Sports Medicine
Sports Injury Prevention & Rehabilitation

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Calf Cramps

What is a calf cramp?
A calf cramp is an involuntary and painful contraction of the calf muscle that can occur suddenly and may prevent the individual from continuing activity. Research suggests the mechanism of cramps is related to disturbances within the nerves and muscles.
The muscle group at the back of the lower leg is commonly called the calf. The calf comprises of two major muscles one of which originates from above the knee joint (gastrocnemius) the other of which originates from below the knee joint (soleus). Both of these muscles insert into the heel bone via the Achilles tendon.
The calf muscle is one of the most commonly affected by cramp. This typically affects the gastrocnemius muscle although occasionally the soleus may also be involved.

Causes of a calf cramp
There are a number of factors which may in isolation or combination predispose patients to developing a calf cramp. These factors should be assessed and corrected with direction from a physical therapist, podiatrist, nutritionist and/or doctor. Some of these factors may include:
  • Dehydration
  • Low salt levels (potassium and sodium)
  • Inadequate carbohydrate intake
  • Excessive muscle tightness
  • Neural tightness
  • Muscle weakness
  • Muscle or neural fatigue
  • Excessive training or activity (particularly running or running sports)
  • A lack of fitness or conditioning
  • Joint stiffness (particularly of the ankle, heel or foot)
  • Poor biomechanics of the foot (such as flat feet)
  • Inappropriate footwear, equipment or training surfaces
  • Certain medications
  • Poor recovery strategies between training sessions or matches
  • A lack of sleep

Signs and symptoms of a calf cramp

Patients with a calf cramp usually experience a sudden, intense involuntary contraction or tightening of the calf muscle. This is usually associated with significant pain and a pulling sensation in the calf that may be temporarily disabling. Calf cramps can often spontaneously resolve as quickly as they have developed, particularly if appropriate stretching is applied to the calf muscle.

Diagnosis of a calf cramp
A thorough subjective and objective examination from a therapist or athletic trainer is usually sufficient to diagnose a calf cramp and exclude other conditions. Occasionally further investigation such as an ultrasound may be required to rule out other injuries.

Treatment for a calf cramp
Immediate treatment for a calf cramp should comprise of gentle stretching of the affected muscle, careful walking and soft tissue massage. Heat treatment may also be of benefit and should be applied to the affected area at a comfortable warmth.
It is also important that the factors that are likely to have contributed to the development of the condition are identified and addressed to help prevent future recurrence. This may include maintaining adequate levels of hydration and ensuring your dietary intake of sodium, potassium and carbohydrate is adequate. Drinks which have a diuretic effect need to be avoided (such as tea, coffee, caffeinated soft drinks, energy drinks and alcoholic beverages). You should also ensure that you are performing regular calf stretches to maintain optimal flexibility. In individuals who are experiencing cramps due to excessive training or activity, modifications may be necessary to reduce the likelihood of recurrence. Patients also need to ensure that they are getting enough rest and are fully recovered between training sessions and matches – this includes adequate amounts of sleep.
Implementation of a strength and conditioning program to improve muscle function along with ensuring footwear, equipment and training surfaces are appropriate are also important factors which may need addressing.
In patients who are unresponsive to treatment, a review with a doctor may be indicated for advice regarding any medications which you may be taking that could be contributing to the development of cramps, appropriate blood tests and/or the prescription of medication to prevent the onset of cramps.

Physical therapy for a calf cramp
Physical therapy for patients who suffer from calf cramps can help to identify and correct certain factors which have contributed to the development of the condition and therefore minimise the likelihood of recurrence. Treatment may comprise:
  • soft tissue massage
  • stretches
  • joint mobilization
  • heat treatment
  • electrotherapy (e.g. ultrasound)
  • exercises to improve strength, flexibility, fitness or balance
  • education
  • activity modification advice
  • biomechanical correction
  • footwear advice
  • a gradual return to activity program