Can tight calves after running cause referred pain?

Tight calves can affect anyone from the seasoned runner to the athlete starting their couch to 5km. But can tight calf muscles cause pain in other parts of the body? Yes, they can.

To understand more about how tight calf muscles can impact on the body we need to look at muscle chains.

What are the Muscle chains of the body?

Muscle chains (also known as muscle slings or myofascial chains) are groups of muscles linked by connective tissue that runs throughout the body. These muscle chains are what help the body to move as a unit.

There are approximately 640 skeletal muscles in the human body (320 pairs). However, there is also a growing belief that we have 640 fascial connections and 4 muscle chains;

1. Posterior (the back)
2. Anterior (the front)
3. Lateral
4. Spiral*

Posterior chain muscles

Posterior chain muscles are the main engine for running. The muscles on the front are for show, and the muscles at the back make you go. Examples of the muscles that make up your posterior chain muscles are;

• plantar muscles (sole of the foot)
• calf muscles (connected through the Achilles tendon)
• the hamstrings,
• the gluteus maximus,
• erector spinae muscle group (lower back)
• trapezius (mid-upper back)
• posterior deltoids (shoulders)

When you start to think about muscles working in chains you can start to see how having a tight calf can cause pain through the hamstrings and into the lower back.

Can tight calves cause foot pain?

A tight calf, mainly the gastrocnemius muscle, can cause foot pain. A tight calf can reduce the range of movement you have in your ankle and cause an overloading of the forefoot if you are unable to get your foot completely and comfortably flat on the ground. If you are a long-distance runner or used to walking then the additional forces through the balls of your feet can cause irritation and inflammation to the big toe joint or other smaller joints in the foot. This can also lead to other injuries such as nerve entrapment and bursitis.

Can tight calves cause heel pain?

Tight calf muscles can also produce pain in the heel. The two primary conditions are Achilles tendonitis and plantar fasciitis, although you may experience both at the same time.

Achilles tendonitis

Your Achilles tendon is directly attached to your calf muscles and joints to the back of the heel. So, it makes sense that this will be one of the first areas to become irritated if you have tight calves. These tendons are designed to transfer the power in your calf muscle down to the foot when you are running and walking. Tendonitis is caused by inflammation around the tendon due to tiny tears. It can start as a dull ache after running, but if not treated, can develop into a sharp pain whilst running and at rest.

Plantar fasciitis.

Tight calf muscles can cause plantar fasciitis.  The plantar fascia is found on the sole of the foot and it is a tight band or layer of connective tissue. It overlaps and joins with the Achilles as part of the posterior chain and any tension applied on the Achilles tendon from a tight calf will transfer onto the plantar fascia.

Plantar fasciitis is caused by the tissue becoming stressed and inflamed. It can start as a dull ache after running, but can quickly develop into a sharp pain in the sole of the foot whilst running and at rest. The signature sign of plantar fasciitis.

Can tight calves cause knee pain?

Your calf muscles attach at the back of the knee at the same point as the hamstrings. Knee pain from tight calves can be caused by;

Calf tendon.

A tight Calf muscle can cause tendon strain at the back of the knee. Irritation and inflammation to the tendon can cause pain in the knee. Additionally, tight calves will limit how far you can bend your knee causing weakness and problems in the hamstrings.

Patella femoral pain (pain around or behind the knee cap).

Through the posterior chain, tight calves will also be linked to tight or weak hamstring muscles. Any tightness at the back of the knee will but an increasing strain on the knee joint between the two leg bones and the knee cap (patella-femoral joint). This can cause a painful irritation of the joint.

Joint Loading.

This can happen if your tight calf muscle is causing you to limp or change your gait in any way. When you carry an injury the body will naturally avoid movements that cause pain or risk further injury but when it does this other joints, such as the knees and hips, experience an increased level of load and stress. Over time this loading can cause pain and swelling in the joint and surrounding muscles.

Can tight calves cause back pain?

Not directly as the calf muscle does not attach to the lower back, but it can generate low back pain from any compensatory movements. In most cases, runners will experience pain on the contralateral side – tight calf on the right leg and pain in the left side lower back.

Another reason for your tight calf may be linked to having weak or underactive glutes, a very common issue amongst amateur runners or people returning from a period off. What happens is that instead of using the big glute muscles to generate power the body uses the small hip flexors and the calves to generate the power. This means that the glute weakness will be the primary contributing factor that is causing both your tight calf and back pain.

Products to help manage tight calves.

*The spiral slings have also been sub-categorised into 50 groups by Dr Richard Smisek, who research founded spiral stabilisation and muscle chains.