Calf Muscle Injuries


by Doug James |InTraining July 2018 free magazine

Injuries to the calf region can be painful and limit your ability to enjoy running.  Frequently these injuries are misdiagnosed or ignored, requiring long periods off running to rehabilitate. With the running season in full swing, make sure you know the difference between a niggle and an injury to keep you on track for your fitness and race goals this year.

Anatomy : The calf muscle complex consists of the soleus which is the longer, deeper calf muscle and the gastrocnemius, which is a pair of thicker muscles located on the upper half of the back of the lower left (the tibia bone).  The primary roles of these muscles during running is to assist with shock absorption and energy storage (via the Achilles tendon) during foot strike before converting that energy into propulsion as you push off (6 other muscles assist to lesser degrees).  These roles vary based on speed, terrain and running style - and each of these factors will influence your risk of a calf injury. 

In addition to the factors above, other considerations such as fatigue, dehydration/electrolyte imbalance, muscle and nerve tension, strength, training load and running experience can contribute to calf injuries.  A previous, poorly healed calf injury can also be predictive of future calf injuries.

Mild Calf muscle injuries :  Less sever calf injuries tend to be felt more after a run has finished.  Delayed onset muscle soreness (DOMS) and training related muscle tension (following weeks of hard training) are generally considered 'niggles' rather than injuries.  They tend to make the muscle feel stiff and slightly uncomfortable to walk on, but usually warm  up during an run with little impact on performance.  These niggles can be addressed with massage and foam rolling with good effect and generally don't require much time off running.  Mild calf tears (where a small number of muscle fibres are damaged or strained are often difficult to differentiate from the muscle tightness niggles mentioned above, though they can become worse if treated incorrectly or if training resumes at too high of a level.  If in doubt, reducing running intensity for a couple of weeks can help to settle this injury.

Moderate Calf Muscle injuries :  Moderate injuries tend to be quite noticeable during running.  Grade 2 muscle tears (where a greater number of muscle fibres are damaged) and exertional (chronic) posterior compartment syndrome are frequently sore to run on, often becoming worse with more distance and intensity.  Grade 2 muscle tears tend to start as  noticeable sharpness or pull and are sore to walk on afterwards, often resulting in a limp.  Compartment syndrome develops due to excessive pressure forming in the calf muscle sheath, which may be due to swelling and/or blood from a muscle tear.  Calf muscle tears more commonly affect the medial gastrocnemius (felt superficially on the upper calf on the in the inner side of the left), whereas posterior compartment syndrome injuries ten to b felt deeper and along the length of the calf). 

Both of these moderate calf region injuries will require seve4ral weeks off running to settle and require a rehabilitation program.  In some cases compartment syndrome may require surgical intervention.  Returning to running should be done cautiously with distance and intensity kept to a minimum over a number of weeks.

Severe Calf Muscle injuries :  Distance runners are less likely to develop grade 3 muscle tears (complete rupture of the muscle) which are more likely seen in sprint athletes or contact sport competitors.  Acute posterior compartment syndrome is a dangerous condition where the pressure inside the muscle reaches dangerously high levers and can impact circulation, nerve and muscle function in the leg.  It usually occurs due to a fairly severe injury such as a fracture, pact trauma or grade 3 muscle tear.  Treatment requires urgent surgical intervention. 

Other Calf Muscle injuries : Cramps can fall into any of the categories above based on their severity.  If running persists in spite of the cramp, tears often occur in the muscle.  The cause of muscle cramps is still poorly understood, but it is through that high intensity activity, dehydration and/or electrolyte imbalance may increase the risk of them happening

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