chronic calf pain

i have just had a (58 year old) long distance runner in complaining of chronic calf pain. i am lost to what the cause of this may be as all rom for the ankle and knee are fine, strength for knee flex/ext, ankle d/f and p/f are at grade 5. there is no swelling, redness or temp. changes. or palpable tenderness of the calf or hamstring, the pain has been constant and is no different when walking or running, i have checked for DVT, the client has never suffered from back pain or hip problems. the only positive tests are pain on the end rom of passive knee flexion and slight pain on resisted soleus at end range of p/f, there is a slight loss of muscle bulk. as far as treatment all i gave was a massage and strengthening exercises. Can anyone help to what may be causing this and any treatment rehabilitation advice? there has been no changes in training or trainers.

[alophysio]

Is it really constant pain? Or is it constant when walking or running?

Diagnostic U/S of the calf?

No history of back pain but did you examine it?

Compartment syndrome?

Intermittent claudication?

It's late - I am sorry!

What is his Straight Leg raise like?? Sensitize it with DF/ADD/NF. What is the effect? SLUMP? Has he had any previous trauma to the calf that could have caused adherance around the nerve, or is there a possibility that he might have adherance higher up?

Stress fracture? What about his Hip???

thank you for your reply, sorry i'm so late in getting back to you i am in the middle of setting up my own sports injury clinic.

the pain he is getting is only a deep aching pain in which there is no palpable tightness or painful sites, suggesting that it is not related to a vein or artery. once aggravated (which is unclear what aggravates) the intensity of pain is the same whether running or walking or even sometimes stood. the runner was not suffering at the time i saw him other than an aching pain on the end range of knee flexion (described as a pulling sensation), the runner says it occurred after an 8 mile race two months ago and he hasn't been able to train or race aswell as before the occurrence.

i am going to examine his back and hips but this seems a real puzzler. i have advised him to book in with his doctors to get some diagnostic tests done i.e. ultrasound. straight leg raise and slump are clear

could this be degenerative meniscus pain, i read you can get pain at the end range of knee flexion with this condition?

[neurospast]

You do not mention if you have examined his feet. Is there any difference in the position of the feet (e.g. arches, varus /valgus) when you compare left with right. How long has he had the problem was there a sudden onset? Have you checked his walking, shoes. How long has he used his running shoes. Have you checked the mobility of the proximal syndesmosis between tibia and fibula, compare left with right.
And last but not least as mentioned before: you have to check thoroughly the back by 3 dimentional testing, overpressure and deep palpation para vertebral from mid thoracic to S1. By the way if anyone over 40 claims to have no history of back pain, you might well doubt what he/ she tells you during the interview.

[Physiobase]

I would also suggest assessing the superio tib fib joint in about 70 degrees flexion. Mobilisation of the joint might well reporduct some on the symptom or might reduce the symptoms after mobilisation.

If is is implicated then you either have an issue with rapid pronation during stance and or excessive hamstring influence across the keen during loading. Gluteal work etc for proximal stability will be part of the way forward. In any case a calf issue following a run is likely to be due to over work in some way, more likely due to the cumulative effects of prior training rather than the run itself. Treat is like something more of a chronic nature and enjoy looking at and fixing the fundemental biomechanis of his running.

If you are setting up a sports clinic get out the video camera and watch him run. This will give you the most information. Look at the soles of the feet, first ray, great toe etc to see the repeated effect of loading. You might well be able to diagnose the problem without even touching the calf.

As for the back, well it is going to be tight somewhere, in some direction, it always is! Well almost always. Addressing it is important but if you look there you will always find something to address, just don't base you diagnosis on it (to many false positives).

Can you give a bit more specific info about exactly where the pain is. Pain on EOR flexion should also be able to be palpated with the patient in prone and the knne gently flexed to relax the gastrocnemius. Have a "dig" in the back of the knee with the muscles in a relaxed postion and tell us more precisely what you find

[vishal]

check out for the neurovascular signs aconstant pain during in activity gives an indication for neurological symptoms

[jacinta]

hi all,

I am lost of idea in my case.

* pt is a 40 y.o /M/footballer by profession

-on & off mild pain since few episodes of trauma to med Rt. calf(started few yrs ago)
-pain increase 3/52 ago; symptoms only reproduce during kn flx to mid range with
foot grounded ( single leg squat/single leg support)
-no pain in sitt. / std.; occasionally when walk down the stair with Lt. leg down 1st, followed by Rt.
- on deep palpation: hardening cord-like structure of med gastroc at
tendinomusculo junction; mildly tender
-all muscle power 5/5, pain at full range against resistance

* claims pain mildly reduce aft 3 sessions of rx.
* pt is due to play next week.

any suggestion/idea is deeply appreciated.

jacinta