Calf and shin pain - Sports Injury

$fibula stress fracture$

Do I have a Fibula stress fracture?

by Pete Colagiuri - Sports Physiotherapist

Fibula stress fractures are less common that Tibial stress fractures and much harder to detect!

That’s because the Fibula isn’t like other leg bones – it’s not a weight-bearing bone!

Most leg stress fractures happen due to forces associated with ground impact.

But Fibula stress fractures are unique – the injury occurs due to muscles pulling on the bone.

What are the symptoms of a Fibula Stress Fracture?

The first warning sign is a vague pain on the side of the calf.

It feels similar to an overworked or sore muscle.

That can get confusing because the most likely cause of lateral calf pain IS an overworked muscle.

Initially it only feels sore after exercise.

The more intense the exercise, the greater the post session soreness.

Next phase of the injury, the soreness begins to last longer.

What used to resolve in a few hours now takes longer that 24 hours to disappear.

In the last phase before a stress fracture, we often see the symptoms become more constant.

The intensity may vary but it’s still aching day and night, regardless of exercise.

How is a Fibula Stress Fracture diagnosed?

The first step for most people is a clinical diagnosis – that is, getting assessed by a doctor or physio.

The is usually enough to suspect a Fibula Stress Fracture but not enough to CONFIRM a stress fracture.

From here, imaging is needed to get a confirmed diagnosis.

MRI is the best option, but also the most expensive. It can see bone reactions as well as cracks in the bone. It gives the whole picture.

X-ray is not sufficient as it’ll only see a bone that has already cracked. Even then, it’ll only spot it if the crack is at a particular angle (relative to the image).

Bone scan is helpful as it shows the bony reaction around the stress fracture. It can’t see the fracture itself but it’s good enough to confirm a significant bone reaction.

CT scan shows a much more detailed picture of the bone but, like an X-ray, will only see a bone that’s already cracked. It can’t spot the reaction that’s the immediate precursor to a fracture.

What’s the rehab plan for a Fibula Stress Fracture?

Fibula stress fractures tend to occur because of the actions of FHL (big toe muscle) or Peroneals (lateral ankle and medial foot stabilisers).

The first step in the rehab is to back off the causative activity.

That doesn’t mean rest!

You can still keep active, provided it doesn’t cause pain or load on the stressed bone.

Then you’ll need to add in a strength program to maintain muscle function while you’re not as active.

Lastly, you need to rebuild the causative activity.

For example, if faster running has caused the problem, it might be linked to FHL loading.

You can return to running after 4-6 weeks but you’ll need to back off the pace.

Over the next few weeks or months, you can gradually return to fast paced running as the bone adapts and strengthens.

It’s important that you listen to your body and give yourself enough recovery time between training sessions.

Remember that you’re recovering from reduced activity, so you can’t flick a switch and be back to normal in a week.

Don’t waste money on KT tape for calf pain

by Pete Colagiuri - Sports Physiotherapist

KT tape only works for 3 types of calf injuries!

You’ll often see runners using KT tape for calf pain – the bright colours typically give it away!

Aside from the colourful patterns though, can KT tape for calf pain really make a difference?

It seems that dynamic tape generally, including KT tape for calf pain, is seen as a cover-all fix.

However KT tape is only effective for 3 types of calf injuries – soleus muscle injuries, Achilles injuries and neural tension (or nerve) injuries, like Sciatica.

(If you’re using KT tape for an Achilles injury, see our Achilles-specific analysis of KT tape here).

This is due to the action of the tape and what it offers the runner.

It also means that KT tape for calf pain is ineffective for gastrocs muscle injuries (Gastrocs is the larger calf muscle at the top), shin splints, calf muscle overload issues and bone stress injuries.

Causes of calf pain

Using KT tape for calf pain misses the point – you need to address the underlying cause of the injury.

If the calf pain is arising due to abnormal loading on the Achilles tendon, the tape improves the control on tendon forces by giving feedback on tendon stretch.

If the calf pain is due to bone loading and impact, taping your calf won’t change the impact loading on the bone.

We’ve got more detail on the causes of calf pain here, as well as how to differentiate between causes.

Intended actions of tape

The tape is an effective method of improving control of calf loading and ankle movement.

It does this by using skin sensation to augment the feedback to the brain from tendons and joints.

Rather than judging how much the calf is loading based on the Achilles tendon stretch, the brain can also use information form the tape pulling on the skin.

What tape can’t do

The tape is elastic, very elastic. It stretches easily and stretches further than muscles, tendons and skin.

