What is shin pain?
The calf muscle is part of a group of muscles called the triceps surae, which includes the gastrocnemius, soleus, and plantaris muscle. The gastrocnemius has 2 heads and acts on the knee and ankle joint, the deeper soleus acts only on the ankle. The triceps surae group share a common tendon, the achilles which attaches into the calcaneus (heel bone).
What are the causes?
Strains to the gastrocnemius are more common than soleus, injury to this muscle group is most common on medial aspect (gastrocnemius), lateral aspect (soleus) and can also occur at the musculotendinous junction (Where muscles join to achilles tendon). Injury to the triceps surae group is most often the result of the following:
- Sudden acceleration from a stationary position or sudden eccentric contraction, i.e. stepping onto a kerb and the heel suddenly drops.
- Previous injury: a previously poorly managed strain will have resulted in the build up of scar tissue, which is characteristically shorter and weaker than normal healthy muscle tissue.
- Training Errors: Taking on too much too soon, ignoring warning signs, taking inadequate rest can all contribute to calf injury.
- Poor flexibility and muscle conditioning: inadequate strength and flexibility can affect the overall function of the muscles and joints. Poor balance in the musculature can cause overload to occur increasing an individual’s risk of injury.
- Inappropriate footwear: Appropriate running shoes should be the most important purchase by any runner, altered foot mechanics such as over pronation can cause internal rotation of the tibia, and fibula, which causes all structures to be forced into unwanted positions
What are the symptoms?
- Individual often complains of a sharp tearing sensation in the muscle at or near the musculotendinous junction.
- Often painful to walk/run, stairs and hills may often cause pain.
- There may be swelling and bruising present depending on the extent of the tear.
- There is usually pain while stretching and contracting the muscle.
- Depending on the grade of injury (Grade 1: few fibres torn, minimal pain and disruption to gait; Grade 2: anything from a few fibres to just before a complete rupture, usually significant pain and disruption to activity and Grade 3: Complete rupture, often reduced pain due to complete rupture of nerve endings, there will be significant disruption to activity) will depend on the management of this injury.
How to manage the pain?
- Reduction of any pain and swelling is essential, rest from aggravating activity, and the use of ice, compression and elevation are essential in the early stages (first 24-48 hours). Non-steroidal anti-inflammatory medication may be used at this stage to minimise pain.
- Cross training as soon as pain allows (Swimming, cycling, cross trainer)
- Initiation of flexibility and strengthening program as soon as the pain has reduced. Progression through non-weight bearing to gradual weight bearing to full to single leg exercises will ensure the muscle is appropriately loaded.
- Correction of any training errors.
- Self massage with a foam roller (only when pain and swelling have gone completely to avoid further injury)
- As over pronation and under pronation can significantly affect the function of the foot, wearing the correct footwear is essential, visiting a specialist footwear store such as run 4 it will ensure you are measured correctly for the most appropriate shoe for your running style. N.B. It is not advisable to get fitted for running shoes if you are experiencing pain and discomfort following injury, as this may alter your normal running technique.
Sports massage and mobilisations have been found to be an effective method of reducing the pain associated with calf injury, increasing the mobility at the joint and improving the muscles flexibility, will enable the individual to perform the necessary strengthening exercises which are essential to ensure a speedy return to running. Sports Injury Scotland will provide diagnosis and treatment of any musculoskeletal injury offering advice on not only the management of pain, but direction on how to avoid recurrence.