Calf pain and calf muscle tightness,
on exercise, relieved by rest

Intermittent claudication is calf pain as above, mostly due to ischaemia (inadequate blood supply) of the muscles from blocked arteries and extra work load.

This often appears suddenly and then gradually diminishes over a few months, as collateral arteries develop to bypass a blockage.

If you have been a smoker, now is the time to give it up.

When I first entered family medical practice, I more or less served an apprenticeship under Dr. Alister Hinchley. He was a wonderful old doctor and a very good diagnostician.

He diagnosed his own myasthenia gravis after a neurologist had missed recognizing it. He was forever picking up my mistakes. When he was on holidays, I missed him.

He was a chain smoker, and when he got a duodenal ulcer, he knew he should stop, but didn't. When the drug cimetidine first became available, he responded very well to it, and continued smoking!

Later, he developed calf pain and knew it was due to blocked arteries. He told me he didn't stop smoking immediately, but made an appointment with a vascular surgeon, knowing full well what that gentleman would say.

He went cold turkey and never smoked again.
The prospect of an amputation was what it took for him.
How do you feel about your smoking?
More below.

Neurogenic intermittent claudication from spinal stenosis

This condition has similar calf pain symptoms to the above.

The passage down the center of our spine where the brain (spinal cord) and nerves sit, can be narrowed enough to squeeze the neural structures badly.

A person with this problem will usually have bad back pain as well, from the disease causing the spinal canal narrowing.

Abnormalities of the disk usually do not cause symptoms of central stenosis in a normal-sized canal. In developmentally small canals, however, a prominent bulge or small herniation can cause symptomatic central stenosis.

Here pain is worse standing upright and walking downhill. It gets better lying face up rather than face down, sitting, squatting and bending forwards - not by just standing still.
Absence of pain when seated and improvement of symptoms when bending forward are the most useful individual findings⁷.

Climbing stairs, pushing something and cycling cause less calf pain as one is bent forwards (flexed.)

Lumbar spinal canal cross-sectional area increases with spinal flexion and decreases with extension (bent back.) Furthermore, cross-sectional area is reduced 9% with extension in the normal spine and 67% with severe stenosis.

The distinction of vascular versus neurogenic exercise induced calf pain, is essential as they have very different treatments.

Magnetic resonance imaging (MRI) is best to confirm spinal stenosis, but only when the clinical picture is definite.
It often shows abnormalities in people without symptoms, so cannot be used on its own to diagnose the problem.

Angiography is x-rays for blockages of the arteries, outlined by injected contrast medium. This is undertaken if doppler ultrasound suggests the likelhood of the need for surgery or angioplasty.

In ultrasound examinations, the sound is bounced off the column of blood flowing down the artery. The doppler effect allows calculation of the speed at which the blood is flowing. Arterial narrowing speeds up the blood through the narrowed segment. The amount of narrowing can be roughly calculated from the speed.

Treatment of intermittent claudication.

Your peripheral vascular disease has to be causing a fair bit of calf pain, to warrant invasive procedures such as angioplasty or surgery.

Angioplasty is stretching the artery, if the narrowed segment is short. A stendt is sometimes inserted to keep it open.

Your doctor will want to know how far you can walk on level ground, before it stops you.

Test yourself out and measure the distance accurately. Record the distance and time, so you can track your progress later.

Walking in boots with higher heels than ordinary walking shoes, will reduce the pain by reducing the calf muscle work.

Walking is very good treatment⁸, as it encourages the growth of collateral arteries to bridge around any blockages.

Walk 4-5 days a week, for 30-45 minutes, repeatedly pushing oneself just past the point when discomfort starts, then waiting until it subsides before resuming the walk. In 12 to 16 week trials this doubled the distance people could walk.

Other proven natural treatments include Ginkgo. In one study it gave a 20% greater increase in pain free walking distance than the placebo.
240mg per day has been found beneficial.

Propionyl-L-carnitine, 1 to 2 g/day has also been shown¹ better than placebo.

Natural vitamin E 500iu per day- synthetic has some of wrong shaped molecules, not absorbed even, let alone used by our body.

Any time large doses of vitamin E are taken, extra selenium and extra vitamin C are advisable. These both work with the vitamin E.

Magnesium is often mentioned. I could find only one study², from 1985 and probably in German. This is a common deficiency, and toxicity from a therapeutic trial is extremely unlikely.

When I suspect magnesium deficiency, I always test for zinc deficiency, which commonly leads to poor assimilation of magnesium because gastric acid is low.

For other symptoms of this see the magnesium deficiency page of this website.

Frequent calf pain from any cause will often be associated with residual tender spots in the calf muscles. If you can find tenderness on digging into the muscles, they need stretching.

For calf stretching technique, see heel pain page of this site.

You can stretch your calf anytime you are doing anything standing, just by placing that foot flat on the floor, far enough behind you (and keeping that knee straight.)

Calf pain from "doing a monkey muscle" or getting "tennis leg"

You're playing tennis, or maybe just walking along minding your own business, then wham, you're hit in the calf by a rock (or a tennis ball.)

At least that's what it feels like.

It's a muscle tear without the rock - it just tore. It isn't actually the monkey (plantaris) muscle but your gastrocnemius.

The foot is a second order lever system³, but the calf muscle is pulling on a pretty short lever arm, so it has to work hard, accelerating our entire body weight.

Here maybe there was some incoordination or perhaps a weak area from faulty maintenance.

First aid is to lay down and put the limb up in the air immediately, for about 10 minutes.

