Lower Leg & Calf Pain

Often, poor ankle stability, weak hip and core muscles, incorrect footwear, or training errors can lead to leg or calf pain. Treatment of pain in your lower leg will depend on the cause. Therefore, at Just Physio, we will discuss your specific situation with you, do a complete physical assessment, and then develop a treatment plan specific for you. Below we discuss the most common causes of lower leg and calf pain.

Achilles Tendon Injuries

Your Achilles Tendon (TA) is the largest and strongest tendon in your body. It connects your calf muscles to your heel. Your TA can be injured in multiple ways. Acute TA injuries include tendon rupture or tendonitis, whereas more chronic problems are more likely a tendinopathy.

Achilles Tendon Rupture

The Achilles tendon is the most frequently ruptured tendon in the human body. A rupture typically happens when the tendon is overstretched, when there is excessive calf muscle contraction, or when you fall onto your foot with your ankle pulled upward. A very common way to rupture the Achilles tendon is a forceful push-off as you start running or sprinting.

The fibres of any tendon are not elastic and cannot stretch much. Therefore, tightness in your calf muscles can predispose you to a tendon injury. People who participate in recreational sport without doing the proper conditioning and training are at higher risk for tendon injuries. Steroid use has also been a proposed risk factor for tendon injuries.

An acute rupture will cause immediate, sharp pain. A very pronounced crack or popping sound will be heard with a complete tendon rupture. You will struggle to walk on your injured leg or stand on your toes. You may even notice an indentation in your tendon.

Sometimes the tendon can tear little bits at a time to develop into a more chronic rupture. In this case, you will have pain, reduced strength and mobility of your calf and ankle, and feel like your calf becomes tired quickly. You will have more and more difficulty with walking or exercising as the injury becomes worse.

Achilles tendon ruptures can be treated conservatively without surgery with good outcomes if the rehabilitation program is followed strictly. The aim of our physiotherapy treatment will be to encourage healing, manage pain, swelling and inflammation and restore the normal length, strength, and endurance of your tendon. A period of rest and limiting movement of your ankle will be required. This will be followed by a progressive rehabilitation program consisting of ankle mobility, muscle strengthening, and stretching, as well as walking and balance training. We will also help get you back to your activities, exercise, or sport.

In severe cases, when surgery is required, rehabilitation following the surgery is also crucial and will follow the same principles of treatment stated above.

Achilles Tendonitis and Tendinopathy

Both tendonitis and tendinopathy typically develop when your tendon is overloaded and cannot keep up with the stress and strain being placed on it. Repetitive activities that cause high loads or strain through the tendon can start causing small tears through its fibers. As amazing as our bodies are, it tries to heal these small tears by producing an inflammatory response.

Achilles tendinopathy is fairly common. Although it is seen more in people participating in sport and exercise, it can happen to anyone. There are a few things that increase your risk for developing tendinopathy and include being overweight, a diabetic, having tight or weak calf muscles, a weak core, weakness in your hips and/or knees, and stiffness of the joints in your ankle or foot. Sportspeople who increase or change their training too quickly can also risk getting tendinopathy.

The most common symptoms of tendinopathy are pain, stiffness, and tenderness over the tendon. Pain can vary. Some people struggle to do exercise because pain prevents them from doing so, while others can exercise through some pain, only to have increased pain once they stop exercising. You may feel that your TA is very stiff in the morning but improves after walking for a while. When touching or squeezing your tendon, it may feel tender. Occasionally a little bump will start to form on your tendon as your body tries to heal the injury.

The best treatment for tendinopathy is appropriate for rest, ice, and physiotherapy. Try to avoid activities that load your tendon too much. At Just Physio, we can advise you on alternative ways to stay active. Applying ice for 15 – 20 minutes at a time can ease pain and inflammation. Our physiotherapy treatment will help with reducing your symptoms and then focus on improving the health and function of your tendon. We may perform hands-on techniques such as joint mobilisations, massage, dry needling, ultrasound or electrotherapy. Most importantly, we will take you through an exercise program to stretch and strengthen your calf and other leg muscles. Eccentric exercises have been shown to be especially effective in the treatment of Achilles tendinopathy. Call us today to book your appointment.

Calf Muscle Strain or Tear

Your calf muscles are the power drivers of your legs and are essential for propulsive movements such as walking, running, or jumping. The two major muscles that make up your calf are the gastrocnemius muscle (gastrocs), which is the common calf muscle, and the soleus, which lies beneath the gastrocs. Between these two muscles, the gastrocnemius muscle is most commonly injured due to the fact that it extends above your knee to the back of your thigh bone. By extending over two joints, namely the ankle and the knee, the gastrocs are more to injury. The soleus muscle attaches below your knee joint.

