This information is not a definitive list but only a guide to possible causes of your pain which can be helped by your physiotherapist. There are a wide range of medical conditions that can cause your pain. An assessment by one of our physiotherapists will allow them to take a detailed history and perform a thorough examination to give a diagnosis. They can then treat you effectively or recommend a medical referral if it is required.
Muscle strain or tear
There are a 2 main calf muscles that can be strained or torn which are called the gastrocnemius (main calf muscle on the surface) and the soleus (smaller calf muscle below the gastrocnemius). If you strain one of these muscles suddenly there will be a sudden pain on tearing sensation in the main part of the calf of near where the calf muscle inserts into the heel. There are other muscles deep in the calf including the flexor hallucis longus which flexes the toes and the tibialis posterior which turns the foot inwards. When stretching the muscle or resisting movement of the muscles there is commonly pain. Also depending on the extent of the strain or tear you may have swelling or a haematoma which is bleeding within the muscle which comes out as bruising.
Physiotherapy can help with advice, ice, massage, soft tissue techniques, ultrasound and taping. Exercises can be set to regain flexibility and strength of the muscle and prepare your body to return to sport.
Chronic muscle strain
This is a strain of one of the calf muscles which usually happens over time.
Physiotherapy can help with advice, soft tissue techniques, ultrasound and taping. They can also assess your walking/running biomechanics and correct any issues that may be contributing to the problem. Exercises can be set to regain flexibility and strength of the muscle.
Accessory soleus muscle problems
This is a very small muscle in the calf which rarely gives problems. There can be a small swelling on the middle part of the lower calf and near the Achilles tendon. If the accessory muscle is a possible source of symptoms then normally a medical referral is required.
Artheroschlerotic disease
Calf pain as a result of problems with the arteries usually happens later on in life and there is normally a history of cardiovascular disease. Symptoms include pain in the thigh and calf with exercise. A medical referral is required if suspected.
Compartment syndromes
A compartment contains a group of muscles and the blood vessels and nerves that supply them. There are 2 compartments in the back of the lower leg. The superficial one which contains the gastrocnemius and soleus muscles and the deep one which contains the main toe flexor muscles and tibialis posterior that turns the foot inwards. Normally pain is felt with activity and relieved by rest. The pain is related to a build up of pressure within the compartment that can damage muscles and nerves and reduce blood flow.
Physiotherapy can help with soft tissue therapy and correcting any biomechanical problems in walking or running. If this is not successful then medical referral is required.
Deep Vein Thrombosis
This can occur occasionally following calf injury or surgery due to a lack of movement therefore not using the pump effect of muscles and the effect of swelling may lead to problems with blood flow. Symptoms include constant calf pain, tenderness, swelling and possible redness and heat. Immediate medical evaluation is required.
Referral of pain from other areas of the body
It always needs to be considered that pain can be referred from another part of the body. In this case the possible areas that can refer include the lower back, knee joint, tibiofibular joint or other trigger points in other muscles.
Stress fractures
The majority of stress fractures occur to the back middle tibia (main lower leg bone) and a smaller number to the front edge of the tibia. Typical symptoms include pain that starts gradually and is aggravated by exercise which can be pinpointed when touching the bone. The pain may even occur with walking, at rest and even at night usually lasting up to a few months.
Stress fractures of the fibula (small bone on outside of lower leg) are rare and tend to happen secondary to muscle pulls on the bone.
Physiotherapy can help by determining which factors are contributing to the problem and advice on exercise that can be done without causing pain and making the problem worse. They will refer you to a medical specialist to confirm the diagnosis and monitor the healing process of the fracture.
Chronic Pain
Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.
Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top London pain consultants who can help you.
Other possible causes
Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:
- cardiovascular symptoms
- respiratory (breathing) symptoms
- gynaecological symptoms
- urinary or genital symptoms
- digestive symptoms
- immune system symptoms
- lymph system symptoms
- hormonal symptoms
- neurological symptoms
- dermatological (skin) symptoms
- medication side-effects
- virus
- infection
- cancer
- disease process
- psychological problem ie. depression, anxiety
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