Calf Muscle Pain

What are the calf muscles?

The calf muscles are located at the lower back side of your leg. It consists of two muscles- the gastrocnemius (superficial muscle) and the soleus (deep muscle).

The gastrocnemius is the muscle belly you feel at the back of your leg. It has two heads- the medial and the lateral head.¹ The two heads merge and join the soleus muscle, which is a deep muscle (you cannot feel it superficially) and form the Achilles tendon (calcaneal tendon) that inserts into your heel bone (the calcaneus).

What is calf muscle pain?

Calf muscle pain is when you feel discomfort in your calves during walking, sleeping, or performing daily chores. Although calf muscle pain varies from person to person, the pain can be continuous throbbing, dull, sharp or prickly.

Types of calf muscle pain

It can be muscular, neural, and can happen to anyone: athletes or frequent exercisers put a lot of strain on the calf muscles; elderly people who are not very active; people with sedentary lifestyles; or someone with health conditions can have calf muscle pain.

Common causes and types of calf muscle pain

1. Muscle cramps - ‘Cramps’ are the most frequently heard word in calf muscle pain. Cramps are sudden contractions that last for a few seconds to a few minutes and mostly subsides on their own.

Muscle cramps can be due to:

• Dehydration
• Loss of electrolytes
• Lack of calf stretches
• Weak calf muscles
• Sedentary lifestyle

Studies show that nocturnal leg cramps occur in 37% of Americans over 60 years of age. About 6% of the American population is affected by nocturnal leg cramps and suffers from cardiac health conditions and depression.²

2. Sciatica or neurogenic claudication - the sciatic nerve is the largest in the human body. It runs from the buttock region and passes through the back of the thighs and knees to the heel and sole. Compression of the sciatic nerve causes sciatica. Sciatica is one of the causes of calf muscle pain since the pain usually radiates down to the back of the knees. The pain increases with prolonged sitting or standing, with pain in the buttocks radiating down the lower leg.

Sciatica can be managed by:

• Pain killers
• Physical therapy
• Avoiding bending, and prolonged standing

In severe cases, consult a doctor when it disrupts your daily life.

3. Muscle strain - this occurs when there is an imbalance in the calf muscles and any strenuous activities that put pressure on your calf muscles. Any injuries like falls, or a direct hit to the area, can also cause calf muscle pain. You might experience sharp, needling, or burning pain in the back side of the leg. Mild to moderate pain can be managed with a hot or cold pack and pain killers.
   
4. Achilles tendonitis - overuse, stress, or strain on the Achilles tendon causes inflammation of the tendon. The pain is felt at the back of the leg to the heel bone.

The symptoms are:

• Pain
• Tenderness at the injured site
• Stiffness in the back of the leg which increases more in walking and prolonged standing

It can be managed by:

• Stretching the achilles tendon
• Cold pack
• Rest

5. Deep vein thrombosis (DVT) - this is a condition where a blood clot is formed deep in the vein.

People who are more likely to develop DVT are:

• Smokers
• Obese
• Have a sedentary lifestyle
• Have a blood clotting disorder

Symptoms of DVT are:

• Leg cramping
• Skin discolouration
• Visible veins
• Tenderness and warmer skin

DVT is an emergency and you must visit the doctor immediately.

6. Arterial claudication - a blockage in the arteries prevents the blood flow to the legs. Restricted blood flow causes pain in the calf muscle. The person experiences relief at rest, but the pain starts during walking.
   
7. Diabetic neuropathy- High blood sugar level for a long time causes damage to the nerves.

People with chronic diabetes feel:

• Tingling sensation at the feet
• Numbness in the lower leg
• Cramps in the leg

If you are diabetic and experiencing these symptoms, check your blood sugar level and consult a doctor.

8. Compartment syndrome:  a very painful condition that occurs after a fracture or any injury that puts a lot of stress on the injured site. Accumulation of blood or fluids builds up inside the bandages, leading to stiffness in the tissues which causes swelling of the blood vessels and nerves. They may experience difficulty in daily activities, visible bulging of the muscle, or painful and tingling sensations.

When to see a doctor

Usually, calf muscle pain resolves with gentle care and medication. But if these symptoms persist, making it difficult for you to perform daily activities, and you have other health conditions as well, it is better to consult a doctor.

Treatment for calf muscle pain

The following are conservative treatments, and in case of health conditions or ruling out other causes of leg pain, a visit to the doctor is a must.

• Rest and compression - rest is an essential part of the treatment program. Usually, calf muscle pain subsides with home remedies
• Compress the area with a crepe bandage. Hot compression is also a good way to reduce pain
• NSAIDS (non-steroidal anti-inflammatory drugs)
• Gentle range of motion exercises - stretching of the calf muscles
• Straight leg raises
• Rolling of cold rollers on the calf muscles

Treatment for vascular calf muscle pain

Peripheral artery disease (PAD) is damage to the arteries that restricts blood flow in a limb. As a result, there is an inadequate balance of oxygen and nutrients in the body.³ The primary cause of arterial blockage is atherosclerosis - deposition of plaques in the arteries causes restriction or smooth flow of blood. 

Claudication is the main symptom of PAD, and the pain is felt in your buttock, calf, or thigh when you walk, but provides relief at rest. However, as the disease worsens, there is pain even after walking a shorter distance.

A treatment plan will be given to you based on an assessment by your doctor. That includes your age, gender, past medical history, signs, and symptoms, etc.

Treatments may include:

• Stopping smoking
• Include low-saturated fat diets and greens
• Treating other health conditions like high blood sugar and high cholesterol
• In severe cases, angioplasty is a preferred option to remove the blockage

Prevention

• Regular check-ups for blood sugar and cholesterol levels
• Lowering triglyceride (fats) in the blood
• Increasing the HDL, the good cholesterol in the blood
• Maintaining normal blood pressure levels
• Regular exercise (advised by a physical therapist)
• Keeping your body hydrated
• Wearing DVT stockings if you have DVT
• Proper footwear ill-fitting shoes can increase calf muscle pain

Summary

Calf muscle pain is a painful condition and is characterised by dull, throbbing, or sharp pain. It is treatable by conservative methods like rest. Thus, if the symptoms don’t resolve after rest, medication, and lifestyle modifications, it is advisable to consult a doctor urgently.