Calf pain is a common gripe for many runners, whether it be soreness, dull or sharp pain, temporary or chronic issues, etc. Part of the issue is the pain itself, and part of it is frustration in not knowing what exactly it is and how to mitigate it.
Because the concept of “calf pain” is so vague, determining what your specific symptoms mean can feel a little enigmatic. There may be plenty of resources that talk about the “top 5 quick fixes to alleviate calf pain,” but the trial and error process won’t yield true, long-term success. (That’s what biomechanical data and physical therapy are for.)
One blog isn’t nearly enough space to cover the full spectrum of minimal to severe calf pain… But, it’s enough to start dissecting some of the most common kinds of pain runners experience, as well as why it typically happens and what a general recovery process looks like.
Let’s dive in!
Anatomy of Your Calf and Ankle
Before we dive into the details that affect calf pain, let’s get acquainted with the anatomy.
People most commonly associate the calves with the gastrocnemius and soleus muscles, which are the two largest, outermost muscles in the back of the lower leg. They’re also the primary muscles that connect to the Achilles tendon, which attaches the muscles to the back of the heel.
However, people don’t often realize how much more there is to the calf muscle group; beneath these outer structures are deeper systems, like the posterior tibialis and toe flexors (which are the layers underneath the gastrocnemius and soleus). And let’s not forget the peroneal muscles, which make up the lateral portions of the calf muscle.
Athletes typically don’t pay attention to all the little structures that go into the full calf. But, in order to truly understand what calf pain is and where it can come from, it’s important to recognize just how many tissues are involved in the muscle group. (The more parts there are, the more areas that may be susceptible to pain and injury, and that may play a role in the pathology.)
This becomes especially true for the calves, as they’re connected to both the knee and ankle joints. All the tissues play a key role in the kinetic chain of your legs, particularly when it comes to sufficient shock absorption upon impact and a powerful push-off into your next step.
That, in fact, is a major reason why calf pain and injury is such a common theme among runners — the muscles and tendons are some of the first structures that get subjected to the rigors of running impact. If they aren’t physiologically and biomechanically prepared to handle the impacts of your training, they’re left especially vulnerable to injury.
So, without further ado, let’s discuss how that pain may present itself (and what it means for your running in the big picture).
Different Types of Calf Pain
Calf pain can show up in an astounding number of ways. For some, calf pain can feel like chronic soreness after a workout, but for others, it may be more of a gradual but persistent pain that develops over the course of a run.
There are plenty of nuances to your individual running that can impact the intensity, frequency, and location of your calf pain. But, for the purposes of this blog, we’re going to dial in on some of the most common “categories” of calf pain that are specifically associated with varying degrees of calf strain (i.e., when the actual fibers of your tissues are overstretched or torn).
Chronic Calf Pain
For most chronic cases, runners will report a relatively consistent pattern of pain: it typically sets in when you hit a certain time or distance during a workout, and it often feels similar to a cramp when it first flares up.
The longer or farther you run past that point of initial pain, the worse it starts to feel. Though the pain usually doesn’t progress badly enough to put a stop to your training, it can feel overbearing enough to restrict your usual level of effort.
More predictable calf pain like this is often indicative of a chronic, low-level strain in the muscles as a result of overuse. People tend to sustain these types of overuse issues when taking on higher weekly mileage — it’s usually a symptom of repetitive overloading on your system (and often comes paired with insufficient rest days).
Though not the most severe form of calf pain or injury, it’s certainly one that can cause mental or emotional aggravation when it inhibits your usual training capacity.
Dull, Achy Calf Pain
Aching calves are a super common complaint in the running community.
Many runners experience this dull ache when they first start warming up — sometimes the pain will start to ease up as you begin running, but it’ll typically grow worse the longer you progress.
The pain may not feel intense enough to stop your run mid-workout, but many people feel the consequences in the aftermath. Runners will often end up taking longer rest periods or implement more rest days before they go for their next run.
In this case, your body is demanding more recovery time in response to repetitive microtears in the tissues of your calves, otherwise known as a tissue strain. (A prime example of this kind of symptom is Achilles tendinopathy, which is thought to be caused by increased overloading and potential stiffness, tightness, or insufficient functionality in the tissue.)
Sharp Calf Pain
Lastly, we have one of the more alarming sensations: sharp, sudden pain.
Most runners who’ve experienced sharp pains in their calf muscles sustain the issue as they’re running, and the pain is typically severe enough to stop them from running altogether.
As you can imagine, the intensity of this type of pain indicates a much more serious level of muscle strain. Depending on how badly the tissues were damaged, you may experience some visible or tactile symptoms beyond the pain itself, like swelling, bruising, discoloration, or having the leg feel warm to the touch.
Though this type of pain isn’t necessarily as common as the other two, runners will usually report sharper calf pains as a result of a sudden increase in speedwork. The immediate onset of symptoms is a direct indication that your calf muscles and tendons weren’t adequately prepared to take on the large increase of loading forces that come with the demands of high intensity workouts.
