Calf Pain

Calf pain - have you got pain below your knee? In the meaty bits behind your shins, or in the tapered area above the ankle, but below the muscle? We'll lump it all together and say it's pain in your calf.

Many and varied are the causes. Calves are fairly mysterious... sorta like backs... They'll go along just fine for weeks or months, and there you'll be, in the middle of some ordinary activity, and BANG! It feels like somebody threw a rock at you, and suddenly you can't walk properly. From one stride to the next, it stops working. Go figure.

Maybe there's a lot of pain in the calf, or in the tendon just below it, or maybe it's just mild discomfort with a bit of pain when you try to take a non-limping step. Severe calf pain can cripple you.

Too strong for their own good

Calves are some of the strongest muscles in your body. You'd think that would make them tough and resilient ... and mostly, you'd be right. But if you work on your feet, or if you exercise a bit - or a lot - then chances are your calves will give you trouble.

Sometimes, you won't even know it.

You'll have foot pain or knee pain, but it's your calves that are the problem. Other times, your calves are the problem and yes you have actual calf pain. Why?

A rare problem to eliminate from consideration

One problem that affects strength and endurance athletes is muscle compartment syndrome. Chances are, you don't have that causing you calf pain.

The fascia, the flexible container around the outside of each muscle doesn't have enough give when your calf muscle hypertrophies (grows in response to exercise stress). This can put a lot of pressure on the muscle inside, eventually resulting in adhesions, reduced circulation, nerve problems, and other problems with the muscles.

You've heard the proverbial warnings about opening a can of worms? The only way to get 'em all back in the can is to use a bigger can. The fascia surrounding the calf muscles are particularly strong, and if you cram more stuff inside (the muscle inside the fascia tries to grow), the outsides - the can - don't stretch enough to accommodate. The stuff you are cramming gets squished. Painfully. Ow.

There are various treatments, but one surgical option has been used with some success - length-wise slits are cut in the fascia, to relieve the pressure and allow the calf muscles to expand. We shudder to hear that. That's basically creating a hernia.

Most likely, compartment syndrome is not your problem, or you have a mild form of it. It's rare. Sports-medicine doctors can perform painful tests that involve invoking the over-squeezing by means of certain movements and exercises, which drastically raises the local blood pressure in those muscles, which can be measured. And boy do you experience calf pain when they do that.

For the rest of us, calf pain is more likely to result from tears where the gastrocnemius and soleus muscle fascia blend into the tendons that join to become the Achilles tendon. We said those were strong muscles - strong enough to rip their own attachments if you overdo it.

When you say "rip"... you mean... rip? Tear? Shred?

'Fraid so. We think that part of the problem is imbalance when trigger points and adhesions cause parts of a calf muscle to shorten, while the rest of the same muscle is essentially unaffected. Then you do some action that requires a strong contraction, to pull the big tendons going around the heel to flex the foot.

So basically the muscle gives a big uneven yank on the tendon. The tendon is flexible, but has almost no stretch. So the weakest point gives way. That's often the thin, separate attachments to the muscle fascia. And the attachment points are being pulled unevenly because the belly of the muscle has these adhesions and trigger points, so some of those areas ... rip.

Sometimes it's a major tear, and you aren't going anywhere until somebody sews the ends back together.

More often, it's tiny tears that hurt and cause plenty of swelling in the area... which also hurts, which rapidly convinces you to stop using the foot and what makes it go (that calf). Congratulations, you have calf pain.

QUICKLY! Apply ice and compression. Not a lot of either. You need some of that inflammation in order to heal. You don't want to prevent it entirely, because you have damaged a part of yourself and a certain amount of inflammation is involved as your body clears out damaged tissue and begins rebuilding. The problem is that the body often overdoes the inflammation, which can even make a problem area worse. So you want to manage it. Some chillin' (not more than 20 minutes at a time, then give your body-part time to warm up again) and some compression (but you do not want to cut off blood and lymph flow) and some elevation (but you can't keep that up forever...).

NEVER apply heat to a fresh injury. It'll make everything worse.

How about something less violent?

Well, you can have basically the same thing, except in slow motion.

Instead of an abrupt over-use/jolt that tears the fascia or the tendons or the tendon attachments, you can apply long-term abuse, like being overweight, or like carrying a heavy sack of mail every day. Worse, you can wear shoes with heels, that shorten your calves, and cause you to point your toes too much when you stride, or cause you to land heavily on your heel with every step, instead of landing mid-foot like nature intended.

If you ever get a chance to see (a video of) somebody who normally goes barefoot - whether that's your own kids or somebody from a tropical country or one of those freaky people who are trying to revive barefoot-ism in "developed" countries - you might notice that they don't take really long strides.

Whether they are walking or running, they tend to land each stride on the mid-foot or even the forefoot, and almost never on the heel. That's the natural stride of a human being. When we stuff our feet into shoes and boots, which invariably have heels, we constrict and constrain those feet and cause them to move differently during a stride.

Boots and shoes with built-up heels raise the heel of the foot. This encourages you to walk with the heel striking first. The shoe protects the heel from the repeated blows, so you learn to walk that way all the time.

The foot becomes weak.

If you walk or run barefoot, then the muscles of the feet and calves are constantly providing springy shock-absorption as each stride lands, and those muscles and associated tendons also store up energy to release as you come off that foot. At the same time, all those muscles, tendons and bones are shifting constantly to adapt to the terrain and to keep you in balance, no matter what you are walking on. The feet grow strong, supple, and springy.

Built-up, "supportive" shoes take that away, and substitute a padded box around each foot. It might feel cushy and comfy, but it comes at a cost.

When your feet weaken due to disuse of much of their natural structure, they shift the strain to calves, knees, hips. They alter your posture, in a way that eventually gives you back pain and even neck pain.

Just because somebody - who wants to sell you more shoes or orthotics - tells you that human feet are badly designed and need artificial support does not mean that it's true. If you give your feet a chance, they'll live up to the task and they'll improve the rest of your body at the same time.

How do I do that?

The best way is to walk barefoot as much as possible.

Where you can't do that, then wear footwear that protects your foot from sharp objects (glass, thorns, rocks), but that does not cushion, coddle, and restrict motion.

All kinds of shoe manufacturers are finally catching on and supplying "minimalist" shoes for just that reason. The best we've found are Vibram FiveFingers - the ones with the individual toes.

We walk barefoot or in socks, around the house, where there's not usually broken glass or roofing nails to puncture our tender tootsies.

Outdoors, these days, we wear our Vibram Five-Finger Bikilas as much as possible, and we continue to increase the percentage of walking and running that we do in the Vibrams.

We work in an office with a relaxed dress code, so formal shoes are not needed, and we can wear our "ape feet" with no objection. There are a couple of suppliers of minimalist, non-supportive formal leather shoes now, if you happen to be a lawyer or banker or realtor who wears a suit to work.