Calf muscle pain

Calf muscle pain can be due to injury, underlying medical condition or a problem in the nerves or arteries in the lower leg.

Whilst often something minor like a grade one strain, the problem may not actually be in the muscle itself and could be indicative of a serious problem such as a DVT so should always be treated with caution.

Here we will look at the most common causes of calf pain, how the symptoms vary and how to spot a potentially serious problem.

Quick Anatomy Lesson:

The calf is the area on the back of the leg between the knee and the ankle. It is made up of two muscles collectively known as the triceps surae. Triceps surae simply means “three-headed calf (muscle)”. It comprises of a pair of muscles, gastrocnemius and soleus.

The gastrocnemius muscle has two-heads which arise from either side of the bottom of the femur just above the knee joint. It is a superficial muscle, meaning it forms the top layer, just below the skin.

The soleus muscle runs deep (underneath) to gastrocnemius and arises from the top of the tibia, just below the knee joint. The two muscles join together around mid-calf level to form the Achilles tendon which attaches the calf muscles to the back of the heel.

The triceps surae muscles work together to plantarflex the foot i.e. pull the foot downwards and stabilise the ankle. They are particularly important in controlling and executing the push-off phase of walking and running.

Common Causes of Calf Muscle Pain:

Calf muscle pain can come on gradually over time or may come on suddenly. Here we will look at the eight most common causes of calf pain.

1) Calf Injury:

If the calf muscles are suddenly overstretched, some or all of the fibres may be torn known as a calf strain or rupture. This is the most common cause of calf muscle pain. It commonly happens during sports such as basketball, tennis and running where the person suddenly pushes off from a stationary position or has to change direction quickly.

There are 3 grades of calf muscle strain, depending on the severity of the injury, which can take anywhere from a few days to months to recover from. To find out more about symptoms and treatment, visit the calf strain section.

2) Calf Cramps:

Commonly referred to as a Charley Horse in North America, these are when involuntary spasms occur in the lower leg causing calf pain. They are often caused by overuse, fatigue, diet, dehydration and muscle imbalance.

To find out more about how cramp presents and top tips on how to treat it, visit the calf and foot cramps section in our sister site.

3) DVT:

A deep vein thrombosis is a very serious cause of calf pain. It is the formation of a blood clot in a deep vein, usually in the leg. A DVT requires IMMEDIATE medical attention as it reduces the blood flow to the foot, and there is the risk that the blood clot will break off and travel through the bloodstream to the heart or lungs which can cause a heart attack or pulmonary embolus.

The common signs of a DVT are pain, redness, warmth and swelling in the calf region, and the pain often gets worse if your dorsiflex your foot (pull your toes up towards you). DVT’s are often associated with surgery or periods of inactivity e.g. plane journeys.

4) Achilles Tendonitis:

Inflammation or degeneration of the Achilles tendon commonly causes calf muscle pain. The Achilles Tendon is approximately 6inches long, connecting the calf to the heel. The Achilles is extremely strong but not very flexible, making it prone to damage, especially if the calf muscles are weak and tight.

Achilles Tendonitis can take months to recover from. Find out more about the condition including treatment options in the Achilles Tendonitis section on our sister site.

5) Muscle Imbalace:

Calf muscle weakness and tightness is a common cause of calf muscle pain. The weak muscles will often tire quickly if you are on your feet for prolonged periods of time and if the calf is tight, it is prone to damage from overstretching.

You can find a whole range of calf strengthening and calf stretching exercises to help combat this common cause of calf muscle pain.

6) Bakers Cyst:

A Bakers Cyst is inflammation of the bursa (fluid filled sac) that sits behind the knee joint. It can cause calf pain, particularly if the cyst bursts resulting in the fluid tracking down the leg into the triceps surae.

Bakers Cysts are commonly associated with arthritis, but can occur for other reasons. Visit the Bakers Cyst section to find out more including causes, symptoms and treatment options.

7) Trapped Nerve:

Compression of nerves of the lower leg can cause pain in calf, pins and needles and numbness in the calf region. The compression may be coming from the lower back where the nerve originates from, or at any point along the nerve. Any symptoms of nerve compression should be checked out by your doctor.

Peripheral Vascular Disease (PVD)

Also known as peripheral artery disease, this is when there is a narrowing in the arteries which slows blood flow. It is commonly associated with smoking, diabetes, high cholesterol levels and high blood pressure. In severe cases, the foot and lower leg may change colour – this warrants immediate medical attention.

To find out more about these common causes of calf muscle pain, including symptoms, diagnosis and treatment options, choose from the links above.

