pain in inside of calf muscle

[traviskruger]

I recently developed a pain when I run in the inside of both my legs. Its almost like shin splints but on the inside of my leg rather than the outside. I have never suffered any irritation in this area before. Whats wrong and how do I fix it? Are there any stretches which will stretch the muscle in that area?

[elinekk]

Hi,

Could you giveme some more information on your problem? It sounds very much like my own even though I think mine are shin plints related problems.
I started preseason training recently and just like last year I have problems. My guess is the sprinting part of training, (I normally run about 25-40 km a week) which is new.
I know that insufficient use of the gluteal muscles makes that the calf muscles are compensating that. Proper technique in running makes a huge difference, aslo good shoes are inportant. (avarage runner should changes shoes about every 3-4 months)
Streches are also important not only the 2 calf and quads and hammies but do include gluteal and hip flexor alswell. Your biomechanics might be out of balance preventing you from running 'freely' causing these problems.

Anyway, some more infromation on your problem will be appreciated.
How long have you been running for, shoes you wear, road or off road, when does pain start, where exactly, what streches do you do, trainings regime and has that changes recently, etc.etc..

Kind regards,

Eline

[Dr Damien]

I totally agree however since the situation is bilateral you might want to exclude circulatory causes. you say the pains are in both deep calf areas.you can easily to this by checking your dorsalis pedis pulse for both legs...
just a thought

[elinekk]

Hello,

Dr Damian, you oviously know what you talk about. It has never crossed my mind to check for circular malfiunction.
Could you describe how I would have to take the pulse in legs and are you able to give me information (yourself or via article or website) on what would be considered normal and abnormal flow?
Thanks for that insight, I will not forget it!

Kind Regards,

Eline.

[Dr Damien]

There are many ways to check circulation,simple clinical ways or more complex radiographic reports.
The simplest is to feel with your two fingers for pulse just like you check the radial pulse looking for consistency or regularity and most importantly weakness in flow. weakness, felt thinly(described by academicians as thready pulsations) or not at all may suggest a compromise more proximally.you should not press down on the artery as that can give you a false negative result.having said that, the aterial system is marvellous in arteriogenesis(creating anastomosis) therefore if one feels normal (pulse feels adequate)does not mean all is well.

you could improvise with a doppler ultrasound machine to hear the flow.strong flow will be loud and sound like a dog barking(sometimes you can hear a little high frequency dog bark). The most important thing is to hear it and trust me when you do compared to a compromised circulatory situation you will know the difference.Place the doppler against the flow of the artery, trial and error may be needed sometimes to hear the flow.

other ways are to measure ankle/brachial ratios and I forget what the normal ranges are right now. This is perhaps the most objective you could get in a clinical situation. its just measuring the ratio of pedal pulses compared to brachial artery pulse.

finally, good old radio graphs are handy in showing you were a compromise is but you need a marker of a sort to be injected in the artery to outine the course of the circulatory system. Excessive opacities in any aterial segment compared to the contralateral part suggests a compromise.

Cyclists and rowers often get compromises without knowing because they bend a lot closing down the iliac arteries.they only notice when they start to run.

My reasoning is this: bilateral symptoms happening at the same time must have a more central or proximal cause. unlike unilateral problems that could be either. I am not saying you cant have bilateral problems that have independent unilateral causes, you could but if I was to see a case like that, what I would hold priority is a hypothesis that links both symptoms; I think that way because the body is a chain of little blocks.

I reckon that ruling out circulatory problems should be priority in sports medicine especially in unremitting cases. if it was standard practice to do that, I think it would be a lot better.

bilateral shin splints happening at the same time everytime in the same situation must have a link.It is harder to reason that one out, if that is the case, I would be happy to know why.

your suggestions are very valid because you considered many factors that could link both calf symptoms together e.g training shoes etc

I hope I was of some assistance

[physio.smith]

Definitely check out pulses and mobility of nerves, agree that generally if bilateral problem it may well be central in origin.

Pain on the inside of the calf can often be caused by medial periostitis, irritation where the facia attaches to the shin bones.

Generally where the symptoms are bilateral I have found that one leg is significantly worse than the other if it is not circulatory or neurologically related.

Definitely try and get to the bottom of your symptoms as I have seen a lot of cases of stress fractures in this area, where patients have ignored symptoms. Bone scanning has confirmed the diagnosis, however I don't feel that this is generally necessary, as it does not tend to change the treatment.

Biomechanics may be a large factor...
overpronation, tight calf complex, poor popliteus control (lack of locking / unlocking mechanism at knee may be affected), glut. med. control is often poor

Overtraining is often a big factor, you may need to vary the type of training you are doing, reduce the amount of impact activities etc... You can work on endurance and fitness with various low / lower impact work

Recover is important, allowing time for muscle damage (following a session) to recover, having the correct nutrition to optimise healing etc..

If it is musculoskeletal in origin then rest, appropriate strengthening and stretching, improvement of biomechanical issues and a graded return to activity (without aggrevating symptoms) is what is required.

Good luck.

[linbin]

hi guys
as suggested he should check circulatory,neural and stress fracture signs and relevant diagnostic tests.he did not gave a description of pain-superficial/deep,dull/localised/
irritability,
severity
stability
i feel he should also check for muscular involvement.tibialis posterior involvement can producen pain at similat site

[block]

I know its been mentioned - but circulatory tests are good but should also be done after exercise e.g. popliteal artery entrapment - resting post tib pulse is present but dissapears after the exercise which may be after 15 mins running or just a few caf raises - pop artery entrapment often comes with medical calf pain descrptions initally

Hope that helps

[linbin]

hi guys
i think we should also think about soleus syndrome/medial shin splint
should check for soleus muscle tightness

other examinations suggested
muscle strength of tibialis posterior
posture of foot-pronation
gait assessment
calcaneocuboid and talonavicular mobility assessment

[friendlypain]

Hit it on the head linbin! There would be obvious poor capilary refill in the toes and constant cramping if it was a passive vascular issue. The lower limb is hideous in design and any swelling of a muscle/compartment can create painful symptoms from exercise. I suggest an evaluation of dorsiflexion and re-education of the affected structures to perform without hindering the structures in the deep compartment.

Adamo

[linbin]

friendlypain
by checking dorsiflexion what you are trying to prove.which are the affected structures according to you.i was not sticking wholy to vascular ,as you can check it above

[friendlypain]

Hi Linbin,

I am agreeing with your points. Dorsiflexion is, in my opinion, the most important movement that your ankle can make.

Alot of people can not perform a simple modified squat where they cant squat down to their ankles with their knees over their toes. If the muscles in the deep compartment are "tight" and inhibit appropriate dorsiflexion then minor strains are common which causes inflammation and swelling and compresses the structures within the compartment. Just a symptomatic treatment wont work as the joint will be prone to poor range of motion. Re-education is the key to reverse the cause of the symptoms.

Hope this helps
Adamo

[linbin]

hi friendlypain
thanks for the reply.i agree with the need to check dorsiflexion.but i feel you are vaguely mentioning the structures according to you,which may be at fault/source/cause of pain

[friendlypain]

LOL! Yes specifics may be nice eh? Flexor Digitorum Longus, Flexor Hallucis, Tibialis Posterior.

[roycar]

hey, just somethin relatively simple. i know quality foowear was mentioned earlier but its also so important to make sure it fits correctly. get the feet measured. shoes that are too large can cause flexor digitorum longus to become overactive when the toes try to cling on. this can lead on to medial shin pain... well, thats what i've found a couple of times anyway!

[linbin]

even i too agree with your hypothesis