Calf pain or muscle strain is a common problem affecting runners. It is important to differentiate which part of the calf muscle or ‘triceps surae’ is injured in order to best determine the proper course of treatment. The calf muscle is actually composed of two different muscles: the gastrocnemius and the soleus muscles. Of note, the tendon of the triceps surae eventually becomes the Achilles tendon. The calf muscle and Achilles tendon work together to simultaneously lift your heel and allow your foot to push downward or plantarflex, which is essential for running.
Gastrocnemius strain:
The most common location of this type of muscle injury is on the medial (or inside) of your leg, right below your knee. This muscle strain is due a sudden knee extension movement which results in immediate pain, swelling, and inability to place weight on your foot.
Soleus strain:
Calf stiffness/tightness is the typical presentation with a soleus muscle strain. You may notice that the pain is becoming gradually worse over time and with continued use. The location typically is the middle of the calf muscle on the lower portion of the leg.
Diagnosis:
In order to localize the site of calf muscle injury, physical exam involves palpation and assessment of muscle strength as well as muscle stretch.
Treatment:
Rest, ice, and elevation are the mainstays of treatment in the acute setting. Sometimes applying heat may increase stretch and mobility of the muscles, but may also cause more swelling. A compressive wrap such as an Ace bandage but better yet a neoprene compressive sleeve can be quite beneficial. Many runners utilize compression sleeves designed specifically for running.
Other potential treatments include physical therapy as well as laser therapy. Surgery should only be considered in prolonged cases where the muscle injury has not resolved with conservative treatment in 4-6 months.