Triggers for pain in the calf are many. Calf pain can indicate harmless sports injuries, be a sign of overuse or even a warning sign of more dangerous diseases. Many causes can be treated by simple measures. We give you practical tips to find out why the calf hurts!
Causes of calf pain
When your calves hurt, it’s most often due to the calf muscles. The three powerful muscles at the back of the lower leg are active with every step. However, depending on when the calf pain occurs, different causes are possible:
- Calf pain while walking can be caused by muscle strains, a muscle fiber tear or muscle stiffness.
- Calf pain at rest may indicate a problem with the associated vessels or nerves.
- Calf pain at night or calf cramps should be thought of disorders of blood salt balance.
Nighttime calf cramps, as well as pain, restlessness and tingling in the calf can also be signs of restless legs syndrome. The neurological disorder affects the calves and legs during periods of rest and relaxation, and thus mainly at night during sleep. Underlying diseases such as diabetes mellitus can also promote (nocturnal) calf cramps. Other possible triggers for cramps in the calf are, for example, diseases of the thyroid gland or kidneys.
Calf pain after sports
If calf pain suddenly occurs during or after sports, for example after jogging, it is in many cases a harmless so-called muscle soreness. The muscle is overacidified by the stress, which causes pain. Sometimes a real muscle hardening can be palpated. Typically, pain in the calf due to muscle soreness develops one to two days after an intensive workout. Relief is provided by rest, warm-hot alternating showers and ointments that promote circulation. Sports should only be resumed once the symptoms have subsided. As a preventive measure, it is advisable to always warm up well and to choose a load level that corresponds to the training condition. In addition to sore muscles, calf pain during or after exercise can also have other causes. We present these to you in the following.
Muscle strain causes pain in the calf
Common causes of calf pain associated with sports include muscle strain. The pain classically shoots suddenly in the calf, because the muscle tissue is stretched jerkily due to excessive strain or even lack of warm-up training. The muscle strain is thus a typical injury that can be responsible for calf pain during sports. In the case of a pulled muscle, the muscle must first be rested. Cooling provides pain relief and drives back the blood flow to the muscle.
Calf pain after muscle fiber tear.
A more pronounced injury is a muscle fiber tear. In this case, small tears occur up to the complete rupture of one to several muscle fibers. If sudden calf pain occurs as a result of such an injury, the so-called PECH rule will help:
- Pause: stop the training, avoid the load on the leg.
- Ice: This refers to cooling the injured muscle, for example, using an ice pack, cooling sports ointments, ice spray or simply cold water from the tap.
- Compression (German: Kompression): by means of an elastic wrapping, pressure is exerted from the outside on the injured muscle cells, the muscle bleeding is stopped and thus the formation of a painful bruise is prevented. However, such compression wrapping must not be used in cases of known circulatory disorders.
- Elevating: elevating the leg, for example on a pillow, also serves to prevent further bleeding into the muscle.
To complete tears of a whole muscle occurs only extremely rarely and rather in connection with competitive sports or so-called high-impact accidents, for example, traffic accidents or falls while skiing.
Cramp in the calf
So-called calf cramps also occur frequently after sports. The sudden onset of cramp-like pain on one side or even both sides can be broken by stretching the calf muscle. To do this, the foot must be passively pushed or pulled upward toward the back of the foot while the knee is extended.The culprit of a calf cramp is often too much exercise intensity with an accompanying electrolyte deficiency (especially magnesium or calcium). Other causes are circulatory disorders, narrowing of the spinal canal, medication and many other possible triggers that lead to involuntary contraction of the muscle (muscle contraction). The therapy of calf cramps depends on the cause. For healthy athletes, drinking mineral water or isotonic drinks during and after exercise is sometimes sufficient to prevent muscle cramps caused by magnesium and calcium deficiency. If cramps occur regularly, a physician should be consulted to rule out other treatable causes.
