Myofascial pain syndrome in both calves

Hi everyone,

I’m looking for some ideas here as I’ve been struggling with myofascial pain in both my calf for the last 5 months. Back in January I seem to suffer mild-moderate strain in both calves by most likely upping the intensity and volume to fast on the bike trainer and ever since it has been quite the roller coaster. Right away I’ve started physiotherapy and with combination of dry needling, myofascial release massage and home stretching I slowly started feeling better and started training again very slowly. After about a month of starting training again I’ve experienced a setback and pain came back, forcing me off the bike and starting close to square one. After a few weeks of the pain going up and down (and no physio visit at that time with the covid), I finally started feeling a little better, still with dull ache and a mix of sharp pain when riding. Bottom line is that after all that time my progress seem to have plateau and depending on how hard a ride I’ll either feel more or less pain, still always feeling dull ache in both calves. My GP doesn’t seem to think it’s anything vascular either and not a strain and/or tear (being that pain is in both calves). So my physio have tried a lot of different things already and I don’t seem to be responding positively to any treatment at this point (dry needling, deep tissue massage, suction cup, electrical stimulation). I wonder if anyone in here as experience something similar and how they have been able to either healed completely or at the very least manage their pain. I’m pretty depressed not being able to ride pain free and I’m not really able to train at all.

Thanks for your help!

Your post makes me think of bike fit - specifically cleat placement. The further back the cleat, the less the calf is engaged. Supposedly the calves don’t even contribute much to propulsion. They do more foot/ankle stabilizing.

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Thanks for you reply. I did already adjust my cleat backward and it seemed to help alleviate some of the pain I was initially feeling. I also thought it would be a fit related issue (I had a professional bike fit done 1.5 year ago on the same bike by a physiotherapist) but I also feel the pain simply walking so its not only bike related…This what is the most frustrating.

I would highly suggest you get a bike fitter.
Not saying the the physical therapist would not do a good job, but I would say my dad (he is a PT) would do a terrible job at fitting me on the bike. He might have the best intentions, but there are more to it that they probably dont know.

Also, you fit tend to change over time with fitness gains. Maybe is time to get refitted.

I’m sorry I don’t have any more solutions for you.

Did your bike fit include Z-axis (cleats, wedging, correcting alignment of knee tracking)? To me that would be pro level. If your fitter wasn’t at that level I’d look for a real guru who could look at it from that point of view.

One thing that has been helpful for me personally has been using good insoles with a stiff arch over the insoles that come in bike shoes. Another thing has been strength training. I had developed muscle imbalances and cycling was exasperating them. Just a little general strength conditioning went a long way to alleviating all my little aches and pains.

Based on the post that the pain has not responded to conservative treatment for myofascial pain syndrome, other less common etiologies need to be considered. I would recommend that you see a vascular surgeon, who specializes in Doppler studies, compartment pressure readings, to rule out DVT{blood clot}, Compartment syndrome. Your GP is correct, that these entities are usually bilateral, but rare things can occur in medicine. Since these studies are easy to do in a good vascular lab, better to be cautious, particularly since you have failed conservative treatment. I hope this advice is helpful, and I would discuss with your Doctor.

Thanks for your input. I do have an ultrasound scheduled for next week to at the very least rule out obvious things. My GP doesn’t expect we’ll see anything but since they are cheap test to run its a start. When you start getting into seeing more specialized doctor that needs to run more expensive test, that’s when our public healthcare system stops to a crawl since I’m way down the list priority wise…my fear is that I’m heading towards chronic pain that is something you manage not heal. Fingers crossed!

I do not believe Doppler studies, or compartment pressures are expensive.
My experience with the health care system, unfortunately sometimes you have to be aggressive to get what you need. Specialists are required to figure out problems, beyond the expertise of your primary. I do hope you get to see a vascular surgeon. Good Luck

I agree that you have to push them quite a bit in order for them to get you properly tested, especially if it’s not life threatening or you are still functional. What really is problematic is the lack of specialist where I live. I also hope I’m able to see a vascular specialist because after reading quite a lot I might have PAES or something of that nature. Thanks!