Biomechanical Risk Factors for Calf Pain
What’s important to note, though, is that calf pain isn’t solely caused by an increased volume in workload; symptoms are most likely to develop as a result of biomechanical deficiencies.
Improper form alone can be detrimental, and when you combine that with the repetitive nature of running plus higher workloads, your risk of injury will increase exponentially.
Calf strains typically occur during eccentric contraction (when your muscles and tendons are elongated while under load). This encapsulates any portion of your gait from the point of initial contact through peak knee flexion, which is the primary phase where your leg has to absorb impact forces.
And though this phase may seem fleeting the thick of your actual running, there are several common biomechanical deviations that can lead to any degree of calf strain.
When analyzing running form for potential biomechanical errors, one area we look at is the point of peak knee flexion or PKF (which, visually, is when your stance leg is fully planted on the ground).
During PKF, focus on the positioning of your lower leg — if your shin is angled forward, pushing your knees out past the tip of your toes, you run with “knee-dominant” form. This steeper angle indicates that your calf muscle has to work significantly harder to help support the shin as it’s being subjected to excessive loading.
Additionally, with your knee jutting out too far forward, it winds up bearing a brunt of the impact forces upon landing. When this excess loading is displaced onto the joints rather than the appropriate muscle groups, your joints have to bend more to try and compensate for the lack of shock absorption. This leads to increased dorsiflexion at the ankle, which only further exacerbates any strain and loading in the calf muscles and tendons.
The degree of your shin is a common culprit for aggravation or pain, but it can also be worsened by how quickly the loading occurs. Overloading is the primary factor, and when it occurs rapidly within a short amount of time, your tissues are at a higher risk of acute pulls or tears. (And, if left unaddressed, it can lead to chronic issues in the long run as well.)
Improper Foot Landing and Biomechanics
Unfortunately, high dorsiflexion isn’t the only biomechanical factor to consider when it comes to the foot.
Overpronation is an extremely common deviation for many runners; it’s what happens when your feet roll too far inwards, causing the arch of your foot to flatten more than it needs to as you move through the stance phase of your gait.
Having excessive pronation can ultimately cause your lower leg to angle out laterally (even if only a little). It may not be all that noticeable with the naked eye, but the repetitive impact forces of your foot landing can strain those outer peroneal muscles over time.
Quite similarly, crossover can lead to a similar effect — if your feet land past the midline of your body, your legs are likely positioned at a lateral angle when they make contact with the ground. The impact forces that your body then has to absorb are improperly distributed to the passive structures in your calves, like the tendons and shin bones.
Running with either issue indicates that you’re repeatedly having to take in excessive forces (with the incorrect anatomical systems), often suggesting a lack of neuromuscular activation and control.
Adduction or Internal Rotation at the Hip
This issue often comes hand-in-hand with deviations like overpronation.
Hip adduction is the motion that allows you to move your leg in towards the midline of your body. (Think jumping jacks, when you bring your legs back to a regular standing position.) Hip internal rotation, however, occurs when your thigh rotates inward.
Both mechanics are necessary aspects to other training, like mobility or flexibility, but they can have a major negative impact on proper running gait. Take a look at an example from one of our runners in the clinic:
As you can observe, this motion from the hip joint causes the thigh and femur to angle/rotate inwards, creating a subtle “collapse” effect at the knee joints. Not only does this increase loading at the knees, but it also impacts the rest of your kinetic chain, where your lower leg consequently angles inward.
Altogether, these compensatory mechanics create an inward bowing or lateral bend of the entire leg. This places extra loading on the Achilles tendon and other calf muscles, and they have to absorb more lateral forces than they’re built to handle.
Treating Calf Pain: a General Guide
Biomechanical deviations are like the red flags that indicate causes for your calf pain, but tackling the true root of these issues requires a more in-depth approach…
That is, targeted, deliberate training outside of your actual running.
Even if you have top-notch running form, having impaired calf strength or insufficient practice with plyometric exercise can increase the likelihood of calf pain symptoms.
Hence, recovering from calf strain can vary from strengthening exercises to form practice to balance drills, and the amount of time it takes to resolve the issue fluctuates depending on the extent of the injury and the root cause. (We know — that’s a lot of “it depends,” so let’s get into some details.)
How Long Does Treating Calf Pain Take?
The first factor that impacts your potential timeline is the level of tissue damage present. Generally, the severity of a calf tear or strain is discussed using grades, which refer to the depth and suddenness of stretch the calf underwent as well as the accompanying symptoms.
Grade three strains are the most severe and indicate a full tear or rupture of the calf tissue. If a grade three strain occurs, function of the calf will be immediately limited and accompanied by intense or excruciating pain. In these cases, surgery is very likely and rehab will be a long-term endeavor.
Grade two strains refer to moderate tissue damage. Your pain level will be moderate, and you would likely be able to continue with activity, but shouldn’t. Pain is likely to be sharper and there may be visible bruising or swelling.