So it’s unable to support any joints or movement. Tape might feel supportive but that’s the kind of support you get from a warm hug from Mum – not the support you need like an ankle brace.

It won’t protect against excessive movement. Rigid strapping tape, used after ankle sprains, is designed to restrict movement and protect against excessive stretch.

KT tape for calf pain, or any elastic tape for that matter, is unable to provide any restriction or protection against excessive movement.

Application tips

When applying the tape, position the foot slightly pointed and add some light tension to the tape as you stick to to the skin.

Start from below the calf muscle – this may be from the lower Achilles tendon or, for more pressure, from under the heel. Stop the tape just below the knee.

Anchor each end of the tape by applying a circumferential tape around the foot/ankle and upper calf to hold the ends in place. Ensure this piece of tape wraps all the way around and sticks to itself.

To ensure you have the right tension, you should be able to stand up with only mild tension felt. That tension should increase as soon as you begin to squat (ie. ankle moving past 90 degrees).

If it doesn’t tighten up immediately, you can peel it off and restick the same piece of tape a few times before adhesion becomes a problem.

Is it working for you?

If you’re using KT tape for calf pain, you should know if it’s making a difference within 2-3 training sessions.

It might work as soon as it goes on but sometimes it takes a while for the brain to adapt to the new input.

If it hasn’t made a difference after 3 sessions, don’t bother with the tape and save your money.

If it helps initially, you can gradually phase it out by reducing the number of strips of tape per application or just apply it lighter until it’s not required.

10 ways to keep running through an injury

by Pete Colagiuri - Sports Physiotherapist

For any runner, running through an injury is a dilemma that you’ll face sooner or later.

This is because a running program is designed to stress your body to get it to respond and improve.

So during that stress and recovery cycle, it’s possible that the stress may lead to inflammation and injury.

Once you experience the early signs of a niggle, it’s important that you don’t stop training completely.

That often amplifies the causes of the injury and makes things worse in the long run. You can read more about that here.

So you’re then faced with the choice: either back off your training or continue running through an injury.

Running through an injury

Depending on the injury and the injured area, there’s often away you can modify your training and continue running through an injury without losing training volume.

Here’s a list of common running injuries and ways that you can modify your training.

Click on the injury to get more detailed information about it.

Running injuries and modifications to training

Achilles tendinopathy

Achilles tendinopathy is a painful reaction inside the Achilles tendon.

This injury actually prefer more regular running rather than having extended breaks.

It’s just one example of when running through an injury is your best approach.

Modification

Switch to running 5 to 7 days a week and reduce your distance per session to maintain your weekly running distance (eg. 3 x 12km = 36km/week, which becomes 6 x 6km to maintain 36km/week.)

ITB syndrome

ITB syndrome is caused by a poorly controlled inwards rotation of the leg, usually due to muscle fatigue.

If you can improve leg rotation control, the injury typically settles down and resolves.

Modification

Reduce the effect of fatigue by adding a 2 minute walk break after every 6 to 8 minutes of running.

Improve leg biomechanics by running slightly faster than your current pace – read more about how this works here.

You can also instantly improve your leg control with the addition of Low Dye taping or soft orthotics.

Plantarfasciitis

Plantar fasciitis can be the results of ankle or calf tightness, poor stability and/or poor choice of footwear.

It can be difficult to monitor as it often warms up after the first few kilometres of running.

Modification

You can instantly improve plantarfasciitis by supporting it with Low Dye taping.

Move your sessions away from grass and onto hard surfaces (helps improve foot stability.)

Move your sessions to flat ground and away from hills.

Shin splints

Shin splints covers a broad range of injuries and then each got slightly different modifications.

Whether you should continue running through an injury really depends on the underlying diagnosis of your shin splints.

Three most common types of shin splints are tibial bone stress injury, tibial periostitis and chronic exertional compartment syndrome.

Modifications

Tibia bone stress injury: reduce your training session distance so that your symptoms resolve sooner after each run and avoid downhill running.

Tibial periostitis: start each run with a 5 minute brisk walk to allow the pain to ease and avoid hard downhill running.

Chronic exertional compartment syndrome: add in a 2 minute walk break every 6 to 8 minutes to allow the compartment pressure to ease during the run.

Proximal hamstring tendinopathy

Proximal hamstring tendinopathy is often a chronic injury so any improvements are gradual.

You can keep running through an injury but you need to maintain some consistency in your approach to detect results.

Modification

Reduce fast and uphill running for a few weeks.

Add in some gentle running drills at the start of each session to improve tendon bounce.