Calf muscle strains typically happen with sudden, explosive movements such as sprinting, jumping, or a quick change in direction. Athletes doing sports like rugby, soccer, athletics, and dancing that involve these movements are at higher risk for calf strains. Other times a calf muscle strain can occur over time with repetitive muscle overload, where tightness and discomfort build up and continue getting worse. This usually happens in older people and especially in those who have reduced calf muscle strength, endurance, or flexibility. Occasionally, a simple activity like getting up and walking, or going upstairs will cause a calf strain.

With a calf muscle strain or tear, you will feel a sudden sharp pain which is often accompanied by a popping sound or tearing sensation. Depending on the severity of the injury, there may be swelling and bruising in your calf within a few hours. Your calf may also feel tight and moving your ankle will cause more pain. You might have difficulty walking or continuing with your sporting activity.

Calf muscle strains are graded according to severity, ranging from a grade I to a grade III injury. Grade I injuries are the least severe with minimal muscle damage, whereas grade III injuries are most severe with significant muscle damage. Your treatment and recovery times will depend on the severity of your injury. Calf muscle strains rarely require surgery except when there is a complete rupture of the muscle.

The aims of our physiotherapy treatment will be to limit the amount of bleeding and damage within the muscle tissue, to encourage optimal healing, and for you to have the best recovery. During the early healing stage, we can advise you on how to protect the healing tissue. It is suggested that you avoid applying ice during this time, as it can disrupt your natural healing process. Other strategies we may suggest to help protect your calf include elevating your leg, using compression taping or bandaging, and taking a load off your leg by using crutches for example. We may decide to use other treatment modalities such as ultrasound, dry needling, and gentle stretching if necessary.

As tissue healing continues, you need to start with an active rehabilitation program. Extending your rest period for too long can be detrimental. Graded loading on your calf is crucial to regain strength, flexibility, and endurance in the muscle. This gradual increase in the amount of work and stretch your calf muscle takes will be guided by your pain levels. At Just Physio, we tailor a rehabilitation program specifically for you and take you through it step by step, continuously monitoring your symptoms and progressions. Our main goal is to help you recover to your full abilities to enable you to return to your work, home, and sporting activities.

Calf muscle strains or tears are common injuries, and if they are not treated appropriately, your recovery time will be significantly delayed or you may have recurrent injuries.

Shin Splints

Shin splints is a general term given to pain and discomfort felt at the front of your leg that typically gets worse with physical activities that involve running, jumping, and quick direction changes. The medical term for shin splints is Medial Tibial Stress Syndrome (MTSS) since it is usually caused by accumulated stress on the tibia, which is your shin bone. Pain and discomfort are generally felt at the front inner part of your shin and is aggravated by physical activity.

Shin splints are common in people participating in sports such as running, netball, tennis, soccer, and dancing. However, anyone doing physical exercise can develop shin splints. Very often, shin splints are related to a change in the intensity, time, frequency, or environment of your training or exercise program. It is common for people who start a new exercise program and do too much too soon. If you are a runner and you suddenly increase your distance or speed or include a lot of hill running, you are also at risk of developing shin splints. Training on hard or uneven surfaces, or wearing inappropriate footwear, also increases the stress on your shinbone and surrounding muscles.

Initially, you may only have pain or discomfort as you start exercising. Often, the pain will fade as you continue exercising, only to return once you cool down. Not addressing your shin splints can result in pain becoming more constant. You may experience pain throughout your training and have lingering pain for hours, even days, after stopping the exercise.

Repetitive stress on your shin bone will result in a chronic inflammatory reaction, resulting in weakening of the surrounding muscles and even bony changes. Untreated shin splints can lead to stress fractures of the shin bone, which is a serious and very painful complication.

The earlier you seek treatment for your shin splints, the better and shorter your recovery will be. At Just Physio, we will help manage your pain and other symptoms, provide helpful advice as to how to manage your injury and prevent further complications, and ultimately get you back to your sport or exercise.

During your first visit, we will discuss all aspects relating to your injury and training and then perform a physical assessment. We always do a full biomechanical assessment, looking at your painful area but also your foot posture, training techniques, calf muscle strength and flexibility, hip movement, leg length, and core strength. This allows us to identify potential predisposing factors that lead to the overuse of your lower leg.

