Your calves and shins may not have the complex construction or delicate reputation of your knees and feet, but that doesn’t mean they’re indestructible. In a recent survey of 14,000 injured runners, sports podiatrist Stephen M Pribut found that calf pulls were the second most common complaint, with shin splints coming in fourth.
Why are they so common? Anyone who runs on hard surfaces, trains in worn-out shoes, rapidly racks up mileage or neglects stretching and strengthening the lower leg is at risk, according to Pribut, who treats runners in Washington DC in the USA.
Your calves lift the heels about 1,500 times every mile, and your shins support the arches, raise the toes and absorb impact. Because the propulsive motion of running works the rear of the leg more than the front, runners often have overworked, tight calf muscles and weak shin muscles. This can lead to four specific lower-leg injuries – calf pulls, shin splints, stress fractures and compartment syndrome.
A calf pull (also called a strain or tear) occurs when one of the calf muscles (gastrocnemius or soleus) is stretched beyond its limits and separates from the Achilles tendon. When it occurs, you may hear or feel a pop in your calf muscle. Not warming up enough, doing too much hill work, stretching excessively and suddenly increasing your mileage can lead to calf strains. Recovery depends on the severity: minor tears can heal in two weeks, while a complete tearing could take up to four months.
Pain down the front of your lower leg is likely to be due to shin splints – or medial tibial stress syndrome, as medical types prefer to call it. It’s thought of as a beginner’s injury, but shin splints can strike anyone. They’re caused by degeneration of the muscles or tissues that attach to the tibia (shinbone). Overtraining, improper biomechanics or tightness and weakness in the calf muscles are all contributing factors, says exercise physiologist Janet Hamilton. Typically, this pain strikes when you start to run and stops once you’ve warmed up. If you have shin splints, the best remedies are rest, icing, stretching and strengthening exercises and anti-inflammatories.
If the pain is persistent, however, you could have a stress fracture. Stress fractures – or small cracks on the surface of bones – rarely occur from one sudden trauma, but from accumulated damage. The definitive test is a bone scan or an MRI, but a touch test often gives it away. "You can usually find one spot on the tibia that makes you jump off the table," says Dr Pierre Rouzier, author of The Sports Medicine Patient Adviser (Sportmed Press). Of the shin injuries, stress fractures demand the strictest rehab: usually six to eight weeks of rest. Research suggests using anti-inflammatories can interfere with bone mineralisation and prolong recovery, making it important to diagnose a stress fracture early, as anti-inflammatories are a typical treatment of other lower-leg injuries.
Exercise-induced compartment syndrome can also cause lower-leg pain. The repetitive nature of running can lead to swelling within the lower leg’s compartments, which house its muscles, tendons and nerves. "When you run for a long time, a compartment can swell up and essentially choke off the blood vessels that run to the nerves in the foot," says Dr Rouzier. Damaging those nerves can make your feet feel numb. Symptoms generally disappear within an hour after you stop running but recur if you resume. Rest usually alleviates the problem but occasionally surgery may be necessary. Most issues can be dealt with by looking at your training and biomechanics to determine treatment. After all, while ice may ease the pain, you won’t prevent re-injury unless you find and fix the underlying cause.
Build stronger lower legsWhen runners make the time to strengthen and stretch, they tend to focus on the bigger leg muscles – the hamstrings, quadriceps, glutes – but may neglect the smaller muscles of the lower legs. All runners will benefit by working these moves into their routines, but if you’re currently experiencing any lower-leg pain, consider them essential.