Calf muscle overload

Calf muscle overload often feels like deep pain and tightness through the calf area.

These symptoms can often get mixed up with the symptoms of tibial bone issues so it’s worth confirming the diagnosis if it’s not improving.

Modification

Move your hill training onto stairs and ensure you place your whole foot on the step (not just your toes).

Use cross training every third day instead of running to give your calf muscles time to recover.

Deep hip rotator overload

Literally a pain in the bum, this injury is often a sign that your training beyond your current capacity.

You can read about the injury in detail here.

Modification

Where possible, some of your training onto technical trails as this provides more variety for the deep hip rotator muscles.

Switch your tempo or continuous running into an interval format with faster running and regular breaks.

Patellar tendinopathy

Patellar tendinopathy is a gradual onset injury and shouldn’t be mixed up with Osgood Schlatters disease or patellofemoral pain syndrome.

Modification

Avoid downhill or stair running – if there is a hill on your regular run, turn around and run down backwards to take all pressure away from the tendon.

For trail running, stay away from technical trail whenever possible.

FAI

Hip impingement can be tricky because it can trigger in slightly different positions for everyone.

Modification

Avoid any significant hills as these are associated with increased hip movement.

Reduce your fast paced running to a level that feels comfortable and doesn’t trigger the injury.

Lower back pain

Running with an injury like lower back pain really depends on avoiding specific cause of your issue.

Commonly this relates to hip movement or muscle overload.

Modification

Reduce the pace and duration of your run to reduce the chance of a cumulative muscle overload.

Avoid hilly runs as they often force hip movement and cause pressure on the back.

Best running shoes for calf pain: look for these…

by Pete Colagiuri - Sports Physiotherapist

Finding the best running shoes can be a challenge. Trying to find the best running shoes for calf pain adds another dimension!

Running shoes can have a big impact on the pressure in the calf muscle when you run. So it makes sense that the right running shoes should be able to help take the pressure off the injured area.

To get the best shoe for your calf, you ideally need to know what’s causing your calf pain.

We’re releasing an app in the 2nd half of 2021 that can provide you with an accurate diagnosis for your calf pain.

Until then, have a read of this great article that can help you find the cause of your calf soreness.

Choosing the best running shoe for calf pain

When we choose the best running shoes for calf pain, there are number of key features that control how much load the calf muscle is under:

Heel-toe offset
Level of support
Stack height
Grip/outsole

Feature #1 – Heel-toe offset

The first is heel toe offset, also known as heel to toe drop. This describes the height of the heel relative to the height of the toe.

It tells you how much the foot is angled downwards when you’re standing. This downwards angle reduces the amount of stretch on the calf. So a high heel toe offset, typically around 10mm or greater, will reduce the amount of stretch of the calf.

If your calf symptoms are linked to shorter calf muscles, a higher heel toe offset is helpful.

A high heel toe offset is also useful for very painful, irritated conditions as it provides some pain relief. It allows you to run faster with less pressure on the calf compared to low drop shoes.

Feature #2 – Level of support

The level of support is rated from neutral (no direct support), then minimum/moderate/maximum support levels and finally, motion control.

Neutral shoes make the calf work harder by increasing the amount of muscle work required to stabilise the ankle.

The min/mod/max support options provide more structure and support (obviously) which reduces the stability work required. But it can inadvertently make it harder for the calf to propel you forwards.

Motion control options are rarely required and make normal biomechanics almost impossible.

The best advice for support levels is to go with the lowest level required to maintain a consistent running technique for the duration of your runs. If you start well but lose form in the last few miles, you might benefit from an upgraded support level.

Feature #3 – Stack height

Stack height refers to the overall height off the ground – basically it’s the amount of foam under your foot.

Higher stack heights, as seen with Hoka running shoes and other brands, reduce the calf muscle work with landing. As you impact, the cushioning help with shock absorption. That means your calf muscles won’t be as active, which should reduce calf muscle fatigue.

Feature #4 – Outsole or grip

Last on our list is the outsole or grip on the shoe. And this one might surprise you!

Better grip – either from new shoes or more aggressive grip patterns – actually increases the load on the calf.

As you push off, the improved grip ensures that you don’t slip. So all that force generated in the calf is matched by a firm attachment to the ground, maximising calf muscle loading.

Compare that to an old shoe, smooth grip patterns or road shoes worn on trail, and the opposite occurs. The calf force is allows to slip a little as it pushes off, reducing the forces pushing back against it. that will reduce your performance slightly but it’ll also reduce your calf pain in each running session.