Once we have discussed your injury and identified the physical concerns, we will tailor a treatment program specific to your needs. Your initial treatment may consist of active rest, ice application, ultrasound, electrotherapy, and soft tissue mobilisation to relieve pain and reduce muscle and fascia tension. As healing occurs and your symptoms improve, we start a more active approach to your treatment where we improve your muscle strength, flexibility, and endurance. We can also advise you on how to adjust your training, perhaps including cross-training and lower-impact activities. Gradually, we will increase your training intensity, duration, and frequency and start introducing more sport-specific training. In this way, we help you return to your full training program.

Referred Pain

A less common but important cause for pain in your lower leg or calf is referred pain. Referred pain is when pain comes from one part of your body but is experienced in a different area. Lower leg or calf pain can come from your knee, hip or lower back.

Referred pain is typically poorly localised, meaning that it is not easily pinpointed in a specific area. Pain can feel like a constant ache, sometimes with episodes of sharp, shooting pain in your leg. You may also experience calf muscle tightness, cramps, or discomfort. Some people also experience abnormal sensations in their legs such as pins and needles, numbness, or tingling. Referred pain can be confirmed with special tests that we perform. We always perform a full assessment to determine where your pain is coming from.

Referred pain from your lower back can be the result of many things. Arthritis, spinal trauma, degenerative changes, or disc prolapse that narrows your spinal canal can all put pressure on sensitive nerves. Nerves exiting your spinal canal travel down through your pelvis and into your legs. If these nerves are irritated, compressed, or inflamed, they can send pain signals anywhere along their path. Sometimes you might not have any lower back pain with your referred leg pain.

Referred pain occasionally comes from muscles in your buttock or hip. Trigger points may develop as a result of chronic overuse of these muscles. These tender areas in muscles have specific referral pain patterns. Pain from muscle spasms or trigger points can be successfully treated using massage, trigger point release techniques, dry needling, muscle and fascia activations, and targeted stretches.

Referred pain, although more challenging to treat, can be successfully resolved with physiotherapy. Every treatment plan is individualised to address your specific condition. Exercise therapy will be a vital aspect of your treatment. We will teach you the best and safest exercises and stretches to do to manage your symptoms. We may also choose other treatment techniques such as spinal and nerve mobilisations, soft tissue release, dry needling, taping, and electrical stimulation depending on your situation. Referred pain should be addressed as early as possible. Ignoring your referred pain can result in worsening symptoms and permanent damage. Treatment time and recovery will be longer for more chronic, persistent symptoms. However, at Just Physio, we are always here to help you. We will help you resolve your symptoms and empower you to achieve full recovery.

Compartment Syndrome

Compartment syndrome is a condition resulting from increased pressure within one of the tissue compartments in your body, causing reduced blood flow in that compartment. It is a very rare cause for lower leg pain but important not to be missed. As pressure builds up, blood vessels are compressed and cannot deliver sufficient oxygen to the tissues within that compartment. The lack of oxygen (and other nutrients) to muscles and nerves within the compartment will cause damage to these structures.

Acute compartment syndrome usually develops after injury. Fractures of the lower leg, muscle injuries, crush injuries, burns, or bites can cause compartment syndrome, especially if there is bleeding or fluid collection within the tissues. Other conditions that can cause compartment syndrome include bleeding disorders, infections, improperly fitted casts, splints or bandages, and even repetitive, strenuous exercise. Symptoms of acute compartment syndrome will include rapidly progressing pain and swelling in your lower leg, tightness, inability to move your ankle or knee and difficulty walking or standing on the affected leg. Pain will be constant even when you are resting.

Chronic compartment syndrome results from repeated overuse or strain of the tissues from vigorous exercise or other strenuous activities. Chronic compartment syndrome develops more gradually over time. Pain typically starts within the first half-hour of exercise and goes away when you stop. Your lower leg will also swell and feel tight in response to exercise. The recurrent decrease in blood flow that is caused by the increase in pressure every time you exercise causes minor, but potentially irreversible, tissue damage each time. Therefore, the longer you wait to seek treatment, the more tissue damage there will be.

Men are far more likely to develop compartment syndrome, possibly due to their larger build and more muscle mass. Very active younger people are also at risk for developing compartment syndrome, especially after a serious injury.

