Written by Tom Goom, senior Physio at The Physio Rooms Brighton. Follow Tom on Twitter.

Calf pain after an injury is expected but runners often complain of calf soreness with no history of trauma to the area. In these cases, like many in running, the key is identifying the cause and rectifying it.

Non-traumatic calf pain usually follows a fairly predictable pattern – the pain develops when running and gradually worsens as the run continues. The calf may feel tight and even stop the runner from going any further. After running the pain subsides a little but the calf often continues to feel tight for a day or so. Commonly when not running symptoms are minimal.

There are a few potential diagnoses for this including superficial posterior compartment syndrome and ‘sciatica’ but the most common reason I see clinically is simply fatigue of the calf muscles. This leads to the question of why are my calf muscles becoming fatigued? Every muscle has it’s different level of strength and endurance, exceed that level and it will usually start to become painful and tight. The answer to why this happens usually has 2 parts to it;

  1. The calf is being overloaded
  2. The calf muscles are weak or lack endurance.

Overloading the calf

The first question here may be what’s changed recently that coincides with your calf problems?

Common causes can be introducing hill or speed work, increasing weekly mileage and increasing training intensity. It’s also very common for people transitioning to barefoot running to have calf pain. Running barefoot often involves landing on the forefoot and this usually loads the calf muscles and achilles tendon more than running in shoes. Another factor is exercise you do in addition to running – if you’ve started to introduce gym sessions and running on the same day, or the following day, the calf may already be somewhat fatigued before you start.

There is a cumulative effect to exercise that can be quite subtle. If you run regularly you might be quite accustomed to running on heavy tired legs. You can become unaware just how fatigued muscles are getting. I developed calf tightness in my marathon training and was amazed to discover I could hardly perform a calf raise on either leg even when there was no pain!

The first answer when you have been overloading your calf is often rest. The dreaded R-word! A few days rest, some stretching and a session or 2 with the foam roller will often work wonders. I would recommend this before you start thinking about addressing any calf weakness – adding more exercises to an already fatigued calf can add to the problem. Secondly, you may need to think about your training schedule. Are you doing too much with too little rest? Adding a rest day or reducing your mileage temporarily can help resolve symptoms, allowing you to progress again. Our article on training error can give you more guidance on this.

Assessing calf strength

The easiest way to do this is a single calf raise;

  • Stand on 1 leg with your finger tips on a wall/ table for balance (not to push up from).
  • Push up onto your toes and slowly down again
  • Do as many as you can (going right up, not just lifting your heel a bit!)
  • Count the repetitions and compared left and right side

You should be able to do the same amount left and right and it should feel as easy both sides. Clinically I like to see runners achieving 40+ reps on each leg, though I have no research to support this number. Below 30 might suggest a lack of endurance. You may find this test causes your symptoms, in which case stop, don’t push through pain.

The single calf raise is very effective to strengthen the calf. Do as many as comfortable, rest for 1-2 minutes and repeat for 2-3 sets. Aim to work up to 3 sets of 25-30 reps. Do this 2 or 3 days a week on days that you aren’t running. The exercise can also be done on the edge of a stair to allow for greater range of movement by letting the heel drop below the level of the step. (RunningPhysio will shortly be adding a detailed article on calf strengthening).

Addressing calf tightness

Calf flexibility is also important and not to be overlooked. Gently stretch the calf dynamically prior to running using mini squats, lunges, wall presses etc. anything that stretches the calf a little in a comfortable, controlled way. After running or doing strength work use your static calf stretches (as detailed on our previous article on calf injury) and as mentioned previously, the foam roller can help to release tight calves (although it is painful to do!).

Final thoughts: non-traumatic calf pain is often a case of doing too much or having weakness in the calf muscles (or a bit of both!). A combination of a little rest, some changes to your training and some strength work is usually enough to resolve the problem.

If you have any additional symptoms such as severe pain, swelling, skin redness, pins and needles or numbness consult your GP or health care professional. As ever on RunningPhysio if in doubt, get it checked out.

27 COMMENTS

  1. Just wanted you to know that we shared your informative calf pain blog on our RecoFit Facebook page. We also recommend — of course! — wearing RecoFit calf compression sleeves to help warm up calf muscles, support venous return, reduce muscle vibration and enhance recovery. Thanks!

