3 Reasons for Calf Pain while Running all Runners Should know

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  • Extremely tight calf muscle?
  • Have to stop running to stretch?
  • Rolling out constantly with no improvement?
  • Calf muscle pain after running?
  • Calf tightness while running?

Speak to someone at our Support Center here.

Calf pain while running can be extremely frustrating.

You aren’t alone. Calf tightness and calf strains happen to over 25% of runners and we have answers right here. I’ll be going over some effective stretches, exercises and rehab for calf pain when running.. you can access them now via my Youtube and iTunes Podcast.

With proper rehab and treatment, you too can overcome these injuries…BUT you have to make sure you have a correct diagnosis.


Here are some common reasons for feeling calf pain as a runner:

• Soleus Strain
• Posterior Compartment Syndrome
• Deep Vein Thrombosis

The last one is a life threatening condition. If it’s treated like a strained muscle, you can die.

So, here we go with all three top reasons for calf tightness while running.

Posterior Tibial Tendonitis


• Dull, throbbing ache in the middle of your calf?
• Deep cramp in the lower leg?
• Have to halt your run and hobble back to the car?
• Pain walking downstairs?
• Calf pain while running?

These are how some of my runners have described their Soleus Strains. These are not the only symptoms of a soleus injury, but they are typically the most common complaints.

You do not have to continue suffering from a calf injury. If you have been diagnosed with a soleus muscle strain, this article will greatly assist you in understanding your rehab.

You are probably wondering… “Should I run with calf pain?”

I had a conversation with a running coach at my office just yesterday about this.

He wanted to just go test it.

So I asked him candidly…

“Have you done all you can to responsibly to rehab it?”

If the answer is No, then no I would not run with calf pain.

What is a Soleus Strain?

A strain is a small tearing of a muscle. They are typically called micro-tears. By definition, they are also Grade I soleus muscle tears.

Wondering if you have a Grade II tear?

Achilles Tendon Runner

Grade II tears will normally have some visible skin bruising due to greater tearing of the muscles than a Grade I will.

The soleus muscle is one of the larger muscles of the calf, which attaches to the heel via the Achilles tendon. The soleus actually makes up the majority of the calf muscle if we were to assess it by volume.

The soleus muscle is considered a slow twitch muscle and for that reason, it carries you through a run. Its internal composition allows it to produce more endurance than the overlying calf muscle, the gastrocnemius.

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What causes a Soleus Strain?

Soleus Strains can happen for many reasons:

• Overtraining
• Poor fitting shoes
• Hill training
• Over pronation/Flat Feet
• Poor core strength/endurance
• Poor hip flexibility
• Poor hip strength/endurance
• Gait abnormalities

You see, it can be for so many reasons.

The reason for your injury would have to be tested.

I call it the “white elephant” in the room.

Calf pain while running

Do you visibly have flat feet? No…let’s move on.

Are you more flexible than most of your friends? Yes…let’s keep looking.

Do you do core training for 15 minutes or more three times a week? No…ok, we are on to something!

I would test the core and hips to see if there is below average strength and/or endurance, and then suspect gait breakdown when under strain if you tested positive.

The “white elephant” is the top target on the rehab hit list, and is usually the thing you smile and say “Noooooo” to when asked if you do it or not.

How can you rehab calf pain while running from a Soleus Strain?

Let’s say we keep going on the same track… feet looked good, flexibility looked better than average, and core strength was suspect.

I test the core in three planes of motion:

• Forward/Backward
• Side to side
• Rotate and rotate

That is six motions total in three planes.

Perhaps we found rotation stabilization was poor and extension was too.

I may suggest a Birddog exercise because it challenges those two motions.

If you failed in flexion and rotation, I may give a Dead Bug exercise.

Here is a video of a good friend of mine doing these two exercise progressions.

Of course, there is a lot more to rehab than just these two progressions, and we have an advanced online course we will be offering.

If it is up, you will see a link HERE.. if not, then it is coming, I promise.

What kinds of treatments can be done for calf pain while running because of the soleus?

For decreasing pain associated with a soleus strain, I really like these treatment options. They are extremely effective, but even though pain decreases, you still need to rehab the “white elephant.”