Acute compartment syndrome is an orthopedic emergency and must be surgically released as soon as possible. A fasciotomy procedure is performed to release the pressure, often leaving an open wound to allow the swelling to reduce completely. Thereafter, a skin graft is often used to close the surgical wound. If this procedure is delayed for longer than 6-8 hours, there will be permanent damage to muscles, nerves and/or blood vessels. Timely identification of acute compartment syndrome is crucial. Diagnosis is typically made by looking for very distinct symptoms we call the 6 P’s, which are pain, pallor, poikilothermia (inability to maintain core body temperature), paraesthesia (abnormal sensation such as tingling), pulselessness and paralysis.

After a fasciotomy, physiotherapy treatment is essential to your full recovery. We will teach you how to get out of bed and walk with crutches for the first few days to weeks. During this time, we also help to protect your wound, restore your mobility, start improving your leg muscle strength and monitor for any complications such as wound infection. We will also show you how to keep your unaffected leg and arms strong.

After the first month of recovery, we progress your treatment program to more active exercises, while still helping to manage any pain and swelling you may still have. Your rehabilitation program will also include walking retraining and balance exercises. Later on, we will start focusing your rehabilitation on regaining your full strength, mobility, and function.

Chronic compartment syndrome can sometimes be managed without surgery. If your condition allows, non-surgical management is often tried first for up to 3 months. Your treatment plan will include resting from any aggravating activity, modifying your daily activities to avoid further damage, gentle stretching and massage. Your doctor may prescribe anti-inflammatory and analgesic medications. You may also require some sort of orthotics such as a heel pad, which we can discuss with you. We can also advise you on alternative exercises to do if you wish to maintain your fitness levels.

The success of your recovery largely depends on your commitment to your physiotherapy program. At Just Physio, you are guaranteed to receive the best treatment and support we can offer. We are also highly skilled and will refer you to an orthopaedic surgeon quickly if we see that you have serious and threatening compartment syndrome.

Peripheral Artery Disease and Intermittent Claudication

Peripheral Artery Disease (PAD) is a cardiovascular condition affecting your blood vessels. PAD occurs as a result of atherosclerosis, which is the build-up of fatty substances in your arteries. These fatty substances cling to the inner walls of your arteries, forming what we refer to as plaques. As these plaques accumulate, they narrow the arteries and reduce the amount of blood that can pass through. Ultimately, your muscles will not receive sufficient oxygen and other nutrients due to this lack of blood supply. PAD is a rare cause of lower leg pain but one that should be addressed promptly.

Some people with PAD do not have any symptoms. People with advanced disease may start experiencing symptoms of pain, cramping, feelings of numbness or tingling, and weakness in their legs, especially when they walk. This is known as intermittent claudication, where symptoms are produced during walking and eased with rest. Symptoms are also worse when walking uphill. You may also notice that your feet feel cold or look pale as a result of the reduced blood flow. Occasionally, people can have pain at rest and have difficulty sleeping. To relieve the pain, they often dangle their feet off the bed to encourage blood flow to their legs.

Cardiovascular disease occurs more in people older than 50 years, in men, and significantly more in people who smoke. Other risk factors for cardiovascular disease include diabetes, high blood pressure, high cholesterol, eating a diet high in saturated fats, and being inactive. Cardiovascular disease can be a silent disease, not causing any notable symptoms until it has progressed to a threatening disease. Therefore, symptoms such as intermittent claudication must be identified and treated as soon as possible. Having cardiovascular disease puts you at risk for other complications such as heart attacks and strokes. Drastic lifestyle changes are fundamental to the prevention and management of cardiovascular disease.

Medical management of cardiovascular disease, specifically PAD, is essential and will include medication to promote the opening of blood vessels. Medication to control your high blood pressure, cholesterol and diabetes will also be important.

We can play a vital role in the management of your PAD and intermittent claudication. A progressive physiotherapy program including walking training, leg and arm resistance training and general cardiovascular conditioning will be highly beneficial to you. We develop the program specific to your condition, abilities, and goals and work through it with you every step of the way. At Just Physio, we approach each patient’s condition holistically. Therefore, we can provide you with valuable advice (and encouragement) on lifestyle adaptations such as quitting smoking, improving your diet and living a more active life.

Your walking program is super important to manage your symptoms, encourage blood flow to vulnerable muscles, improve your strength and functionality and ultimately reduce your risk for cardiovascular complications. Sessions will be supervised initially. Thereafter, we aim to promote your independence by providing you with a home exercise program. Your commitment to this program, which is usually 12 weeks, will ensure your recovery and improved health.