  2. I’m getting pain in my calf whenever i run. It happens about 3 miles in and gets more and more painful. I’ve seen 3 physios who say there is no injury yet for 2 months I’ve had this. The physio I’m seeinng at the moment is saying it’s fine to run but I’m not convinced I’m thinking of having a few months off running( ive tried resting it for 3 weeks)
    I have the GNR next weekend, can you suggest anything to help when the pain starts? Thankyou

  3. I’ve been running for about 3 months now. I run 5 -6 days a week and do anywhere from 1-3 Miles. Suddenly I’ve been experiencing severe calf pain. They are sore when I’m not running and when I do run I have to stop within a few minutes of starting. At rest I feel no pain but while walking I feel it constantly. What could ne causing really sore calves? I stretch a little before and after running.

    • Hi Sarah,
      I know this is a year on but did you find out what was causing this or was there any remedy?
      I have the exact same symptoms as you and am worried my running days are over as I rested for a couple of weeks after this happened to me and on my first jog back not even 1 mile into my run the pain started up again. It was so bad I instantly had to stop running.and even hurt as i walked home.
      I have soreness and stiffness for a day or two then it feels okay. Any advice or info you got would be great.
      Cheers

    • Hi Sarah, this sounds similar to what I experienced. I saw a physio who got me to put sports orthotics in my shoes and do arch excercises. Went running straight away, no problems.

    • Perhaps you are doing too much exercise and not giving your calf enough time to rest. I used to run 4-5 times a week for a few months but then became injured and developed ‘runners knee’, typical.

      Maybe ruduce the amount of times you run per week or even carry out shorter runs, say 1 mile instead of 3 for a few weeks as it won’t put as much pressure on the calf or aggravate it.
      Hope this helps in some way.

  4. Hi, I enjoy canicross which is running with a dog, I run about 5 miles 2-3 times a week I don’t do any other exercises that would fatigue my calfs. I ruptured my right calf playing rugby which is an awful thing to do and took longer to recover than my open hernia op.

    I’m overloading my calfs clearly because I’m 17 stone or 105 KG, my calfs are the largest, strongest and defined that I have ever seen, BUT they’re just not cutting it, I’m of a build that just won’t be slim and love running I need to be able to do it because I’m a soldier but they cramp and pull quite easily.

    More foam rolling I think, I’m already stretching on every step I see, I get really odd looks!

    • Hi Neil, just because your calves are large, strong and defined doesn’t mean they function well in specific tasks such as running. For running you require strength through the full range of motion, i.e. on full stretch or in inner /shortened range, Also you need concentric strength and eccentric strength… i.e. strength while the muscle is shortening AND strength while the muscle is lengthening. A good physio can thoroughly assess and target your specific stress of weakness. I don’t believe foam rolling and stretching is going to stop the cramping and pulling that you complain of…. you need a specific, progressive strengthening program targeting your weakness…not your strength. Stretching is necessary if your muscle is actually tight in length, but length without strength through the full range could be your problem. Try single leg calf raises off a step, try both knee extended and also knee slightly bent… can you do 30 controlled all the way to the top and to the bottom of the drop? Your running technique could have a part to play as well, as could other weaknesses such as lazy hip extenders resulting in more propulsion from the calves rather than glues… can get complicated.

  5. Compression sleeves on calves seem helpful. Also like to carry dry ice on warmer marathons, to rub on the calf sleeves (holding 1-2 lbs of dry ice in a back pack and handling it with knit gloves). Inflammation seems to cause the calf muscle to press on the tibial nerve – an internal nerve as opposed to a superficial nerve. Aspirin during a marathon may also help – keeping down inflammation. Over-striding – trying to get extra push from the calves – may be a contributing mechanical issue.

    Thanks for the thoughtful article.

    Sorry to say my medical knowledge is just from Google.

    Would love to have my Huntington Beach CA marathon go off without a calf issue on February 2 2014. The last 2 miles are where the problem seems to pop up most often for me – suggesting it may be partly anxiety-related. Do my marathons barefoot or in Vibram FFs, which may make me a bit more susceptible. Have done around 3 years of training runs barefoot. In my age group, 3:38 is a Boston Qualifying time. My Orange County marathon in 2013 finally (13th marathon) got me into the Boston event. Fingers crossed re calf cooperation on Feb 2.

