Have you ever been in the middle of your half marathon and felt a sharp, pulling, cramping feeling in the back of your leg below your knee?
Calf pain affects a great deal of runners and can present as Achilles pain, back-of-the-knee pain, or just a good old tight calf cramp. Usually, the pain comes on quickly and keeps you from a normal running stride leaving you limping the rest of your run.
What’s equally frustrating is that the pain will come and go. One run might feel great and the next you can barely finish your first mile.
Likely you have tried stretching, foam rolling, rest, and the now sweaty and smelly calf sleeve. Although these tactics might help temporarily, my guess is you are looking for the “fix” so you can get back to working on your speed and distance.
Let me shed a little light on the common causes of calf pain in running and provide you actionable steps you can take today to ease your calf pain.
The “Cause” of Calf Pain in Running
There are 3 main muscle groups that you use when running. These are your gluteus muscles (buttocks), your quadriceps (thigh), and your calf complex. Combined, these muscles absorb the force and shock when you land and provide the strong push you need to run fast and forward.
When a muscle sustains a force greater than it’s loading capacity or is asked to do repeated work in an abnormal position the fibers that make up the muscle will strain and become injured. This can result in tightness, pain, cramping, sharp or stabbing sensations, and decreased muscle function.
In optimal running, there should be a shared workload between the calf, quadriceps, and gluteal muscles. Additionally, the muscle should be loaded over a large enough distance to allow the muscle fibers to do their work. If loading of the muscle happens too fast, injury is soon to follow.
So, how does this relate to the calf muscle?
The calf plays a large role in two distinct parts of running gait. The first job the calf performs is slowing the tibia (shin bone) down as weight is absorbed on the leg. From the first moment your foot touches the ground to the moment when your knee is most bent, the shin bone is quickly moving forward. If the calf doesn’t contract and “hold it back” the shin bone would continue its rapid progression forward and you would fall directly onto your knee (ouch!).
The second job done by the calf is to push off the ground at the end of stance. Your calf is a powerful muscle (it can lift your whole-body weight by itself with ease!) and it’s used to propel your body weight forward.
Injury to the calf can occur in either of these two roles and figuring out which role most affects your pain is key to determining the treatment strategy.
The 2 Most Common Running Form Errors That Cause Calf Pain
- Excessive knee movement forward of your toes with hips too far forward (at peak knee bend)
- Too much knee bend in push off (terminal stance)
Let me show you what these two running form errors look like…
As you can see in the picture above, the knee is aligned forward of the toes which makes the calf work extra hard to keep control of the shin bone. This also creates more pressure at the knee (patella) and is a common cause of knee pain.
The ideal posture of the knee at this phase of running gait should look like this…
Here the knee is aligned at or slightly behind the toes allowing equal usage of the quadriceps, calf, and gluteal muscles. By spreading the workload between these 3 muscle groups you will fatigue less and have more “kick” at the end of your run.
Now let’s take a look at the second most common cause of calf pain in running…
This runner has too much bend at their knee during the “push off” part of running gait. In push off your leg needs “triple extension” to create power and speed. Triple extension means the hip moves backward, the knee moves towards being straight, and the ankle “plantarflex” or move like pushing a car gas pedal.
When there is decreased straightening of the knee it means the thigh muscle (quadriceps) and hip muscles (gluteus) aren’t doing enough work forcing the calf muscle to do double duty. Over time, this will cause overuse to the calf and pain will follow.
Here is a runner who has excellent “triple extension” and is able to run with speed and power…
You can clearly see that there is a straight line from the ankle through the thigh and follows through the torso. This runner demonstrates a strong and powerful push off that is using all the leg muscles at the right time.
Now, you might be thinking, WHY do these running form errors happen?
The 3 most likely reasons a runner would demonstrate these form errors are…
- Decreased “activation” and strength of the gluteal tissues
- Decreased calf muscle strength and power
- Poor single leg quadriceps strength and power
When the brain can’t “access” the buttocks muscles, a runner will naturally move their hips forward to load the thigh muscle and calf. Your gluteal muscles can be difficult to use correctly when doing strength work. (you can check out this article which describes in greater detail muscle “activation” or the buttocks).
As mentioned before the calf is a super strong muscle. The most common test for the calf muscle is to perform 25 full height single leg calf raises. (try it…it’s harder than you think!). Additionally, the calf needs to work FAST to run properly. Doing calf strength drills slow and fast would be beneficial for running.
Lastly, when a runner has any weakness in the quadriceps, the knee will bend too much causing more work from the calf. This is rarer in running but can happen after foot, ankle, or hip surgery or when there is any neurological issues such lumbar disk compression.
Two “Simple” Tips to Help Alleviate Calf Pain
- Practice “sitting back” while running. To do this right, sit back only a tiny bit…like you are moving your butt onto a really high barstool. This will automatically pull you knee back behind your toes making your butt muscles work harder and your calf work less. Over time this will help alleviate calf pain.
- Increase your running cadence by 5-8 steps per minute. By increasing the amount of steps you take per minute you will need to move your legs faster allowing less time for excessive knee bend. In turn, this will limit workload on the calf muscle.
Of course doing proper “activation” and strength work to the calf, quadriceps, and gluteal muscles will help.
If you have specific questions about your calf pain, or have tried “everything” and are losing hope that you can run without pain, don’t hesitate to reach out to your local physical therapist who specializes in running.
If you are in the San Jose area of California, our team at Competitive EDGE Physical Therapy would love to help you get your stride back and run free of calf pain. You can reach us at 408-784-7167 or email firstname.lastname@example.org.