Grade one strains are mild, and they can be accompanied by some pain and sensitivity, or simply excessive tightness in the calf. Onset of symptoms may be delayed by a day after activity.
Grade one and two strains can vary substantially in their healing times. Low- to mid-grade strains can range anywhere from 2 weeks to 3-4 months to heal fully, depending on the amount of damage done and the immediate care in the weeks following injury.
Your timeline will also be impacted by the type of rehab required, which necessitates diving into why your injury occurred in the first place and how to prevent recurrence in the future. (So basically, it’s time to be a biomechanics detective!)
Types of Treatment for Calf Pain
Your treatment plan will depend on the level of strain you’ve sustained, the tissues damaged, and the primary cause of injury.
If you’re experiencing mild pain and are able to perform regular movement, your practitioner will perform a variety of strength, range of motion, and form tests to determine likely causes of injury and create a plan of care. If you’re able to run, they may also take a running record or perform a biomechanical analysis to determine any form errors or inefficiencies contributing to your injury risk.
Once the primary cause of injury is determined, as well as the current level of pain and inhibition, your practitioner can outline the type of treatment best suited to your recovery. But, regardless of the severity of injury, calf strain recovery is built upon five main staples of training:
- Muscle Activation is the process of building a connection between your brain and your muscles to allow recruitment of those muscle fibers during specific movement patterns. Following an injury (or after years of relying on other muscle groups), the brain’s connection to a muscle set can diminish, making it harder to recruit and leading to compromises in form. Using specific, targeted exercises, your physical therapist can help “retrain” your brain to access necessary muscle groups and encourage proper biomechanics.
- Muscle Strength is required once all your muscles are “awake” and accessible. If you’ve been neglecting a certain muscle group over the years, chances are it’s not as strong as it needs to be to help offset the load from running! Strengthening takes several weeks of concentrated effort on specific exercises that your practitioner can outline depending on your needs (for instance, targeting the tibialis anterior or getting those glutes going!).
- Movement Control is the next step in injury prevention and proper biomechanics. Once the foundation of activation and strength is set, you can move into controlling that power through sport-specific movements. This may include things like split squats to target hip control, pallof presses to train your foot muscles, or any number of other coordination drills.
- Stability Training sounds a lot like movement control, but it’s function is focused on reaction and reflexes in the lower extremity. Running requires countless micro-adjustments to things like pavement slope, debris, or even internal balance. In order to accomplish this, your muscles need to practice responding to unexpected stimuli. This may include working on a balance board or reacting to light push while in a running stance.
- Running Retraining is the final, crucial piece to resolving calf pain long-term. While the strategies above may resolve your pain temporarily, without addressing the root issue that created the injury in the first place, it’s only a matter of time. Running retraining involves optimizing your running form for shock absorption, power generation, and injury prevention. Depending on the findings of your specific injury and assessment, you may address hip hinge, running cadence, ankle pronation, and a whole host of other common form errors that can contribute to calf pain.
And there you have it — the key elements to addressing calf pain injuries with running. We know; it’s a little vague, but that’s because there are so many varied causes of calf pain that it’s definitely not a one-size-fits-all solution.
Instead, it’s imperative that you receive treatment based on your specific injury, and focus on the categories above to build sound running form and reduce your risk of injury moving forward.
But you don’t just have to take our word for it; let’s turn to one of our actual runners.
Case Study: Rehabilitating Years of Calf Pain
Back in June 2020, we had a runner, Russ, come to our team with a seemingly unsolvable problem:
Over 20 years of on-and-off calf pain.
Russ was an avid runner since his childhood; he was the fastest in his class in elementary school, and his love for the sport carried well through his high school and college careers. He gradually moved from running to cycling as he moved further into adulthood, but he always felt that itch to get back to running again.
Unfortunately, he wasn’t as physically prepared to take on the rigors of running.
In his first attempt to get back to it, he pulled his calf muscle almost immediately. The injury, interestingly enough, didn’t affect his ability to cycle, but it caused pain any time he walked (and more so if he were to try to run).
He made countless attempts to mediate the problem — stretching, warming up, variations in weight training, multiple beginner training plans, and so on. Yet, despite all his efforts, he still wound up with the same injury, year after year. With every new attempt he would make to get back to running, his calves would get reinjured after his 2nd or 3rd run.
You can imagine how consistently sustaining the same injury time and time again can be incredibly discouraging. For a good while, Russ felt that he was entirely unable to get back to his favorite activity again, so much so that he had even come to terms with it…
Until he came across The Running Blueprint.
Our online Running Blueprint program was a complete game-changer. After just a matter of months (combined with plenty of dedication and tenacity), Russ was finally able to get back to running without ANY calf pain!
It was truly astounding to witness such a major accomplishment. After struggling with more than 2 decades of debilitating injury, reinjury, and ineffective solutions, Russ is finally back to successfully running free of calf pain!
Check out Russ’ testimonial about how he overcame his calf pain: