The Likely Causes of Calf Pain

Calf pain is a common compliant and if not managed correctly, they can persist for months and cause a lot of frustration. The calf muscles refer to two major muscles; the gastrocnemius and soleus and the small plantaris muscle. These muscles have a joint tendon called the Achilles tendon, which inserts into the heal.

As the upper part of the calf crosses both the knee and the ankle, it is more susceptible to injury. Muscle strains generally occur on the inside of the calf muscle. Soleus muscle strains are also common; tenderness is more often felt on the outside of the leg deep to the calf muscle. Stressing the muscles with the knee straight or bent can differentiate between the two injuries.

A sudden burst of speed, over-stretching or direct contact with a player or equipment may cause an acute injury. With chronic injury people often present with cramping pain in the calf that seems to come and go. This may be due to previous calf strains and weak scar tissue that hasn’t recovered fully.

Certain individuals can naturally be more susceptible to calf cramps, these may occur during exercise or at rest after activity. This is most likely due to excessive fatigue. Improving the strength and endurance of the calf muscles can improve these symptoms.

Collapsing of the upper part of the foot can overload the calf muscles as they are trying to push the body forward during running. This can lead to muscle tightness and soreness and increase the risk of muscle strains or tendinopathy.

Recovery from calf strains require progressive loading to prevent tight scar tissue developing, helping the tissue to repair. Chronic strains require more time to heal as scar tissue remodelling is necessary to reduce the chance of a recurrence. This is achieved through loading the tissues as they are lengthening  and shortening. Assessing the movement patterns during functional activities such as jogging, lunging, jumping and landing is used to help find the route cause of the issue. Looking at how the individual is adsorbing, distributing and creating forces that push them forward is a key component to understanding the cause of the injury. If necessary corrective training can then be used to help prevent injury reoccurring.

Catherine Simpson

MISCP, MSc Sports Medicine

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Anterior Knee Pain

Anterior knee pain is one of the most frequently seen symptoms in the clinic at Sports Physio Ireland. Common causes of this pain in athletes and the general population is patellofemoral pain syndrome. Another common cause mainly in sportspeople is patellar tendinopathy (injury to the tendon running from your knee cap to the front of your shin). Osgood Schlatter’s disease is often the cause of anterior knee pain in young athletes. If a sudden growth spurt occurs the plate can overgrow and cause irritation of the insertion of the patellar tendon.


Patellofemeral syndrome is generally the result of a movement or mechanical abnormality. Whereas patellar tendinopathy is generally caused by overuse but mechanical abnormalities may predispose the tendon to being stressed excessively.


Distinguishing between the two is sometimes difficult as the clinical signs and symptoms can be similar. Running downhill, steps and repetitive activities like distance running are the common aggravating activities at the onset of pain in patellofemoral syndrome, although it may present in the sedentary population with gradual onset or after a dramatic episode such as falling on the knee. Patellar tendinopathy is mainly brought on by a history of repeated loading of the patellar tendon such as jumping and landing. The specific location of the pain is the main determining factor between the two injuries.


Knee injury associated with pain and or swelling may result in the quads not firing correctly. This can set up imbalances on the forces acting on the knee cap, with a tendency to patellofemoral pain. The same is true with excessive tightness of the IT band and hip muscles that could also cause your knee cap to be pulled outwards. More commonly, it’s weakness in the glutes that results in your hip and knee dropping in. Causing the structures on the outside of the knee to be in a lengthened position and pull on the knee cap.


The majority of the client’s that come in with knee pain tend to be knee and quad dominant which means they load these structures excessively during everyday movements. If the glutes are not activated then there can be excessive force through the knee, creating irritation at the back of the knee cap on the thigh bone. This is purely due to overuse and degeneration of the structures. If the knees are painful, using the glutes to offload them is a key component of retraining movement patterns.


Examination will include a thorough history taking, observation, palpation, special tests and functional tests to determine the cause of the client’s pain. For an example a squat done on a decline will stress the patellar tendon more and is therefore more specific to patellar tendinopathy.


Treatment will depend on the underlying cause of the pain and may focus on lengthening structures in one person and strengthening of the quads or glutes in another. One of the main components of the treatment is looking at how the individual naturally moves and ensuring they are not loading their knees excessively.


Catherine Simpson

MISCP, MSc. Sports Medicine

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