9) Plantaris Muscle Rupture:

The plantaris muscle is a thin, small muscle that is not even present in about 10% to 20% of the population. The muscle runs along the gastrocnemius muscle, but is a tiny fraction of the size. The plantaris muscle can rupture, causing a sudden, snapping pain in the back of the leg. Because the muscle is of no functional importance, treatment is non-operative.

10)Injury-related causes of calf pain:

Calf pain may arise from injuries including:

• Laceration or contusion

• Muscle cramp (charley horse) commonly caused by dehydration or overuse

• Pulled or torn muscle or ligament

• Strains and sprains

Infection-related causes of calf pain:

Calf pain may arise from various infections including:

• Cellulitis (skin infection)

• Infected wound or other sore

Degenerative, inflammatory, and neurological causes of calf pain:

Calf pain can be caused by degenerative, inflammatory, and neurological conditions including:

• Nerve entrapment or compression

• Peripheral neuropathy, such as diabetic neuropathy

• Rheumatoid arthritis

• Tendinitis (inflammation of a tendon)

• Varicose veins

Other causes of calf pain:

Calf pain can be due to other conditions including:

• Cancer

• Deep vein thrombosis (blood clot in the leg that can break loose from the leg, causing a pulmonary embolism in the lung, a heart attack or stroke)

• Peripheral artery disease (PAD, also called peripheral vascular disease, or PVD; a narrowing of arteries due to a buildup of fat and cholesterol on the walls of arteries, which limits blood flow to the extremities.)

Questions for diagnosing the cause of calf pain:

To diagnose the underlying cause of calf pain, your doctor or licensed health care practitioner will ask you several questions related to your symptoms. You can best help your health care practitioner in diagnosing the underlying cause of calf pain by providing complete answers to these questions:

• What is the exact location of your pain?

• Describe the pain. When did it start? Did it develop slowly or suddenly? Is it is constant or intermittent?

• Is there any swelling?

• Are you are experiencing any other symptoms?

Provide your full medical history, including all medical conditions, surgeries and treatments, family history, and a complete list of the medications and dietary supplements that you take.

What other symptoms might occur with calf pain?

Other symptoms may occur with calf pain depending on the underlying disease, disorder, or condition. For example, a soft tissue infection or inflammation in the calf might be accompanied by redness or warmth in the area. Calf pain due to a pulled muscle may be associated with swelling from fluid buildup. Other symptoms that may accompany calf pain include:

• Burning feeling

• Flu-like symptoms (fatigue, fever, sore throat, headache, cough, and aches and pains)

• Joint pain

• Muscle spasms

• Numbness

• Reduced range of motion

• Skin bumps

• Skin discoloration, such as bruising

• Sleep disturbances

• Swelling

• Unexpected weight loss

• Varicose veins

Serious symptoms that might indicate a life-threatening condition

In some cases, calf pain may occur with other symptoms that might indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care if you, or someone you are with, have other serious symptoms, with or without calf pain, including:

• Change in consciousness or alertness; confusion

• Cold and pale leg, particularly one leg compared to the other

• Difficulty breathing, wheezing, or shortness of breath

• High fever (higher than 101 degrees Fahrenheit)

• Inability to walk or put weight on your leg

• Pain after walking or mild exertion that does not go away

• Pale or bluish skin (cyanosis)

• Popping sound at time of injury

• Red streaks around a tender area or lump

• Red, warm, and swollen calf or leg

• Weakness or lethargy

When should I see a doctor about calf pain?

If you are unsure of the cause of your symptoms, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of calf pain must be directed at the specific cause of your problem. Some signs that you should be seen by a doctor include:

o Inability to walk comfortably on the affected side

o Injury that causes deformity of the lower leg

o Calf pain that occurs at night or while resting

o Calf pain that persists beyond a few days

o Swelling of the calf or ankle joint area

o Signs of an infection, including fever, redness, warmth

o Any other unusual symptoms

Treatments for Calf Pain

Treatment of calf pain depends entirely on the cause of the problem. Therefore, it is of utmost importance that you understand the cause of your symptoms before embarking on a treatment program. If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment plan.Some common treatments for calf pain are listed here. Not all of these treatments are appropriate for every condition, but they may be helpful in your situation.

• Rest:

The first treatment for most common conditions that cause calf pain is to rest the muscles, and allow the acute inflammation to subside. Often this is the only step needed to relieve calf pain. If the symptoms are severe, crutches may be helpful as well.

• Ice and Heat Application:

Ice packs and heat pads are among the most commonly used treatments for calf pain. So which one is the right one to use, ice or heat? And how long should the ice or heat treatments last?

