The Relationship Between Age and Calf Injuries

We examine the research on why older runners are at a higher risk of calf injuries and steps they can take to prevent them from occurringIn our article about Common Running Injuries in Men, we found that particular injuries that are common among male runners—knee osteoarthritis, meniscus tears and calf strains—are also conspicuously more frequent as runners get older.

Calf strains (or tears) in particular are a very common problem among masters athletes, so today we’ll be looking into why this injury occurs more often as you get older.

Did you check out our latest podcast with Masters World Record Holder Kathy Martin? Kathy is a great example of getting stronger (and faster) as you get older!

Examining calf injuries and age

Calf injuries appear to be unique among muscular sports injuries in that they appear more frequently as you get older.

A study of professional soccer players by Jan Ekstrand, Martin Hägglund, and Markus Waldén at Linköping University in Sweden found:

Hamstring and adductor injuries were more common than calf injuries, the incidence of calf strain increased with age, while the risk of injury to the other muscles of the leg remained unchanged.

The calf actually consists of two muscles: the gastrocnemius and the soleus.  The gastrocnemius has two “heads” which make up the meatier upper part of the calf, while the soleus is the more slender lower part of the muscle.

Both the gastrocnemius and soleus can be strained, but the medial head of the gastrocnemius is the most common location for injuries.

Though calf injuries are a problem for runners, they also occur quite frequently in ball sports like tennis, soccer, basketball, and cricket, so many scientific studies, including the ones we’ll be looking at, involve competitors from these sports.

Research-backed theories

The first step in answering the question of why calf injuries become more common with age is understanding the mechanics at play when a calf strain occurs.

One creative study, published in 2002 by sports injury clinicians at the Australian Cricket Board, examined the exact moment of a calf strain, caught close-up by multiple TV broadcast cameras during an Australia vs. England cricket match.

  • The authors of the study noted that the calf strain— clearly visible in the video, when the athlete’s calf appears to slacken on the lateral side—occurred just as the player’s opposite foot left the ground, as the calf transitioned from an eccentric contraction to an isometric “stance phase.” 
  • The authors also cite other work which indicates that calf injury occurs not as you push off  the ground (a concentric contraction), but just as you transition from landing to supporting and beginning to drive off the ground (eccentric and isometric muscle contractions).  This is significant because it can help us predict strategies for prevention.
  • Eccentric loads are also known to be more damaging to muscles, though the body is capable of supporting significantly more weight in an eccentric contraction than a concentric one.  Knowing this, we can predict that aging would increase the risk of muscular injury, as muscular strength gradually decreases as you get older.
  • Not only that, but aging selectively weakens the “fast twitch” muscle fibers that are tailored to handle high-power contractions and rapid loading.
  • Less muscle strength overall will also lead to increased fatigue, which has been implicated in muscle strains—at least in one study at Duke University using rabbits.

Unfortunately, this still leaves open the question of why the calf in particular becomes more susceptible to injury with aging, and not the hamstrings, quads, or adductors.

I found no research that could directly explain this phenomenon.

It could simply be that the calf has less muscle mass overall when compared to the other prime movers of the lower leg, like the hamstrings and the quads.

A consistent rate of muscle fiber decline with age would therefore affect it to a greater extent than these other muscles.

On the other hand, there could be something biologically unique about the calf or its function during sport that makes it more susceptible to injury with age—either differences in the muscle itself, or differences in the relative amount of force that it must handle.

Final thoughts

Older runners, especially men, need to be aware that their calves get more vulnerable to injury as they age.
Our understanding of the injury process can also help predict some preventative measures; since we know that calf strains occur during the eccentric and isometric phases of the running gait, it is likely that calf strengthening routines that focus on these aspects will be more successful at preventing injury than simply doing traditional calf raises, a primarily concentric exercise.

Eccentric heel drops,  often used to treat Achilles tendonitis, are a highly effective eccentric strengthening exercise, while “toe walks”—walking forwards or especially backwards keeping your heels off the ground—are a good isometric exercise that even strong runners will find challenging after a few sets of 15 or 20 meters.

These are explained in our Instagram video, which you can check out HERE.
Staying healthy is an integral part to success as a masters athlete, so being aware of the causes and possible ways to prevent calf strains will help your training and racing greatly.

