Calf pain is common in individuals who spend a lot of time on their feet, whether standing at work, school, or training athletes. The calf muscle/s take on a tremendous amount of load throughout the day. Climbing stairs, jogging, running, and hiking increase strain on the muscles. In most cases, calf pain results from an overuse injury of the calf muscles. Improper footwear can also contribute to issues around the foot and ankle that include:

• Tightness
• Loss of strength of the foot
• Decreased mobility

Short or tight calves can lead to dysfunctional movement, cramping symptoms, chronic pain, and stiffness. A combination of chiropractic active release treatment and physical therapy can help quickly eliminate calf pain.

Anatomy

The calves are comprised of two muscles, the gastrocnemius, and soleus.

• The gastroc originates just above the knee.
• The soleus is below the knee.

They both insert on the back of the ankle as they join to form the Achilles tendon. The gastrocnemius is the power muscle used for explosive movements like jumping. The soleus muscle is predominately a slow-twitch muscle. This means it is very active during extended activities, like standing, walking, exercising, and running. When dealing with calf and ankle issues, other muscles can also contribute. These include:

• The posterior tibialis lies deep in the inner portion of the calf and plays a role in foot and ankle function.
• The posterior tibialis is heavily involved with Medial Tibial Stress Syndrome or MTSS, also called shin splints.

Calf Muscle Pain

Most commonly, calf pain is caused by the overuse of the calf muscles. This is often the result of the consistent pounding of the feet and lower legs from standing, walking,  and working. Over time, the repetitive pounding can cause tiny tears in the muscles of the lower legs and calves. If detected, early rest and recovery are recommended to allow the muscles to relax, loosen, and heal. However, repeated use can lead to more severe injury without proper treatment, like compartment syndrome. Certain types of calf pain can signify a medical emergency that requires immediate treatment.

Compartment Syndrome

A tough and fibrous covering surrounds the calf called the fascia. During physical activity or exercise, blood flows into these muscles, causing them to increase in size. If the fascia cannot stretch enough when these muscles enlarge, pain and tightness can develop. This is known as chronic posterior compartment syndrome. The discomfort typically goes away when the activity stops but is likely to return without proper treatment.

Calf Overuse Injury

Soreness, tightness, and pain are usually felt along the back or inside of the lower leg. The calf muscles are generally not painful to touch but maybe tender when deep pressure is applied. Calf pain and tightness often come with extended physical activity, exercise and disappear once the activity is stopped. If the injury becomes chronic, calf stiffness can present even when not active, along with numbness and/or tingling in the lower leg or foot.

Treatment

It is recommended not to ignore any discomfort, pain, and stiffness in the calves. Continued overuse can lead to scar tissue formation and chronic pain potential without proper care. Active Release – ART, and chiropractic effectively treat this type of injury. ART breaks up scar tissue, returning normal function to the calf muscles. And chiropractic loosens up stiff joints in the hips, ankles, and feet that may be contributing to wear and tear on the calves. Together they can quickly and eliminate calf pain. Part of a treatment plan includes:

• Joint manipulation or mobilization
• Soft tissue mobilization
• Nutritional recommendations
• Rehab-based exercises and stretches

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Body Composition

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Metabolic Adaptations

Aerobic exercise substantially impacts the body’s muscles’ energy production system and cardiovascular adaptation. The blood delivers oxygen to the muscle cells to produce energy that powers all the exercise being done. Aerobic exercise primarily relies on oxidative energy production, which takes place within the cells called mitochondria. Aerobic exercise also breaks down fat molecules for energy, which can only happen within mitochondria.

• Aerobic exercise training improves the muscle cells’ ability to burn fat by generating more mitochondria and enhancing their functionality. Specifically, the body burns more fat than usual in the hours following each training session.
• With more precise quality and quantity of fat-burning machinery, aerobic training can increase the resting metabolic rate, resulting in more calories burned.
• High-intensity aerobic exercise also increases the excess post-exercise oxygen consumption – EPOC, resulting in increased calorie burn in addition to what was burned during the exercising.

References

Alfredson, H et al. “Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis.” The American journal of sports medicine vol. 26,3 (1998): 360-6. doi:10.1177/03635465980260030301

Bright, Jacob Michael et al. “Ultrasound Diagnosis of Calf Injuries.” Sports health vol. 9,4 (2017): 352-355. doi:10.1177/1941738117696019

Campbell, John T. “Posterior calf injury.” Foot and ankle clinics vol. 14,4 (2009): 761-71. doi:10.1016/j.fcl.2009.07.005

Green, Brady, and Tania Pizzari. “Calf muscle strain injuries in sport: a systematic review of risk factors for injury.” British journal of sports medicine vol. 51,16 (2017): 1189-1194. doi:10.1136/bjsports-2016-097177