• Stretching:

Stretching the muscles and tendons of the calf can help with some causes of calf pain. A good routine should be established, and following some specific suggestions will help you on your way.

• Physical Therapy:

Physical therapy is an important aspect of treatment of almost all orthopedic conditions. Physical therapists use different techniques to increase strength, regain mobility, and help return patients to their pre-injury level of activity.

Anti-Inflammatory Medication:

Nonsteroidal anti-inflammatory medications, commonly referred to as NSAIDs, are some of the most commonly prescribed medications, especially for patients with calf pain caused by acute inflammation.

@@Calf strains may be minor or very severe. Your physiotherapist will grade the injury accordingly:

Grade 1:

The muscle is stretched causing some small micro tears in the muscle fibres. Recovery takes approximately 2 to 4 weeks if you do all the right things.

Grade 2:

There is partial tearing of muscle fibres. Full recovery takes approximately 4 to 8 weeks with good rehabilitation.

Grade 3:

This is the most severe calf strain with a complete tearing or rupture of muscle fibres in the lower leg. Full recovery can take 3-4 months and, in some instances, surgery may be needed.

How to Treat a Calf Muscle Injury:

Calf tears are one of the most common problems that we see at PhysioWorks and it is unfortunately an injury that often recurs if you return to sport too quickly – especially if a thorough rehabilitation program is not completed.

Researchers have concluded that there are essentially 6 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence – these are:

Phase 1 – Early Injury Protection: Pain Reduction & Anti-inflammatory Phase

As with most soft tissue injuries the initial treatment is RICE – Rest, Ice, Compression and Elevation.

Your calf muscle is a large powerful group of muscles that can produce sufficient force to run, jump and hop. In the early phase you’ll be unable to walk without a limp, so your calf needs some rest from weight-bearing loads. You may need to be non or partial-weight-bearing, when crutches or a wedged achilles walking boot may be the best treatment.

Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.

Anti-inflammatory medication (if tolerated) and natural substances eg arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication.

As you improve a compressive bandage, supportive taping or an elastic calf support will help to both support the injured soft tissue and keep the blood from pooling in your foot.

Keep your foot elevated above your heart (where possible) to allow for gravity to help drain your calf and lower leg swelling.

Phase 2: Regain Full Range of Motion

If you protect your injured calf appropriately the torn muscle will successfully reattach. Mature scar formation takes at least six weeks. During this time period you should be aiming to optimally remould your scar tissue to prevent a scar that will re-tear in the future.

It is important to lengthen and orientate your healing scar tissue via massage, muscle stretches and neurodynamic mobilisations. Signs that your have full soft tissue extensibility includes being able to walk without a limp and able to perform calf stretches with a similar end of range stretch feeling.

Phase 3: Restore Concentric Muscle Strength:

Calf strength and power should be gradually progressed from non-weight bear to partial and then full weight bear and resistance loaded exercises. You may also require strengthening for other leg, gluteal and lower core muscles depending on your assessment findings.

Phase 4: Restore Eccentric Muscle Strength:

Calf muscles work in two directions. They push you up (concentric) and control you down (eccentric). Most calf muscle tears occur during the controlled lengthening phase. Your physiotherapist will guide you on an eccentric calf strengthening program when your injury healing allows.

Phase 5(contractile and non-contractile).

In order to prevent a recurrence as you return to sport, your physiotherapist will guide you with exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.

Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepares you for light sport-specific training.

Phase 6: Return to Sport

Depending on the demands of your chosen sport, you will require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.

Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimised your chance of future injury.

What are the potential complications of calf pain?

Complications associated with calf pain can be progressive and vary depending on the underlying cause. Mild calf pain due to overuse usually responds to rest, ice, and over-the-counter anti-inflammatory medications. Because calf pain can be due to a serious disease, failure to seek treatment can result in complications and permanent damage. It is important to visit your health care provider when you experience any kind of persistent pain or other unusual symptoms. Once the underlying cause is diagnosed, following the treatment plan outlined by your doctor can lower your risk of potential complications including:

• Chronic pain

• Inability to perform daily living tasks

• Loss of limb (amputation)

• Loss of strength

• Permanent nerve damage

• Pulmonary embolism (blood clot in the lung)

• Spread of infection

• Stroke

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Safety Advice:

Episodes of calf muscle pain should always be assessed by your doctor to ensure it is nothing serious such as a DVT which requires immediate attention. Pay particular attention to the signs for a DVT, redness, swelling, warmth and pain around the calf.

Also, calf pain that is worse at night or makes it difficult to walk warrants immediate medical attention.