calf pain

Calf Pain

Calf pain. Strain. Spasm.


This is a condition which, in my physio experience, often re-occurs. Despite runners resting, reducing their mileage, stretching, rehabilitating and then (maybe) attending a physio…a few runs later – BAM! Same calf. Same pain. Back to square one. And HUGE frustration!!

How can we break this cycle of pain and re – occurring injury?

Should we stretch more?

Change our running style?

Strengthen? And if so, strengthen what and how often?

calf pain

The Calf Muscles

The basics.

There are two sets of calf muscles. In each leg. The big Gastrocnemius at the top and then Soleus muscle at the bottom (which is under the gastrocs). Both muscles push your foot downwards. Additionally, the gastrocs also bends the knee. The soleus is known more for stabilising in posture and walking, while the gastrocs is your firing/ power muscle. Both play an important role in life and running.

It is important to know, that BOTH muscles need to be stretched and strengthened. The Soleus muscle is stretched with a flexed (bent) knee (and more effectively off a step) while the Gastrocs needs an extended knee (straight). See diagram below. Similarly, the same is needed for strengthening. In order to strengthen the gastrocs predominantly, one needs to do extended leg exercises for the calf, and the flexed knee for the soleus. Therefore, BOTH are needed.

calf pain

Calf Endurance Test

One of the tests I ask my runners to perform  in my running analysis, is the calf endurance test. The main importance of this test, is firstly to see if the left side is similar to the right, then secondly to see what their endurance is like. This determines whether specific strength exercises may be needed for the calf muscles in order to prevent injury and improve endurance.

One of my runners complained of cramping around 30 km every marathon that he ran. I went through the running analysis and picked up that his calf endurance ,for both soleus and gastrocs, was poor. After some specific strength work, he found he no longer had cramping as his muscles had improved their strength and therefore their endurance.

calf pain

Some Calf Culprits

The underlying cause of injuries: LOAD EXCEEDS the ABILITY which leads to FATIGUE and can cause INJURY.

Here are some examples of what could possibly contribute or cause calf strains/ pains:

  • Sudden increase in speed, hills (especially the gradient AND camber – slope – of the hill), mileage and terrain training.
  • Drastic change in footwear – for example maximalist to minimalist (or v.v) or large heel to toe drop changes.
  • Cold weather – not warm up as quickly before doing a quality session.
  • Change in running technique – especially change from heel to toe strike as the energy now TRANSFERS more to the calves.
  • Previous calf strains without adequate rehabilitation.

A Preventative Approach

So what can you do to prevent calf injuries? What can you do to reduce the risk of re – injury?

Here are some practical tips:

  • GRADUALLY and consistently increase the load while you train. Check out my Comrades Top 10 Tips
  • Warning signs – respond! Any tightness or niggle in the calf that doesn’t ease (or worsens) within 2 days, get it checked!
  • Strength work – is vital. Not only for the calf, but as a runner, your core and legs especially. Additionally, address the Hamstrings.
  • Sometimes it is not the calf that is the problem. Check out your biomechanics WHILE RUNNING to assess what may be the cause of the calf pain.
  • Stretch and strengthen BOTH your soleus and gastrocs muscles.
  • Try calf sleeves for improved circulation during and after running for recovery.

Please be aware that there can be other causes of calf pain. A big concern is deep vein thrombosis (DVT) . Sudden onset of swelling, redness and very painful calf MUST be assessed by a health professional. Additionally, referred pain from the back and vascular restrictions may also be possible factors which need to be ruled out.

Lastly, Tibialis Posterior Tendonopathy can also be a culprit…but that, is for another blog.