Treatment is to anaesthetize the muscle area concerned, by injecting 0.5% lidnocaine or similar; immediately make a 3-4cm heel raise; and walk.

Exercise the muscle with repeated contractions, non weight bearing and with your foot bent down and knee fully bent.

Massage the area daily.

Reduce the height of the heel raise as quickly as pain allows.

As with all muscle injuries, rest and over exertion are both harmful.

              From calf pain page to sciatica page

             From the calf around to your shin page

        From calf pain page to general lower limb page

A couple of ways to leave cigaretes behind

Easy Way to Stop Smoking (Penguin health care & fitness) Allen Carr

This is a workbook, for your process of changing your mind.

The other way is using creative visualization.

First, why bother - it's a lot of effort so you need reasons.

Future health, other budget priorities, aesthetics - why?

This is setting goals, to give you something valuable to focus on.

It might be getting fit enough to go mountain climbing, remaining in good health to enjoy grandchildren growing up, obtaining something you've had your heart set on.

Whatever your reasons, now make a mental picture of them achieved. If you wish, make a physical picture.

Having a clear picture in your head of your perfect end result, you now need to set up a way or ways of reminding yourself of it regularly.

When I learned this method at an alpha meditation course years ago, there were no pills, chewing gum or patches. They specifically advised against fighting the habit - no setting a date and going cold turkey.

The advice was to have a cigarette if one wanted it, and not to have a guilt trip over it. However, every time one lit one up, they advised to turn one's eyes up and imagine seeing one's picture.

These days with the supposed aids to stopping, people are usually setting a date and stopping, so I advise people to chose such things as going through a particular doorway, turning the ignition key, using a particular tap etc - anything, to remind them to visualize it several times a day.

Your brain will gradually get the message from your visualization, and understand "this is how it is." Your behavior will then follow so as to make it so.

Middle of the night calf pain - cramps

Jumping out of bed and hobbling around moaning at times?

It hurts more momentarily, but stretching the cramped muscle is the quickest way to end this calf pain.

Calf stretching can also help prevent more cramping calf pain too.

The message that salt is bad for you, seems to have gained wide acceptance. It's ironical that incorrect "health" messages may be accepted before really valid and important ones.

Salt is not bad for you, unless you have heaps of it, as in a diet consisting mainly of convenience and prepackaged foods. A small proportion of people with longstanding hypertension, respond to salt reduction. Other people on a home cooked diet of unprocessed foods, can have salt ad lib.

I see more people these days, with symptoms due to lack of salt than too much.

The term "stokers cramps" derived from the experience of the men who shoveled the coal into the boilers of the old steam ships. They would be continually bathed in perspiration from the heat, losing a lot of salt in the process.

Magnesium deficiency is probably a more common cause, however.

The Scheussler biochemic salts used are Mag. Phos. and Calc. Phos., and Silica if they don't help. These remedies have relatively small amounts of the minerals, but are prepared as homeopathics, by serial dilution and succussion⁴.

They work through the electrical energy of the salt, rather than correcting a deficiency.

Magnesium deficiency correction needs much bigger doses⁵.

I'm told that heating your calf can help it recover, with a heat bag or with a hair dryer.

Quinine is obviously effective, so I have patients with limited means who will pay for it gladly.

It can be used intermittently, for a few days at a time, when calf pain from cramps dictates.

Its use for this purpose has just been reviewed⁶. The authors hunted through nearly 60 years of published papers, and found only two good quality studies which supported it's use. It hasn't attracted much interest from researchers, apparently.

The 2006 FDA statement on this treatment, cautioning consumers about quinine, noted 663 reports of adverse events and 93 deaths attributed to quinine since 1969.

To my mind that makes it a pretty safe drug, as drugs go.

Need help or have a helpful tip to share, or an experience others can learn from?

You can have your own page on this site, be anonymous if you prefer, and help other people or get useful opinions.

It's very quick and easy

References for calf pain

1. Brevetti G, Perna S, Sabbá C, Martone VD, Condorelli M.J
Am Coll Cardiol. 1995 Nov 15;26(6):1411-6

2. Neglen P, Overfordt P, Eklof B
Peroral magnesium hydroxide therapy and intermittent claudication
VASA. Zeitschrift für Gefässkrankheiten. (Journal for vascular diseases) 1985;14(3):285-8.

3. The second order lever system here, has the ball of our foot as the fulcrum, the load at he ankle and the effort applied at our heel - exactly the same arrangement as in a wheelbarrow.

4. Homeopathic medicines are manufactured by grinding, shaking or thumping the diluted substance, then diluting it further and repeating the process.

Some form of energy signature is transferred to the diluting medium by this process. It has magnetic properties, because strong magnetic fields destroy homeopathics, as do volatile oils.

5. My naturopath mentor found magnesium ascorbate the best absorbed form. He made in the spot, by sprinkling ascorbic acid powder into magnesium bicarbonate (fluid magnesia.)

If using a magnesium chelate tablet, 1gm three times a day is a good starting dose (after getting your doctor's ok.)

6. Neurology. 2010;74:691-696

7. Pradeep Suri et al Does This Older Adult With Lower Extremity Pain Have the Clinical Syndrome of Lumbar Spinal Stenosis? JAMA. 2010;304(23):2628-2636


"There is a considerable body of evidence, including 37 identified randomized trials and 7 systematic reviews or meta-analyses, demonstrating the efficacy of supervised exercise to improve symptoms of claudication ..."

Circulation. 2012; 125: 1449-1472


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