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References

1. Ekstrand, J.; Hägglund, M.; Waldén, M., Epidemiology of muscle injuries in professional football (soccer). American Journal of Sports Medicine 2011, 39 (6), 1226-1232.
2. Dixon, J. B., Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Current Reviews in Musculoskeletal Medicine 2009, 2 (2), 74-77.
3. Orchard, J. W.; Alcott, E.; James, T.; Farhart, P.; Portus, M.; Waugh, S., Exact moment of a gastrocnemius muscle strain captured on video. British Journal of Sports Medicine 2002, 36, 222-223.
4. Lindle, R.; Metter, E.; Lynch, N.; Fleg, J.; Fozard, J.; Tobin, J.; Roy, T.; Hurley, B., Age and gender comparisons of muscle strength in 654 women and men aged 20–93 yr. Journal of Applied Physiology 1997, 83 (5), 1581-1587.
5. Larsson, L.; Grimby, G.; Karlsson, J., Muscle strength and speed of movement in relation to age and muscle morphology. Journal of Applied Physiology 1979, 46 (3), 451-456.
6. Mair, S. D.; Seaber, A. V.; Glisson, R. R.; Garrett, W. E., The Role of Fatigue in Susceptibility to Acute Muscle Strain Injury. American Journal of Sports Medicine 1996, 24 (2), 137-143.

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25 Responses

  1. Cured!

    Here’s my story…

    I went through calf injuries on and off (more on than off) for 6 years until slowly I couldn’t run more than 3kms, and then only slowly and never 2 days in a row.

    I’m a 47 year old male runner (best marathon 2h52 back in the day..!) and it was heartbreaking to battle this for years – but I refused to give up.

    For 6 years I tried everything: physiotherapy, foam roller, “the stick”, rest, ice, shoes, orthotics, ART, shock
    therapy, Pilates, vascular tests for compartment syndrome etc. Everthing. I had MRIs of both calves – they never showed any scar tissue.

    It started with Achilles problems and maybe at the time I had been over-doing it. That developed into chronic calf tears in both legs.

    Except finally, after 6 years, I found out that it never was.

    I finally mentioned to my sports physician that my back was always stiff – never sore – just stiff. He sent me for an MRI and found a slipped disc L5/S1. My calf pain had been neural referred pain all along.

    A single epidural cortisone injection resolved the problem literally overnight and 9 months later I’m still 100% injury free and back to my best.

    1. Thanks Ralph, I think you just gave me the answer that I’ve been looking for for 2 years: I was diagnosed about 5 years ago with a prolapsed disc in L5/S1- I am a 42 year-old runner and have had almost identical calf strains for the last 2 years. Every 3 months or so I get the same calf pain that is so bad it sidelines me for 1 month, and so I make no progress … I used to post great half marathon times – now I wonder if I can last 30 mins without something going ping..and I’d never thought the 2 problems were related. Thanks again, it totally makes sense now…

      1. Glad you were able to find some answers from Ralph! Hopefully his suggestions, in combination with our post, will give you a better idea of what to do. Check out our posts and podcasts over the next few weeks. We have a lot of helpful advice coming for older runners. I am sure you will both find it very helpful!

  2. Thanks for writing what you wrote. I’m 54 and enjoy running but every so often my right calf blows out while training. I run SLOW, never race, but enjoy distances. When my calf goes out it starts as a slight twinge that feels as though I could work it out but then quickly balloons into what feels like a burning knife in there. It’s only there when I run or extend my calf. I can still ride a bike with not much pain but running is out of the questions for weeks.

    This only happens once a year or so but wow, it hurts and is heartbreaking. Any thoughts? I have had spine surgeries but I’m wondering if my calf pain is different than what you suffered. I love hearing how you recovered, congrats.
    Thanks
    s

  3. Hi Siro,
    My story is similar to yours, although I’m 47. Unfortunately I don’t have a solution to the calf problem, however I am still extremely fit, and not just for my age. The trick is to find what you can do to maintain your fitness while the calf gets better.
    I find dynamic squats (lifting off the ground off the heals, not the ball of the foot) pain free even after a week of the injury, and of course your upper body is free to work as normal. Try TRX for instance; you get as much support from the apparatus as you need to keep working hard. When I’m injured, I use it as an excuse to get creative with my workouts. Most importantly, don’t stop working!

    1. Great advice Ian. I am sure Siro will find your suggestions very helpful, and using TRX is definitely worth a try to see if it works. That is great you are able to stay in shape, and have found what works for you. You are right when you say that as long as you are creative, there really are few excuses, as you can always find a way to do what works for you based on your limitations. Thank you for your contribution Ian, very inspiring to the result of the running community!