  6. What kind of injury would it be. If while I am running I get pain in my calf. There is not set amount of time or distance that passes. I would describe the pain as intense and makes it hard to walk. Its as if I am flexing the muscle non stop. It even continues for a few days after the initial pain even while sitting. I do stretch before hand. I am fit and I do work out. I can easily calf press 350-400lbs with no pain. I half been training to compete in Spartan runs and other mud runs, but until I can figure out what is the cause or ways to prevent the pain I am kind of sidelined for the moment.

    Any advice would help.

    Thanks,

    Kyle

  7. HA! I thought I had an injury,so I came here to see what it could be. Then I read the causes for calf fatigue, and I have every, EVERY single thing you said could cause this. Running barefoot, gym and running in the same day,sprinting uphill.

  8. Hey, great insight on how the problem can be dealt with. The detail makes it very simple to understand. Great report!

  9. Hi Tom,

    I began feeling mild aching high up in my left calf right below the back of my knee a few hours after my long run yesterday. It is still a little sore and tight/stiff today. I felt nothing on my run but I know I was pretty tired at the end. It feels a little tight when walking, and is only mildly achy when I contract the muscle with a straight leg. When my knee is bent and I flex the muscles, there is no aching. Would this likely be simple fatigue/overworking of the calf, or does this sound more like an actual mild strain? Thanks in advance!

  10. I am a bit confused. I have been doing heel raises on a flat surface (trying to treat insertional achilles tendinopathy) since March 1st twice a day, 15 reps x3 plus foam rolling every day. A few days ago I was cruising along on a run faster than I should have been and my calf tightened up and became painful. I stopped immediately. Rested for 5 days, went out today very slowly and at about 2 miles my calf started hurting again. Can it still be related to weakness in the calves? Everything was as you described above concerning the onset of the injury.

  11. Hi!
    I’ve recently started running with walking as a warm up. My problem is that after day three the lower part of my calf (couple of inches above my heel) started to feel strained and I feel a little pain. I don’t know if I just overwhelmed the muscle or it’s something else. Any advice?

  12. I’ve been trying to build up to running 5k, with the 15 miles being my overall long-term goal, since 2012. Yes, it’s been four years. I get terrible pain in my left calf only. When I stretch and squat, my right calf has a greater range of motion than my left. Almost 2x more! There has been no trauma. In 2014 I joined a running group because I figured an actual coach with years of experience would be able to give me advice. Once I got over a bought of bronchitis, I started improving and running farther. However, we utilized the track at a large public park for our Saturday meet and this ended up making everything worse. Now not just my left calf hurt, but my right as well, and the pain was so extreme that I would be in tears. It hurt to run, and it also hurt to walk. One day (six weeks later) while walking my dog (in a different park), I realized that I was walking with no pain. I discovered by accident that the new pain was due to the dirt track. I spent the next week experimenting with this hypothesis, and after 4 separate runs on different surfaces I found that I could not run on the loose dirt track. Our coach had never heard of this, but to this day I avoid dirt tracks and THAT specific pain has not been an issue since. However, I’m still dealing with this tight/painful left calf that seizes up when I run. I naturally run on the balls of my feet and suspected that my shoes needed more heel support. I’ve tried various shoes with various drops. The most comfortable shoe I’ve tried to date were HOKA ONE ONE. I love HOKA’s. My feet feel fantastic, but I have a new issue. The back of the shoe rubs my skin completely raw. Every. Single. Time. This completely sucks. So, I’m back in the Saucony A5’s. My calves are crying for mercy, but at least my heel isn’t bloody and raw. I’ve thought about calling it quits and investing in a decent racing bike, but even after four years I don’t believe this is a permanent issue. I think a yoga or barre program for cross-training would help with weaknesses and range of motion, so I’m looking for a class that I can join during the week after work. Worse case scenario, I’ll find some dvd’s and cross-train at home. In the meantime, I’m icing, foam rolling, doing epsom salt soaks, and using compression sleeves. (o.O)

  13. HI, just anecdote from my expirence .Nearly 2 month’s of training (running, strenght training and bike) and everything is perfect and last run with no problems are cca 20 miles (one race pace , one easy) day after rest , and then the problem start one day 10 min in to run calf’s are pumped to the point that I must finish my workout (can’t move my ankle dorsi or plantar flexion , pumped whole distal calf front and back .And this is repeated 3 day in a row .What are yours oppinion on this ?? thanks for answers!!

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