- Knee Pain Diagnosis
- Calf Pain
Written By:Chloe Wilson, BSc(Hons) Physiotherapy
Reviewed by:KPE Medical Review Board
Calf muscle pain is a common problem that can make walking, running and jumping difficult and painful.
Pain in the calf region may be due to an injury such as a calf muscle strain, an underlying medical condition or a problem in the nerves or arteries in the lower leg.
Whilst calf muscle pain is often something minor like a grade one calf strain, the problem may not actually be in the muscle itself and could be indicative of a serious problem such as a DVT so should always be treated with caution.
Common Causes of Calf Muscle Pain
Let's start by looking at the most common causes of calf muscle pain, how they present and what causes them.
This diagram shows the different causes of calf muscle pain working down the length of the calf.
Now we will look at each of the causes of calf pain, in order of how common they are.
1. Calf Strain/Tear
Partial or complete tear in one of the calf muscles from overstretching. Most common cause of calf muscle pain
Causes: Sprinting, sudden push off from stationary position, quick change of direction
Symptoms: Instant calf muscle pain, bruising, swelling. If complete rupture, unable to push up onto tiptoes
Full Article: Calf Strains
2. Calf Cramps
Involuntary spasms in the calf muscles which can be extremely painful, aka "Charley Horse"
Causes:imbalance of vitamins/minerals, muscle fatigue, diet, dehydration and muscle imbalance
Symptoms: Upper calf pain, tightness and spasming, difficulty walking. May last anything from a few seconds to a few days
Full Article: Calf Muscle Cramps
Collection of excess fluid in the popliteal bursa behind the knee which can burst releasing fluid into the upper calf
Causes: Knee swelling from injury or underlying condition e.g. arthritis or gout
Symptoms: Swelling behind the knee, upper calf muscle pain, worse with activity, bruising around ankle
Full Article: Bakers Cyst Knee
Inflammation, degeneration or tearing of the inflexible achilles tendon. Most common cause of lower calf muscle pain
Causes: repetitive stress through the tendon, jumping , running, overstretching
Symptoms: lower leg pain, thickening in the achilles tendon, pain on tiptoes, ankle stiffness
Full Article: Achilles Tendonopathy
Other Causes of Calf Pain
So we've looked at the most common causes of calf muscle pain, but there are a few other less common causes of pain in the calf region.
1. Deep Vein Thrombosis (DVT)
A deep vein thrombosis can be a very serious cause oflower leg pain. A DVT is the formation of ablood clot in a deep vein, usually in the calf or thigh.
A DVT requires IMMEDIATE medical attention as it reduces the blood flowto the foot, and there is the risk that the blood clot could break off andtravel through the bloodstream to the heart or lungs which can cause a heartattack or pulmonary embolus.
The commonsigns of a DVT are pain, redness, warmth and swelling in the calf region. The pain often gets worse if your dorsiflex your foot (pull your toes uptowards you).
DVT’s often develop aftersurgery or periods of inactivity e.g. plane journeys, and there can be a genetic link.
2. Trapped Nerve
Compression of the nerves of the lower leg can cause pain, pins and needles and numbness in the calf region.
The nerve compression may be coming from the lowerback where the nerve originates from, or at any point along the nerve itself.
Trapped nerves are usually accompanied by changes in sensation such as pins and needles, tingling or numbness and lower leg pain often spreads.
Any symptoms of nerve compression should bechecked out by your doctor. You can find out more in the nerve pain section on our sister site.
3. Muscle Imbalance
Muscle weakness and tightness is a common causeof calf muscle pain. Weak muscleswill tire quickly if you are on your feet for prolonged periods of time, so it is important to work on both strength and endurance.
If the calf is tight, there is greater risk of calf muscle injury due to the increased tension, making stretching exercises vital.
Exercises are the best way to combat this and it important to get the right balance of strengthening and stretching exercises - visit the calf strengthening and calf stretchingexercises sections for a whole range of exercises that will help combat this cause of calf muscle pain and reduce the risk of calf muscle injury.
4. Peripheral Vascular Disease (PVD)
Also known as peripheral artery disease, this is whenthere is a narrowing in the arteries which can slow blood flow. If this happens in the lower leg, it can cause calf muscle pain.
Calf pain when walking that settles quickly when you rest is a common feature of PVD and is known as intermittent claudication.
Peripheral Vascular Disease is commonly associated with smoking,diabetes, high cholesterol levels and high blood pressure. In severe cases, the foot and lower leg maychange colour – this warrants immediate medical attention.