  4. Just had this injury occur. Been a runner for years and never this kind of problem. I did try using Creatine when this happened. So not sure if this is what contributed to it happening??

    1. Could be, it would impossible for us to tell Joe. Best thing to do is just to rest up, and stay away from the creatine, even if there is just a chance they were related. Feel better!

  5. Hi , I am having problems with my calf muscles . I do experience problem with my lower back. I don’t know if they are related. This has been limiting me from running good time s in marathons .tried almost everything you can think of to rid this. I

  6. I have been carrying a soleus pain for more than 10 years. I have tried a lot of treatment nothing work.
    I have competed at a high level in track and field and would love to continue but each time I start training the pain come back, tingling, pain, soleus and middle foot bottom.
    I will try the mri the right side of my back in retrospect seem to be always stiff.
    Thanks for the share.

  7. I also have been struck by calf problems as I have gotten older. I am now 45, and have been running competitively since I was 11. Never had any problems until my 40s. With me, it strikes out of nowhere, and it always forces me to take time away from training. I have tried it all…stretching, not stretching, compression sleeves, the stick, zero drop shoes, big heel shoes, rest, ice, elevation, soft surfaces…..everything. And nothing really makes a difference. I’m open to anything…but nothing helps.

  8. 48 yr old. Run 5 miles bout 8 to 9 min pace 5 times a week. Every other month pull right calf. No warning out of nowhere. Drives me nuts. Just did it today. So frustrating. What exercises do u recommend.

    1. Hi Greg, sorry to hear about your calf pain, it could be because you are doing the wrong strengthening exercises for your calves to prevent issues like this coming up. Check out this post for more information, and follow the recommendations in the post https://runnersconnect.net/running-training-articles/how-to-strengthen-your-calves-and-achilles-to-prevent-injury/ You could also consider if your calf is cramping up during your run, in which case, you should take a read of this article, where we explains about cramping and how to prevent https://runnersconnect.net/running-nutrition-articles/bonk-fatigue-cramp/ Hope this helps! Let us know if you need any more information!

  9. I am 82 yrs old male free from diseases. I used to 1/2 hr walks each in mornig as well as in eveng to keep myself fit but since from about 6 months back my leg muscles from below the joints in both legs strain bit painfully.despite however I have reduced my walking time to 10 minutes each. while sitting however I feel no strain.Any cure?

    1. Hi Sujit, you may have just overdone it a little. It would help you to strengthen your lower legs a little more if you would like to increase back up to the 30 mins. We are very impressed that you are so committed to your exercise, and it will help you to continue to stay healthy. You could try the exercises we recommended in this post https://runnersconnect.net/running-training-articles/how-to-strengthen-your-calves-and-achilles-to-prevent-injury/ if they do not hurt you. Hope this helps!

  10. so pleased I found this article, as I had been at a loss to understand why/how I initially injured my calf muscle – and why it is now recurring, although I would like to know if anyone else has experienced a similar thing, what their advice might be?

    My story: I am 37 year old and whilst I’ve always been sporty and run a fair bit, I had never injured my calf – until about 6 months ago. I was running about 50km a week, and at the tail-end of a typical 15km run, It felt like my calf muscle snapped. I dont think it was my achilles tendon, as whilst it was very sore I was not in agony. Nonethless, I could barely walk to my car and ended up being on crutches for a week, so probably a severe tear. I was confused as to why it happened – as it was definitely not an overextension – I was well warmed up and at the tail end of my run, and going at an even pace.

    I didnt think there would any point in going to a specialist, so just RICE’d it for a couple of weeks and did not run for a month. On my first attempt it went again (bad, but not as bad as before), so I took almost three months off running to make sure it had healed properly. So I’m back running now for a couple of months, but twice now (the last time being last night!), it has happened again, but a much milder way – less pain, can walk fine. Could even run, but not very well! the previous time, I was out for a few days and it was okay after that.

    I am just really worried that this will be a recurring thing and I dont know what to do??? Would specialist help be any use? I am currently studying full-time so watch my $’s and dont want to fork out to see a specialist if I can help it. That said, I love running and am really missing letting loose on my long runs.

    Any advice from anyone who has had a similar experience would be much appreciated.

    Thanks, Al.

