Calf pain and running
Calf pain when running is fairly common, particularly as you’ve just started training or increased your training intensity.
In fact, our Physiotherapists place calf pain in their top 5 complaints for new runners (along with Plantarfasciitis, Patella/kneecap pain, Achilles tendinopathy and ITB issues).
But calf pain generally occurs in the middle or upper half of the calf – lower calf pain when running is less common and a bit more of a concern.
(When we say “lower calf”, we’re referring to the lower half of the area between the knee and the ankle, below where the bulkier muscle is in the upper calf.)
The typical presentation of calf pain goes like this:
- The run starts fine, with maybe some mild calf tightness from the previous run but that loosens up pretty quickly
- After 5-10 minutes, you notice your calves working a little too hard
- After 15-20 minutes, your calves tightness and restrict your running performance
- After 30 minutes, you need to stop as the calf pain when running is only getting worse
- After the run, the tightness continues and becomes painful
- The next morning, the tightness and pain are still there although it’s eased slightly
- Next run, it’s the same pattern but a little worse…and so on.
If this sounds like you, read on!
(Side note: if your pain gets better during the run, but gets nasty afterwards, you might have Tibial Periostitis)
What can cause lower calf pain when running?
Lower calf pain when running often comes down to 1 of 3 issues:
- Soleus muscle overload – a powerful muscle in the calf working too hard. This muscle will overwork to brace the ankle on landing, so the overload is not associated with speed (ie. slow running will overload it just as much as faster running).
- Upper Achilles tendon issue – the tendon protesting due to rapid or excessive loading. This could be due to a sudden change in loading or from underlying break down of the tendon.
- Tibial bone stress injury – the bone struggling to repair itself before the next run. Bone stress is more common than most people realise and can often feel muscular in nature.
How can you tell the difference between these injuries?
The main features that differentiate muscle overload, tendon issues and bone stress are related to how it behaves over the course of a run and into the next day.
Keep in mind that while they all cause calf pain when running, one injury can lead to another so you might have some overlapping symptoms of each condition.
Does it get worse during the run?
Typically muscle overload and bone stress injuries will get progressively worse over the course of a run.
By comparison, Achilles issues can actually feel better as they loosen up (although degenerative Achilles injuries and severe Achilles reactions will get worse as the run goes on).
Does it ache after the run?
Bone issues will ache after a run, even when you’re sitting down with no pressure on the legs. They can even ache while you’re laying bed that night.
Calf pain when running caused by muscle overload/fatigue or Achilles tendon injuries will typically disappear when you take the pressure off the area (eg. sit down).
Is it still causing the same level of pain the next morning?
The one feature that stands out with bone stress injuries is the long period of residual pain after activity. If your pain is no better the day after a run, you must suspect bone stress injuries as a possibility.
Soleus muscle overload will start pretty painful as you get out of bed but usually loosens up and becomes less painful after you’ve walked around the house for about 5-20 minutes.
Achilles tendon injuries will start the morning fairly well and gradually become sore after long periods of walking around (or going for another run).