Chronic calf pain from overuse

Chronic calf pain from overuse: what causes it?

Every muscle adapts to load, as long as there is enough time for recovery. If your calf has more to cope with than it can keep up with for weeks or months on end, the tissue becomes overloaded. The gastrocnemius and especially the soleus, which absorbs your body weight with every step, respond with increased tension, small areas of damage and painful trigger points. Without adjustments, a vicious circle develops: a tense calf tires more quickly, so the overload increases further.

These symptoms are common in runners, walkers and people with jobs that involve standing or walking, such as in healthcare, hospitality and retail. Risk factors are a rapid increase in mileage or pace, lots of hills, switching to minimalist shoes, a stiff ankle, reduced calf strength, insufficient sleep and recovery, and a previous calf injury that has not fully healed.

Forms of long-lasting calf pain

Chronic calf pain covers several different pictures:

• Myofascial calf pain: painful knots and bands in the calf muscle that radiate to the heel or shinbone.
• Recurring minor strains: the calf gets slightly injured again and again during the same session or distance.
• Symptoms from standing work: heavy, tired and painful calves at the end of the day, which improve again after a night of rest.
• Chronic exertional compartment syndrome: rising pressure in the muscle compartment during running, with a tight, full feeling and sometimes tingling, which disappears shortly after stopping.

What do you notice with chronic calf overload?

Overload creeps in slowly. The following symptoms are a reason to have your calf assessed:

• A nagging pain during or after walking or running that has been present for weeks.
• A tight, tired or heavy calf.
• Stiffness in the morning or after sitting still.
• Pain at the start of a session that briefly eases and later returns.
• Tender knots when massaging the calf.
• Less strength when pushing off and tiring sooner on hills.
• Pain at the end of a working day on your feet.

If you get tingling, numbness or difficulty lifting your foot while running, see your GP for further investigation. If your calf suddenly becomes swollen, warm and red, contact your GP the same day. If you are over 50, smoke and get pain after the same walking distance each time, also have your blood vessels checked.

When should you see a physiotherapist for chronic calf pain?

If the symptoms last longer than six weeks, keep coming back or rest only helps temporarily, physiotherapy is useful. Rest often lets the pain settle for a while, but it does not make the calf stronger. Recovery lies in gradually increasing the load your calf can handle. A physiotherapist maps out which factors contribute to the overload in your case, from your training schedule to your work and your ankle mobility.

Building capacity with De Fysio Man

We first reduce the peaks in load and then make your calf stronger step by step.

Treatment and training

• An analysis of your training, workload and recovery.
• Dry needling of stubborn trigger points in the gastrocnemius and soleus.
• A progressive strength programme with heavy, slow calf exercises.
• Mobilisation of the ankle if its mobility is limited.
• Advice on running technique, shoes and the surface you run on.
• A build-up schedule in which you track the pain during and after running as a guide.

Balancing work and recovery

If you stand a lot for work, we discuss how to build in more variety. Think of short breaks, sitting down now and then, well-cushioned shoes and calf exercises in between. Sleep and recovery days also have a place in the plan.

Chronic calf pain, a calf strain and intermittent claudication

Long-lasting calf pain sometimes starts with an acute injury. A calf strain that is fully loaded again too soon can keep flaring up and so grow into a chronic problem. A calf muscle tear that has not been properly rehabilitated also often leaves a weak spot. Pain that in older people comes on after the same walking distance each time and disappears at rest points more to intermittent claudication than to overuse. You can read more about calf pain on the page about calf complaints.

When calf pain takes on a life of its own

If the pain has been present for months, your nervous system may have become more sensitive to signals. The pain then says less about damage and more about an oversensitive alarm system. In that case, we work with graded activity: you build up your activities according to a fixed schedule rather than letting the pain guide you. This helps you regain confidence in your calf and your body.

How we work at De Fysio Man

1. Intake and assessment

We map out the history of your symptoms and your load at work and in sport in detail. We then assess the strength, tension and endurance of your calf and the mobility of your ankle.

2. Tailored treatment plan

You receive a plan that combines treatment of the muscle tension with a strength programme and a realistic build-up schedule for work and sport.

3. A calf that can cope again

We guide you until your calf can carry the load of your work and sport without setbacks, and you know how to keep that balance yourself.