, one being dehydration because I tend not to bring enough liquid to drink outdoors. Another is tight quads and hamstrings from allot of swimming and biking. Since everything is connected a tight hip can also translate into extra strain on your calf. I also stop getting a regular massage in the off season. I get deep tissue massage every 2 weeks.. Often it’s the lower hamstring that’s really tight and when massaged it loosens everything. Your running stride may be off, perhaps you need to shorten your stride. Have you ever counted strides? Minimum should be 90. Count one leg for :30 on a treadmill, should be 44-45. Perhaps do :15 on a stationary bike to warm up before each run. Stretching after you run. After very long rides and runs I will sit in a cold tub of water filled with 4-6 trays of ice for :15. Flushes out the toxins and contracts any inflamed muscles. It has to be part of your regimen.

    • Hi Marc
      Welcome to what seems to be a pretty big club. I have seen dozens of proposed remedies and I’m not sure if there are any silver bullets. I guess we are all a bit different. I have moved to more flexible, lower drop shoes and followed some of the strength and running technique prgrammes on this website. I had a lovely 8 month period with no calf issues at all follwing this. My calves have flared up again, but I seem to be able to control it and minimimse the damage a bit now. One of the best pieces of advice I have found is at the following link;
      http://www.runnersworld.com/injury-treatment/calf-heart-attacks
      It seems to provide a pretty sound way back into running. The advice above is also pretty sound I think. Try a few things and see what recipe works for you.

      Good luck!

  • A salutary lesson…from an old fool!

    OK, I’m 63 and have just suffered my second calf strain in 6 years.

    Now I know this isn’t a running issue…but I found the website whilst looking for ways that I might avoid a similar incident in the future. I believe the majority of the website’s advice applies to ski mountaineers too…

    Last week I set off for a day’s ski-touring in the Austrian’ Alps. I was walking along a fairly level stretch having just skinned up alongside a piste. I heard a ‘twang’ and it felt like someone had just shot me in the leg! Being 5,000 ft up on a mountainside – on my own – with the lifts closed suddenly made me feel what an idiot I’d been venturing out alone..

    As I side-slipped down the mountainside I’d plenty of time to think…and reflect on my past “tough man” mountain philosophy…

    Having been on this planet a fair time – I saw nothing wrong in packing just half-a-litre of water in my day pack. And I’d dismissed those ‘fancy’ mineral enhanced drinks years-ago.

    Warming up? Well a few stretches and I’m ready to go. And as for special training – a daily 20 min, session on an exercise bike/cross-trainer will do. Why bother with specific sports-related exercises…I’ve usually got by OK.

    As you can see I’ve been a real Dumbo!! NOW I KNOW BETTER.

    So, thanks James for posting such helpful information online. It’s really appreciated!

    And anyone else reading this who thinks I’m a: “Dick Head”. Well, I’d be the first to agree!!

    When I got back to the UK I went to see the doc. I’d used RICE and was wearing a compression sock. He offered no real useful advice…and said the waiting list to see a National Health Service physio was 6-8 weeks so I’d best go private! So, don’t believe all you here about our wonderful free health service. GPs are great at dishing out drugs…but when it comes to rehabilitation for muscle tears…well it seems there’s a bit of a black hole in our welfare system…

    Good luck to all those who enjoy outdoor sports – and here’s wishing everyone injury free activitites. Once I’m on the mend I’ll have a whole new regime of exercises to look forward to…thanks to this website (and a few others). Oh, and I’ll be monitoring my fluid intake etc., too! No more orange holes in the snow…apologies if that too much information :)

    Thanks again!