    1. Hi Alan, thanks for reaching out. Sorry to hear about your pain in your calf. We would recommend giving this article a read and trying the exercises we recommended to see if you can strengthen the muscles to prevent it coming back in the future. https://runnersconnect.net/running-training-articles/how-to-strengthen-your-calves-and-achilles-to-prevent-injury/ During this time, it would be best to rest your calf and focus on this strengthening program until you are pain free. Hope this helps, let us know if we can do anything else.

  11. I had the same recurring calf problems since I was 40 (now I am 53), and during the last 2 years it happened almost every 2 months, usually after 15-20 minutes of slow running. This practically made it impossible to continue … till when on holidays I had a chance to run regularly on a sandy beach. I had no problem there, so when I returned home I started running on irregular paths, expecially on thick grass, trying to change continuously the step movement (I am not english mother language so probably this is not the proper term but I hope it is understandable). Again no problem to the calves so far. I am a medical doctor and I knew about bones “stress” fracture. The calf lesion resembled to me that kind of mechanism, that is repeated apparently harmless and effortless movements that hit the same point weakening the tissue structure up to its popping…So the solution could be what I have tried on sand and grass… changing frequently the weight and direction of the step it distributes the “weight” to several groups of muscular fibers , distributing the “stress” and preventing the rupture.

    1. Hi Max, thanks for your feedback, sorry to hear about your calf problems. Glad you have been able to find a solution that works for you, thank you for sharing with our readers, you may provide another solution for them to try. We also would recommend exercises to strengthen them https://runnersconnect.net/running-training-articles/how-to-strengthen-your-calves-and-achilles-to-prevent-injury/
      Best of luck and hopefully a pain free future for you!

  12. Thanks for the info. Interesting to read similar stories as well. I’ve always been very envious of those people who can go out running every day and constantly compete without a hint of injury. I always loved training and I guess overtraining was a big issue for my fragile legs. I ruptured my left Achilles when I was running professionally in sprints about 13 years ago. The surgeon ended up taking out a piece of my monkey muscle I’d torn earlier in the year and wrapping it around the Achilles to improve strength and recovery. A year later after rehab and 100 % pain free in this Achilles I tried to get back into comp but developed tears in the right Achilles which forced my retirement from sport at the age of 25. I am yet to rid this Achilles of tendonitis, although it’s more of a hindrance than anything else, as it’s just a little pain to get through. The last 18 months I have tried converting myself into a more middle distance runner and really enjoy hill running particularly. But probably once every so months I will get a ping in the soleus area of either calf which puts me out for 2-3 weeks. Unlike tendonitis, there’s only so many sessions you can do with a tear in your calf.

    I often wonder whether the damage to my Achilles or missing monkey muscle is causing additional load on my calves and the regular failure to perform a simple jog session. Hearing people diagnosed with back problems is extremely interesting as I have also had lower back pain since teenage years.

    I’m going to try a few of your strengthening exercises and see if built up strength conditioning prior to the recommencement of running can solve some of my problems. thanks again!

  13. Hello, I have some questions about the massage timing. Background: 50 yoa, very active, no Health ins, or medical means. About seven years ago I initially pulled/strained my right calf muscle playing racquetball. I rested my calf while doing other aerobic sports IE: cycling, punching bag, etc… A few weeks later I tweaked my Achilles tendon on my left foot from what I can only imagine was an imbalance to protect my right calf. I went back and forth over the next few months from left to right, AT to AT, calf to calf. I never did much self therapy on my calves beyond icing and rest (slight stretching – eccentric lifts). A few days ago I pulled/strained my left calf, somewhat more extreme, while pushing off on my skateboard. I was about ½ mile from home and I hobbled my way there. I iced religiously that first 24 hours, elevated etc..(RICE). Now a few days later I have found through some Internet searches that I should try to massage the knot out of that muscle any chance I get. I also started walking on my treadmill today without any pain(3 miles @ 3.5mph/50 minutes). So my massage question is this: should I heat up the muscle with a pad first, should I ice the muscle first, should I massage before or after exercise… Basically, when is the best time to do it and for how long? Thanks!

  14. Well i do not even do sports. I barely do any physical exercise. I do walk to school and its quite a distance, about a 30minute walk Yeah so basically we’ve established that I’m not a sporting person. I fail to understand how i have these excruciatingly painful leg cramps on my calf. I cannot even bend my legs without feeling a little bit of pain and I’m only 17. I went to a physio therapist for a while and it subsided now its back. Is there anything you can do to help me?

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