Hi,

Sorry to hear that you are having these pains that is taking away the joy of cycling.

Some really good suggestions thus far in the thread.
The bike fit should be revisited when you get the results of your Ultrasound (that in itself is a very prudent thing to do).
However, can I ask, were you given any strength exercises by your physiotherapist?
If so, was it just calf raises or were there any other exercises prescribed.

I have been suffering with calf cramps when the intensity ramps up. Have been ever since I started cycling seriously.
Many PT’s later and the problem (for me) is more than just the calves.
Thankfully, things have improved greatly with the right exercises, so it may be an option for you to get a second opinion from another physio. Once you hear back from the Doctor of course.

Let me know if you want more details about the exercises and who I went to see, happy to share.
Also, it was all via Skype so no Covid concerns there :wink:

Best of luck with finding a solution.

I’ve been mostly been given eccentric calf raise (focusing on slowly lowering the heel down once up) and fairly standard calf stretches. I’ve been given multiple things to be honest but these are the 2 things that have stuck. I really don’t feel like it helps which is disconcerting…I did have see 2 different physiotherapist (from the same clinic) within the last 5 months and wasted time seeing a sport medicine doctor which basically said he couldn’t help me since on the surface he couldn’t figure out what is wrong, which is odd (took as he didn’t want to deal with a more complex case).

We did briefly investigate pain I sometimes get in my lower back as a possible source of my problem but we didn’t pursue that avenue long enough perhaps.

Like I said previously I maybe have something that is vascular although the pain never goes completely away after exercise and I feel a weird mix of dull pain, slightly sharper pain and burning sensation even. All this in both leg, although it’s worst in the right calf. Location of the pain is also quite diffuse so no precise location.

I would gladly take the name of the physiotherapist and the exercise that you tried out that helped you out. At least it could be soemething new to discuss with my PT.

Thanks I really appreciate you taking the time!

Thanks

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Just DM’d you there. Don’t be shy if you want to know more or have questions :+1:

This is something I have wondered about as well…

When I bought my new cross bike, I got a proper fit for it. Since then, I’ve gotten much stronger (~50 watt ftp increase…), and have been building up a new road bike, than happens to have a zero setback seatpost. This would result in a fairly significant shift forward on the bike if I kept the trek seatmast I have.

Kind of wondering if I should just roll with it, replace the seatmast, get another fit, or all 3 lol.

I just saw your post and wanted to respond with my experience which seems very similar to yours. I went through over two years of frustration before finally being able to ride again. I thought I would share what worked and what didn’t for me. I’m in my 50’s so I don’t heal as quick as I once did.

I have a history of calf strains from running that always healed with relative rest and PT. However in May 2016 I strained my calf on the bike. It came after a particularly hard training week. I should have been taking an easy ride but decided to try to set a PR on a particular hill. Halfway up I felt the pain. Stupid training error on my part.

With prior strains I was able to cycle and even use riding as PT - but not this time. Riding aggravated the injury. I had a thorough bike fit done that made only very minor adjustments - fitter saw nothing that would cause injury. After a couple of months of pain I visited my Sports Medicine Dr. who diagnosed calf strain and sent me to PT. In the end I visited 4 different Sports Medicine Drs., 3 different PTs, had numerous xrays, ultrasounds and MRIs. MRIs showed two tears - one to the tendon/ gastroc muscle juncture and another to the Soleus. All the PTs had me doing strength training (concentric and eccentric) and stretching which did nothing but aggravate the injuries. We tried dry needling and numerous other therapies. I tried to ride through the injury with easier riding to maintain fitness but any ride - even short easy rides - resulted in pain the next day and the injury was not getting better.

After a year of failed treatments I finally gave up and tried my own approach. I knew riding, strength training and stretching all made it worse. So i rested. Completely. For over a year. Bikes gathered dust in the garage. I stopped riding in June 2017. In Sept 2018 I got back on the bike. Very easy riding on flat ground (and eventually easy TR rides). NO strength training or stretching. After a while I started gently stretching but ONLY immediately after a ride when the muscle was warm. NEVER when muscle was cold. After a few months I was able to stretch aggressively. But I learned to never stretch when cold or I would re-tear the injury.

