Running related calf muscle soreness

By Doug James, Physiotherapist and Podiatrist

The New Year often sees people return to running after some time off. This return could be following a couple of weeks off during a Christmas holiday, or starting back run again for the first time in years. During the first couple of months of the year, it’s not uncommon to see runners coming into the clinic with sore lower legs. Differentiating the different sorts of leg soreness can help identify how long it will take to heal, and whether you can continue to run with the injury.

Lower Leg Anatomy

The calf comprises of two main muscles – the Soleus and the Gastrocnemius. The Soleus has a long, wide muscle belly that extends the length of the back of the Tibia (shin) bone. The Gastrocnemius is the muscle on the top half of the calf and comprises of a medial and lateral head which both overlay the Soleus. Together the Soleus and Gastrocnemius form the Achilles tendon, which attaches to the heel allowing us to push off when we walk, run and stand on tip-toe.

Delayed Onset Muscle Soreness

If you’ve recently started running or returned to it after a long time away from it (more than two months) your first couple of runs may leave you feeling a bit stiff and sore. This usually lasts for the following 1-2 days. This can also be felt in more regularly trained runners if they’ve increased the intensity of a session or competed in a race. If there wasn’t any particularly noticeable pain during the run (aside from that of exertion) chances are you have Delayed Onset Muscle Soreness (aka DOMS). This stiffness is usually felt in your quadriceps (thigh) muscles, and possibly your calf muscles.  

DOMS is generally nothing to worry about; in fact, it may actually be somewhat beneficial. It’s been found that experiencing DOMS once, and then training again within a few days can help to reduce it coming back the next time.

Calf muscle tears

Calf muscle tears are fairly common in runners and can result in pain and an inability to run or walk comfortably. They often strike at inopportune times – such as during the sprint finish of a race and can leave the runner unable to run for weeks, or even months. With correct care, healing time can be reduced, safely returning you back to running.

Acute muscle tears

Small muscle tears (microtears) occur nearly every time that we run, however they are usually so small that they heal by the next time that we run. More substantial acute tears can happen when there’s insufficient healing time between running sessions, or more stress is put on the muscle than it can handle – often during sprinting and running uphill/stairs and greater damage occurs.

Risk factors for acute muscle tears include:

• Inadequate warm-up
• Incorrect or worn out shoes
• Running on a steeply cambered road or steep hill
• Tight and/or fatigued calf muscles
• Running with increased speed or power

The tear may feel like a burning sensation, intense tightness and is sometimes accompanied by a ‘pop’ sound as it tears. Depending on the severity of the injury, normal walking may feel slightly uncomfortable to near impossible. The medial (inside) head of the Gastrocnemius is a common site for acute muscle tears, but can occur in either of the calf muscles.

Chronic muscle tears  

Poorly healed acute muscle tears are likely to continue causing pain due to scar tissue which forms during the healing process. Scar tissue is less flexible and can pull on surrounding healthy muscle tissue creating further damage. Running with pain in a muscle will mean that it doesn’t function properly and can expose you to risk of other injuries.

In addition to the risk factors for acute muscle tears, the following may contribute to chronic muscle tears:

• History of poorly healed calf muscle or Achilles tendon injuries
• Leg length difference
• Muscle strength imbalance
• Poor foot biomechanics (excess or insufficient pronation)
• Training program errors

Muscle Tear Treatment

Immediate treatment for calf muscle tears involves the use of calf compression, intermittent ice packs, and ceasing pain-provoking activities (including running) for 2-3 days. After the first few days, massage is useful to help encourage faster healing and reduce scar tissue in the muscle. Seeing a physiotherapist at this point is necessary to help judge the severity of the injury and begin a rehabilitation program. The goal of rehabilitation is to help strengthen and regain flexibility in the muscle in order to return to running and avoid injury reoccurrence.

In cases of chronically reoccurring muscle tears, it is useful to see a podiatrist at inTraining to have your biomechanics, footwear and gait assessed as potential causes of injury.

Tibial Stress Fractures

If you’ve been running for at least a few weeks and calf pain develops without a clear cause other than an increase in running training, it is unlikely to be DOMS, but may be due to a stress injury to the Tibia bone. When these occur on the posterior side of the bone they are easily confused for calf muscle injuries. Stress fractures require complete rest from impact activities such as running.

Calf Compartment Syndrome

Compartment Syndrome refers to an increase in pressure in a muscle compartment. Calf muscles are surrounded by a thin layer of strong tissue (fascia) that has a limited ability to stretch and expand. Compartment syndrome tends to occur more commonly in runners that are new to the sport or have dramatically increased their training. The compartment pressure increases due to a combination of recently increased muscle size, and/or the presence of either more blood or swelling in the muscle. Calf compartment syndrome may develop from calf muscle tears or tibial stress fractures due to increased swelling from these injuries.

Calf compartment pressure usually reduces after exercise has stopped. The pressure that doesn’t reduce shortly after exercising is a medical emergency particularly if feelings of coldness or numbness are felt in the foot. This should be treated urgently in a hospital setting.

 

If you are new to running or starting back after some time away from the sport, it is important to take care of building your running distance and speed gradually. Calf soreness can be a sign of one of several injuries and is best treated early.

If you have developed a running injury, contact the intraining running injury to book an appointment today.