22 Oct Calf pain when running? Treating Biomechanical Overload Syndrome (BOS)
The posterior compartment of the lower leg (‘the calf’) is made up of muscles which help to move and stabilise the foot. Running increases the load placed on the posterior compartment and different styles of running (forefoot, midfoot, hindfoot) can have a large effect on the loading of these muscles. Excessive loading can lead to calf pain and injury.
What causes BOS?
Biomechanical overload syndrome (BOS) is caused by fatigue related muscle failure when a muscle (or group of muscles) is overloaded, and it can be used to define exertional compartment calf pain in runners. Issues with running technique and altered lower limb biomechanics can cause rapid overload of the muscles in the posterior compartment, mix this with other factors such as footwear or increased training loads and BOS may result.
What are the symptoms/who is at risk?
BOS presents as an ache or tightness in the calf when running, symptoms stop once running has been ceased and pain usually increases over a period of time. Deconditioned, recreational athletes aged 40-60 have the highest risk of developing BOS. People who run on the balls of their feet, have recently changed their training loads, have calf weakness or don’t have enough rest after activity are also at a higher risk of developing BOS and experiencing calf pain.
How do you know if you have BOS?
BOS is often diagnosed using a combination calf strength testing, running biomechanics, hip stability and information regarding training loads. Test yourself by seeing how many single leg calf raises you can perform off the edge of a step; if your affected side is weaker or you are unable to perform at least 25 due to calf pain or fatigue, then you may be suffering from BOS.If you are concerned by your results and need a professional opinion you can book a free assessment including running or coputerised footscan via our online booking system.
How can it be managed?
- Ensuring you are running in good quality footwear that will provide your foot with increased stability. Our clinics refer local clients to the team at Pure Performance for all their running shoes.
- Increase your rest periods between runs to reduce fatigue
- Reduce your training load initially, slowly increasing your distances as your body adapts to the demands of your training
- Mix up your training- replace a run with a swim or a ride, this will place less load on your posterior compartment, without having to stop training altogether .
What treatment is available?
If these tips don’t help settle down your pain then you may need a more specific program based around your daily activities and pain levels. Physiotherapists can also use a variety of treatments:
- Dry needling– Assists in unloading muscles, stimulating blood flow and reducing pain
- Massage– Assists in loosening tight muscles
- Taping- Can help to reduce loads through the calf when running and provide some support
- Progressive strengthening program for your posterior compartment
- Running and gait retraining to reduce demands on posterior compartment when running
- Custom orthotics may also be necessary to correct foot posture.
How is it different to a calf tear or strain?
A calf tear or strain involves a sudden onset of calf pain, which is usually caused by a rapid push-off movement. Symptoms are not only present when running, and can be present with daily activities. Pain with a calf tear will be present immediately when attempting to run, whereas calf pain will usually increase gradually with BOS.
Want to find out more and get some help?
Speak to one of our Physiotherapists who can tailor a program involving load management, progressive forearm strengthening exercises and mobilisations to reduce your calf pain.
Call 4952 7033 to make an appointment, or click here to book online in 2 minutes.