Calf Muscle Pain Treatment
The best calf pain treatment will depend on the underlying cause of the pain. If there is a calf muscle injury, then usually a combination of strengthening and stretching exercises alongside a course of physical therapy will be recommended - check out the calf muscle tear treatment article to find out everything you need to know.
You can find out how to treat each of the calf muscle pain causes we have looked at here by using the links to navigate to the full articles on each condition.
Lower Leg Pain With Activities
Calf muscle pain will come on at different times and during different activities depending on what is wrong.
1. Calf Pain Walking
Calf pain walking after an injury is common, particularly with a pulled calf muscle. But what if you haven't actually injured your calf?
Calf muscle pain when walking without an injury is usually the result of reduced blood flow, and therefore lack of oxygen, to the calf muscles and usually settles down quickly with rest.
If you get calf pain when walking everyday that settles within a few minutes of resting, it can be a sign of intermittent claudication. Lower leg pain that persists even after resting may indicate a more serious problem such as severe peripheral vascular disease.
2. Calf Pain In Runners
Calf pain running is typically caused by the muscles being overloaded which can lead to a calf tear. Any sudden increase in running activities, be it distance, speed, surface, or the introduction of speed or uphill work, can overload the calf muscles resulting in pain.
A lack of strength or endurance in the leg muscles is a common cause of calf pain in runners. A good test is to stand on 1 leg and push up onto your tiptoes then slowly lower back down. If you can do this 30 times on each leg, it indicates good calf strength and endurance. If not, you would benefit from do calf strengthening work.
3. Calf Muscle Twitching
A twitching sensation in the calf muscles often indicatesbenign fasciculation syndrome, a condition due to a harmless disorder of the nerves that activate the calf muscles. The twitching usually stops when you use the lower leg muscles e.g. walking, but will often return when you rest.
Calf muscle twitching can also be the first sign ofcramp, or that you have overworked the muscles. In rare instances, the twitching may indicate a more serious condition such as Lyme Disease, Multiple Sclerosis or Motor Neurone Disease.
4. Calf Pain At Night
Calf muscle pain at night is often caused bynocturnal crampswhich will usually wake you up. They tend to settle fairly quickly if you stretch the calf muscles.
Calf muscle pain at night can also indicate restless leg syndrome, where you have an overwhelming urge to keep moving your legs. It is very common to be more aware of pain at night as there are less distractions around.
5.Calf Muscle Tightening
Tight calf muscles are usually the result of overuse such as long distance running, particularly if you don't warm up and cool down properly. Muscle tightness can also develop after an ankle or calf muscle injury.
Stretching exercisesfocusing on both gastrocnemius and soleus, when done daily are usually the best way to overcome calf muscle tightening.
6. Calf Muscle Knot
The technical term for calf muscles knots is myofascial trigger points. This is where a small area of muscle fibres and the underlying fascia tighten forming small lumps in the muscle, like a knot.
They may only hurt when you press on there, or in some cases they can cause pain at anytime for no obvious reason. Knots typically develop after a calf muscle injury but can also be related to poor posture, stress and prolonged inactivity.
Another possible cause of a lump in the calf is that excess scar tissue has formed following a calf tear. Specificcalf tear treatmentsuch as cross friction massage and ultrasound helps to prevent and treat this.
7. Sudden Calf Pain
The most common cause of sudden calf pain is acalf muscle strain, where part of the gastrocnemius or soleus muscles are overstretched causing it to tear.
Calf tears typically occur during sports and may be accompanied by bruising and swelling. Starting calf muscle tear treatment early helps to speed up healing and reduce the risk of reinjury or long term problems.
Calf cramps can also develop very suddenly, either during activity or at rest.
Anatomy Of The Calf Muscles
The calf is the area on the back of the leg between the knee and the ankle.
It is made up of two muscles collectively known as the triceps surae. Triceps surae simply means “three-headed calf (muscle)”. It comprises of a pair of muscles, gastrocnemius and soleus.
The gastrocnemius muscle has two-heads which arise from either side of the bottom of the femur just above the knee joint. It is a superficial muscle, meaning it forms the top layer just below the skin.
The soleus muscle runs deep to (underneath) gastrocnemius and arises from the top of the tibia, just below the knee joint.
The two muscles join together around mid-calf level to form the Achilles tendon which twists and attaches the calf muscles to the back of the heel.
The triceps surae muscles work together to plantarflex thefoot i.e. pull the foot downwards andstabilise the ankle. They areparticularly important in controlling and executing the push-off phase ofwalking and running.