I slowly progressed (with the help of TR structured training this time). By May 2019 (9 months) I was back to a reasonable fitness level. Now in June 2020 I am basically back to where I was pre-injury 4 years ago. I am able to do some gentle strength training but I still take it easy on that. The calf muscle had visibly atrophied and is now back same size as healthy calf.

Here is what worked for me:

  1. Rest. Totally off the bike for a while
  2. Massage and foam roll to increase blood flow and keep muscle flexibility.
  3. Careful stretching. Gently and only when muscle is fully warm
  4. Avoid strength training for a while - particularly eccentric exercises which put more stress on the muscle.
  5. Changed to Speedplay pedals with the mid-foot adapter to push cleat back.
  6. Slowly re-introduce riding and build up over several months.
  7. Stretch after EVERY ride to maintain flexibility.

Happy to help any way I can. It was a long unhappy two years for me that I wouldn’t want anyone to go through.

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I’m afraid that is what might be in store for me, taking a whole year off (still in the denial stage at the moment…not easy when you’re an hyperactive person like myself). I’ve spent so much time over the last few months stretching, foam rolling and doing strengthening work with no real improvement that simply giving up feels like a real option at this point.

Thanks for sharing your experience!

I forgot to ask, do you think your pain stemmed from you 2 tears that were discovered on the MRI or perhaps it was something else? Can you describe what type of pain you felt? Did your pain eventually subside during that whole year or it actually went away after a few weeks but wanted to be very careful? Did you ask after your recovery the opinion of your doctor and what you might have had?

As a reference, my pain is quite diffuse, meaning during the day it will move around the whole leg, sometimes being almost behind the knee, something to the side and sometimes almost in the Achilles tendon. The intensity will also vary and be felt in either one leg (switching side as well) or the 2?

Also, when I’m on the bike the pain will be more localized and will be focusing in on the upper external portion of the calf, especially on one side. Pain will be almost non-existent at first and slowly build up depending on my intensity or on how much I’ve ridden prior to that ride. Longer the ride and the intensity, the more uncomfortable it feels but I do not feel any weakness and I can jump up on the pedals, sprinting out of the saddle with almost zero pain. I also find that simply cruising along at minimal wattage feels almost as bad as when I’m actually pushing close to threshold power (which seems pretty contradictory).

I will feel almost no pain right after I stop but then after a few minutes I will feel some minor muscle twitch and the pain will gradually come back to this weird pressure feeling, dull ache. Thing is, the very precise location of the pain I feel on the bike will switch to more diffuse pain. This will be worst within the next few hours and then go back to the aforementioned dull ache, with no real improvement even 2-3 days after the ride.

Thanks for you input, I might just be in a similar situation as you.

Sorry to hear you are suffering all this pain. Very frustrating,
Have you had your back checked. ? It sounds a bit like referred pain ,from what you describe.
I agree ,to try long term rest . Also you have eliminated several things, and know the treatments youve had are not helping. If it is not a vascular problem, could you get a MRI ,or appropriate scan done on your lower back and pelvis? Hope you can get a diagnosis, and successful treatment. Dont give up , because there is an answer out there. Keep us posted how you get on

I have been reading all the posts regarding your calf pain. I think seeing a vascular surgeon would be a good decision. Doing physiotherapy without trying to establish the etiology often can worsen the problem. MRI are extremely sensitive, and have to be correlated by skilled MD, with the clinical presentation. Particularly spine MRI if not correlated properly with the clinical presentation, objective findings, can lead to incorrect diagnosis, and the wrong treatment. Good Luck, and keep us posted. Hope you get better.

Thank you all for your insight. I’ll keep you posted. Hopefully the journey won’t be too long.

You might consider some ELDOA Myofascial stretching techniques. These techniques were developed by an osteopath. Google it or check out youtube for some examples.