  • Marc Frohock,
    Any luck? I am a 43 year old Male who ran competitively in High School, College and trained with Elites after. During these times I was blessed enough to NEVER have ANY injuries. I hated warming up, but was forced to when coaches were around, but ran exceptionally well during my “peak”. In late 1998 I gave a kidney to my father and few months later saw the birth of my son. I decided to hang up the running shoes and track spikes and did. Jump to summer of 2004 and the Olympics and I caught the bug again. I began to start slow with an easy mile or two with no issues, except for feeling REALLY out of shape. A good month or two went by with no issues. Then out of no where during an easy 2 mile run I felt a little tightness in my outside right calf followed by a sharp pain (like a nail being hammered) so much that I was forced to slow down eventually to a walk. I walked back home “pissed” off. I took a couple days off and tried at it again with no luck. The pain would eventually move to the inside of the calf and stay soar for a day or so. I would rest months at a time, get back up and running and within weeks to a month or so it would come back. Eventually alternating from right to left calf with the same pain. It was so frustrating that I looked into a sports specialist who ran test and an mri and found no tear. I was sent to a physical therapy center that handled athletes of all calibers. I went twice a week for about 6 months for approximately 3 months. They would heat the legs, stretch them out, put me through stretches and plyometric drills, some days treadmill and finally ice the legs and send me on my merry way. After I was done at this place I was sent home with stretches and core workouts and told to start gradually running. I did and thought all was good. After about 2 months of running easy and only getting up to about 2 miles a day off and on, the pain RETURNED. UGH! Frustrated I threw my shoes in my closet and told them to go to hell. “Yeah Funny I Know!” From this point on I would revisit running after 3-6 months off with a good month or two of running before injured again. Last year I began seeing a chiropractor/sports specialist who would do cupping technique and rolling out the calves and stretching out and would have me get massages on my legs every 2 weeks or so. I began to alternate running and swimming before this. I was good for a few months again and just last week after being off of running to recoopearte I returned and “BAM” injured again as of last Monday. I don’t know what I would do if I could not walk, let alone run, but am frustrated as all hell now trying to figure out what next to get better. I’ll stay in shape swimming and biking, but I am neither a swimmer or biker and fell like “a fish out of water” doing both these activities. Please let me know if you found anything that helped Marc or ANYONE on here.

  • This is a really informative article thanks. Since the GSR in late October I have really suffered with firstly my hips and now my left calf. I have no idea if this is a strain or just a bit of an ache. I am unable to run and finding it difficult to put proper pressure on my left foot. I can walk but not using the usual rolling heel to toe movement. Like all runners I’m in a state of acute frustration. Is it best to see a physio or sports masseur first ? Thanks

    • Hi Lauren,

      In my experience, the hips and calves are so closely linked – I’d suggest going to see a physio as a priority, rather than a sports massage therapist. A good running specialist physio will be able to give you a thorough assessment and diagnosis of the root problem.

      If you need any suggestions re who to go and see physio-wise, drop me an email :)

      Cheers,

      James

  • Marc

    Sorry to hear about the ongoing agony you have been experiencing. The stabbing pain and especially the knot sound like symptoms of grade 3 strain from what I read. I think a visit to a doctor will be worth the trouble; from a guy who strives to avoid them outside of a routine annual exam.

    Everyone else: glad to find you all here because I had my first experience in a marathon this past Sunday. It was very much as Cesar had described with tightening and the nail driving. Just before 30k I felt left calf tightening for 50 to 100 meters. Thinking a cramp I pulled off at a loo and water stop to unload and then load. I mention because I was stationary for the unload and was walking a few steps to load up at the water line when SNAP. I actually looked about to see if a stray golf ball wasn’t bouncing away from my leg. With my first attempt to continue walking, I was immediately aware something was wrong. The pain was acute. Looking at my toes and knee cap being 12 o’clock on my left leg a nail seemed to be stabbed into my calf at 4 or 5 o’clock any time I tried to load my toes during a step. No knots or bruising though. It’s Wednesday now and I am able to make a ginger range of motions through a step, but I dare not step on my toes yet!

    From my reading up on this injury, my first at 44, it appears this could be the end of a Boston qualifying time which I was on the way to nab. But the following article appears interesting. Maybe a bit of a paradigm shift in what appears to be a general school of thought.

    http://runnersconnect.net/running-injury-prevention/age-and-calf-injuries/

    Good luck to everyone here, and thanks Mr. Dunne for the forum!!

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