Episodes of calf muscle pain should always be assessed byyour doctor to ensure it is nothing serious such as a DVT which requiresimmediate attention.
Pay particularattention to the signs for a DVT: redness, swelling, warmth and pain around thecalf.
Also, sudden calf of lower leg pain that is worse at night or makes itdifficult to walk warrants immediate medical attention.
Page Last Updated: 10/06/21
Next Review Due: 10/06/23
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1. British Journal of Sports Medicine:Overview of exercise induced lower leg pain. January 2011
2. Physiotherapy Journal:Mechanical calf pain in a 23-year-old male due to dynamic functional entrapment of the popliteal artery. September 2005
3. Harvard Health Publishing:When walking makes your legs hurt -Four conditions for leg pain causes that can affect you when walking. August 2018
Deep vein thrombosis, tendonitis, muscle spasm, and a Baker's cyst are some of the reasons of discomfort below or behind the knee and calf. Although these are frequent illnesses that might cause discomfort, other medical disorders can also cause discomfort in certain areas of the legs.
A tight Calf muscle can cause a tendon strain that can present pain behind the knee and limit your knee flexion. Stretching out the tissue where the muscle joins the tendon can reduce the pain.
Calf pain is usually caused by cramp, when the muscles suddenly contract. This might happen if you have been doing new exercises, if you are dehydrated, or if you are deficient in some minerals. Cramps normally go away quite quickly by themselves.
- Don't skip the exercise, even if you have a structural problem. The key is to know your limits. ...
- Whether you're active or not, stretching is good for the knees. ...
- Losing weight can improve knee pain. ...
- Wearing the proper shoes is important for healthy knees. ...
- Stand up straight to feel better.
Iron deficiency can also cause anemia which in severe cases can cause painful lower leg cramps.
Over-the-counter medications — such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — may help ease knee pain. Some people find relief by rubbing the affected knee with creams containing a numbing agent, such as lidocaine, or capsaicin, the substance that makes chili peppers hot.
Do use "RICE." Rest, ice, compression, and elevation (RICE) is good for knee pain caused by a minor injury or an arthritis flare. Give your knee some rest, apply ice to reduce swelling, wear a compressive bandage, and keep your knee elevated.
Richly colored fruits have nutrients, like anthocyanins and lycopene, that limit the inflammatory response, and citrus fruits are rich in vitamin C that prevents inflammation – blueberries, blackberries, tomatoes (it is a fruit), strawberries, cherries, raspberries, oranges, limes, and grapefruits.
Knee Pain Relief Naturally- Addressing Calf weakness - YouTube
The gastrocnemius goes down the back of the leg and attaches to the Achilles tendon. Gastrocnemius strains are common because the muscle connects to two joints (the knee joint and the ankle joint).
Calf pain can result from a number of causes, including overworking the muscle, cramps, and foot conditions. While most cases of calf pain can be treated at home, other causes may require immediate medical attention.
Several diseases and conditions can cause leg pain, including arthritis. It's important to be diagnosed by a healthcare provider, especially when leg pain persists or worsens. Appropriate treatment depends on an accurate diagnosis.
Recovery time depends on the severity of the injury. A typical grade I calf strain will heal in seven to 10 days. A grade II injury will heal in about four to six weeks. A grade III calf strain may take about three months.
Rest, ice, compression, and elevation (RICE) is good for immediate treatment of muscle issues in the first 48 to 72 hours after you notice tightness and pain. Following the RICE method helps reduce damage in the muscles. Try using an ice pack for 20 minutes every two hours while resting and elevating the leg.
See your doctor as soon as possible if you have:
Signs of infection, such as redness, warmth or tenderness, or you have a fever greater than100 F (37.8 C) A leg that is swollen, pale or unusually cool. Calf pain, particularly after prolonged sitting, such as on a long car trip or plane ride.
When a blood clot forms in this vein, doctors refer to it as popliteal vein thrombosis. The symptoms include pain, swelling, and inflammation in the leg and knee area. Popliteal vein thrombosis can occur due to poor blood flow, damage to a blood vessel, or an external injury.
Can osteoarthritis of the knee cause pain in my hip, leg or calf? Osteoarthritis of the knee can weaken your calf, thigh and hip muscles, but there's no indication this muscle weakness is painful.
Depending on the location of the tear will determine where a person might experience symptoms. Anterior knee pain, pain along the inner or outer aspect of the knee, even at times pain in the calf region can all be signs that a meniscus could be compromised.