Member Case Study: Deep Calf Pain

author : AMSSM

comments : 0

I have a pain deep in my calf about five inches below the knee. A sports doctor did not feel anything wrong in the muscle, and there was no bruising. The tender spot can still be felt on massage.

Member Question from Offthegrid

I am having calf issues. I have a pain deep in my calf about five inches below the knee. Originally it hurt to walk at all, but having a chiropractor perform ART massage on it has definitely helped. The tender spot can still be felt on massage. A sports doctor did not feel anything wrong in the muscle, and there was no bruising. I tore my plantar fascia around the same time, and that is healing nicely, but I am still concerned about the calf. Is this still a muscle strain? What else should be done? I have The Stick, but can't really get a great self-massage that way.
 

Answer by Dr Chris Koutures, MD, FAAP
Member AMSSM

Calf issues are fairly common in active triathletes, and there are several considerations to persisting, deep pain in the calf region. Yes, the described pain could be a healing strain (tear in the muscle). I am not sure how long you have had this pain, but a significant calf strain can take months to heal, especially if you are attempting to train through the injury.

Is there any firmness to the tender spot? Bleeding after a significant muscle strain can occasionally lead to a calcium deposit (myositis ossificans is the medical term) which makes the muscle less flexible and prone to discomfort. Further medical evaluation can determine if this is an issue with your injury.

Was the plantar fascia tear on the same leg? If so, has there been a change in your running/walking gait that might be putting new forces on the calf? A gait analysis by a qualified sports medicine practitioner may help. Also, look at your running shoes—have you noticed a different pattern of wear on the tread (or perhaps a side-to-side difference in tread loss)?

Is the calf pain only with activity? Activity-related pain brings concerns over potential alterations in blood/nerve supply to the calf; compartment syndrome and arterial entrapment are two such conditions. This type of pain tends to start within a certain time period after exercise begins, and tends to be relieved by stopping exercise. If this is the case, seeking urgent evaluation by a sports medicine physician with knowledge of these conditions is essential.

In addition to muscle strains, injuries to the muscle/tendon connection or even a partial tear of the highest portion of the Achilles tendon can cause persistent pain. ART (Active Release Therapy) and aggressive massage are two modalities than can help. Other considerations may include a compressive sleeve, an eccentric strengthening program (strengthening the calf through negative lengthening exercises), topical heat/cold, and frequent stretches (which should be done with knee bent and straight to stretch both calf muscles). Again, consulting with a sports medicine specialist familiar with calf issues and triathletes would be of great help.

Good luck!
Chris Koutures, MD, FAAP
Pediatrics and Sports Medicine, Anaheim Hills, CA

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date: January 5, 2009