• Active Release Technique
• Deep tissue massage
• Band assisted ankle mobilization
• Anti-inflammatory injections
• Tool assisted tissue mobilization
• Prolotherapy
• Chiropractic adjustments or mobilizations

Here is a self-muscle release video you may be interested in:


• Lower leg pain that begins during exercise (not before)?
• Lingers for about five minutes after stopping?
• Feels like pressure in the calf?
• Foot tingling?
• Calf pain while running?

These are all symptoms of Posterior Compartment Syndrome of the leg.

As we go through this article, I am moving through the conditions that I would rather you have less and less.

Posterior Compartment Syndrome is much harder to treat. I have had some runners who’ve had to actually change sports because of its re-injury rate.

I have compiled the information I think you need to know about this painful calf condition. Beyond this information, you may need to speak with someone in person.

Do not try to tackle Posterior Compartment Syndrome alone. It is so much more complex than normal calf pain while running you would most experience.

What is Posterior Compartment Syndrome?

Posterior Compartment Syndrome of the leg is a compression condition. Compression occurs in the deep, backside compartment of the leg from swelling.

Excessive compression of the blood vessels and nerves in the area ultimately forces you to stop moving.

Lack of blood supply means less oxygen for your muscles.

Nerve compression means tingling and altered function of the muscles they control.

This is boring stuff, right?

Hang in there the rehab section is much more fun.

What causes Posterior Compartment Syndrome?

The compression of the vessels and nerves is what causes the pain and swelling.

The compression can occur from structures in the compartment being too large. We believe the muscle grows too large and decreases the free space for everything else.

Some feel the muscles increase in size due to excessive demand or workload, such as with flat feet or poor footwear.

I feel improving gait patterns is a better answer, since ground contact force will increase with gait abnormalities as well.

Correction of the foot and ankle is only half the battle.

How can you rehab Posterior Compartment Syndrome?

So, is the answer to decrease the size of the muscle?

In theory, rest would do that, but no, that is not the answer.

Rest will assist in keeping symptoms at bay, but it does not improve gait, striking patterns, core strength, ankle/foot strength and more.

We need to decrease the workload put on the muscles of the deep compartment.

How do we do this?

Improve the function of the entire kinetics chain (core, hip, knee, ankle, foot etc.).

I like to start at the core and hip.

Here are a few exercises I use with high frequency when I am working with a runner with calf pain.

The Lewit:

The Barbell Hip Thruster:

The Superman:

What kinds of treatments can be done for Posterior Compartment Syndrome?

There are treatments I attempt before getting too extreme on a surgical treatment plan.

Here is what I normally suggest:
• Active Release Technique
• Deep tissue massage
• Tool assisted tissue mobilization
• Band assisted ankle mobilization
• Prolotherapy
• Chiropractic adjustments or mobilizations


• Just get off a long plane flight?
• Deep ache in the calf?
• Have a recent hospital stay?
• Over 60?
• Someone in your family have a blood clot before?

There are more risk factors for blood clots in the leg, but if any of this sounds like your calf pain backstory, DO NOT attempt to massage it out.

This is not a condition I treat in my clinic, but it is one that every runner needs to be aware of.

What is a Deep Vein Thrombosis?

A deep vein thrombosis is a blood clot in a vein of the leg and yes it too can cause calf pain while running.

It often creates swelling in the ankle and foot.

Pain and tenderness are common.

Does your leg feel hot?
Any skin discolorations?

If you are having doubt, I would go to the hospital… seriously.

True story about a running coach I had come into the clinic. He was the last one of the night so I had ample time.

He had a classic presentation with all of the symptoms I just described, and I urged him to go to the hospital.

He didn’t want to.

So, I drove him myself.

As I was driving him in to the ER I thought, “ What if I’m wrong and he doesn’t have a DVT? He is going to be pissed at me for wasting his time.”

But then I thought, “What if I’m right? I could be saving his life.”

Long story short, I sat there in the ER with him for three hours through all of his testing.

Finally, we had the result…Negative.

He wasn’t excited about the experience, but he was very appreciative that I was straight with him.

So, if my story has stuck a cord with you, PLEASE…GO TO THE ER AND PRAY I AM WRONG AGAIN.


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