Deep Calf Pain After Running

author : AMSSM

comments : 0

Deep calf pain can be a tricky problem to deal with, and it’s appropriate that you are paying attention to this pain before it becomes a more debilitating injury.

Member Question

After years of piriformis and calf problems (all on the left side), I was able to get my run mileage up through the off season and build phase in prep for the season - only to have it freak out with three weeks before the first race. That was a week and a half ago.

It does not bother me when I run

It's right in the middle of the gastoc and pretty deep.  Compression doesn't really help.  The pain is never debilitating.  I could go run now and get through it without much pain.  But, I have learned to pay attention to nagging things before they become season ending things.  I'm not sure which one this is. Any help?

Answer from Vijay Jotwani, MD
Member AMSSM 

Thanks for your question regarding deep calf pain after running.  As you have learned, this can be a tricky problem to deal with, and it’s appropriate that you are paying attention to this pain before it becomes a more debilitating injury. 

The first suggestion I would make is to get a physical examination with a sports medicine doctor.  There is a long list of possible causes for calf pain including the possibility of a vascular problem like claudication, a nerve problem like spinal stenosis, a bone problem like stress fracture, or even a blood clot as the culprit for calf pain. 

Another possible cause for your symptoms could be chronic exertional compartment syndrome where the lower leg muscles swell within their connective tissue lined compartment and cause temporary pain, nerve irritation and reduced blood flow.  This is initially treated with physical therapy and deep tissue massage although many cases ultimately require surgery.  

Based on the description you provided of symptoms that are located near the mid-portion of your calf, come on after longer runs and cause tightness that persists for a week, chronic calf strain may be the most likely diagnosis.  The muscle tendon junction of the gastrocnemius muscle is a common site of injury and can take a significant amount of time to heal.  Long runs (in your case > 3 miles) may be continuing to irritate this area resulting in scar tissue formation or tendonopathy.

Stretching and eccentric strengthening exercises under the guidance of a physical therapist, are the best first line treatment.  Evaluating your leg biomechanics including buttocks and hip strength also has significant benefit.  You should be sure you are in the correct running shoe for your gait and consider an over the counter arch supporting insert.  If these treatments are not successful over months, sometimes a newer type of injection, called PRP, may help for wear and tear in tendons.  It will be important to very slowly increase your running mileage as part of your treatment plan.    

Prevention is the best cure in the long term, and it is important to cross train and use resistance training as part of your routine.  Important muscle groups to work out are the quadriceps, gluteus muscles, and core muscles including the obliques and paraspinal muscles. 

Best of luck,

Vijay Jotwani, MD
Methodist Center for Sports Medicine
Houston, TX  77027

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date: July 2, 2013