Importance of the Achilles tendon in severe calf pain
A sudden pop in the lower part of the calf or at the junction with the heel indicates a ruptured Achilles tendon. The Achilles tendon connects the calf muscles to the heel bone and can tear during sudden, very high stress or due to previous damage. Typical causes of injury are fast kick-off movements, for example in soccer. Running is almost impossible afterwards, a bruise and swelling form. Sometimes the gap in the Achilles tendon can be palpated from the outside. A doctor can make the diagnosis through clinical examination, ultrasound and sometimes MRI. Depending on the extent and age of the injury, treatment then ranges from a cast or orthotic to surgery.
What hurts – the back of the knee or the calf?
In some cases, calf pain also occurs with knee pain. This is because sometimes pain passes from the knee into the calf or radiates through the shared pain fiber supply. Injuries to the knee are most painful when the joint is bent or extended, while injuries to the calf are more likely to cause pain when the foot is raised or lowered. Pain in the back of the knee, in particular, can travel to the calf. If you also palpate a swelling of the back of the knee, it could be an outpouching of the knee joint capsule (Baker’s cyst). Pressure pain in the popliteal fossa and calf may indicate thrombosis.
Calf pain in thrombosis
Thrombosis is a blood clot in a vein, most commonly in the deep veins of the leg. Typical symptoms of thrombosis include pain and a feeling of heaviness in the calf and swelling of the lower leg. Thrombosis is a dangerous condition because the clot can detach from the vessel wall and travel with the bloodstream into the pulmonary circulation, where it can become lodged and cause reduced blood flow to the lungs (pulmonary embolism). If thrombosis is suspected, it is therefore essential to see a doctor. The doctor can make the diagnosis through a clinical examination, an ultrasound and certain laboratory values. The risk of thrombosis is particularly increased in certain cases:
- After operations
- With cancer
- In pregnant women
- In young women who smoke and who are taking birth control pills at the same time
- after a long period of immobilization of a leg
- For example by a plaster
- After a long car ride
- After a long flight
If one of the risk factors applies, calf pain should be taken particularly seriously.
Unpleasant varicose veins
The so-called varicose veins (varicose veins) are also a vascular problem. There is a superficial vein system and a deep vein system in the lower legs, whose job is to carry blood from the legs back to the heart. If the deep venous system fails, blood backs up into the superficial veins and they visibly protrude under the skin. The consequences are a feeling of heaviness and tension in the legs, swelling and nightly cramps in the calves. The symptoms occur mainly after standing for a long time or in the evening. Treatment options range from conservative measures, such as compression stockings, to removal of varicose veins through certain interventional procedures or surgery.
Calf pain during pregnancy
During pregnancy, many women complain of severe calf pain and a feeling of heaviness in the legs. The culprit is blood sinking into the legs, which increases in volume during pregnancy. In addition, the tissues become softer in preparation for childbirth and the vessels have a harder time transporting blood from the legs back toward the center of the body.Water retention (edema) occurs in the legs, which can cause tingling, a furry feeling and pain. Compression stockings and cold-hot alternating showers are recommended. Prolonged standing or sitting should be avoided.
Calf hurts with a herniated disc
An isolated pain in the calf is rather atypical for a herniated disc. However, if the pain radiates from the back down the thigh and into the calf, it may be a bulge or herniation of the disc. In this case, the pain can sometimes feel like sore muscles. Depending on the location of the herniated disc, the pain may also extend into the feet. The disc presses on the spinal cord nerves that supply sensation and muscles in the leg. Patients complain of pain, numbness, tingling sensations and, in the worst cases, paralysis of one or both legs. People of any age can suffer a herniated disc. Triggers are often overuse or incorrect loading of the back over a long period of time or simply age-related signs of wear and tear. If a herniated disc is suspected, a doctor should be consulted promptly. It must go quickly if there is paralysis or problems with urination or defecation.
Identify causes, treat calf pain
As shown, there are very many different triggers for calf pain. To treat it properly, you need to know the cause. It is helpful for this to look at the accompanying circumstances. Often you can help yourself with simple measures. Not always a bad disease must be behind calf pain.