Calf pain: What if it came from the back? (Sciatica and more)

calf pain

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

You have calf pain. Maybe she's been hanging around for a while now. You think it may be of muscular origin. But what about the back? Could the pain come from the lumbar region, or from a sciatica ?

In this article, we popularize calf pain from a holistic perspective, trying to determine if your symptoms are coming from the back (or not!). You will leave with a better understanding of your condition, as well as several possible solutions to get better.

Low back diagnoses that can cause calf pain

Believe it or not, sometimes calf pain originates from the back. How exactly?

On the one hand, the spinal nerves originate from the spine, and down into the leg to provide sensation and strength to certain key muscles. Damage to these nerves could therefore cause pain in the calf.

In addition, muscle damage sometimes causes referred pain. Thus, an attack in the lumbar region (or near the buttocks) could cause pain to radiate to the calf.

Let's take a closer look at some diagnoses of lower back injuries that can be responsible for calf pain.

Sciatica

Sciatica is a vague term that refers to a pain behind the thigh (and behind the calf in some cases). These pains are attributed to damage to the sciatic nerve.

Sciatica itself includes a panoply of differential diagnoses, most originating from the lumbar region. Because this nerve runs down to the foot, sciatica damage can cause calf pain (often associated with numbness and/or tingling in the foot).

Herniated disc

La herniated disc refers to a displacement of the gelatinous nucleus inside a disc which pushes and pierces the periphery of the intervertebral disc.

Since the spinal nerves are close to the intervertebral discs, it is possible that the hernia causes irritation of the nerves, and causes an inflammatory reaction responsible for the pain in the calf.

To know everything about herniated disc and its management, I invite you to consult the following article: Herniated Disc: Symptoms and Treatment

Degenerative disc disease

In the presence of degenerative disc disease, progressive lesions are observed in the intervertebral discs. These can be the site of micro tearing, dehydration, deformation or cracking. The most common cause of degeneration is osteoarthritis, and thus leads to progressive wear of the discs. 

As with a herniated disc, the proximity of the spinal nerves can cause nerve irritation, and indirectly pain radiated to the calf.

To know everything about degenerative disc disease and its management, I invite you to consult the following article: Degenerative Disc Disease: The Complete Guide

Spondylolisthesis

Un spondylolisthesis refers to a slip of vertebra(es). She is diagnosed by medical imaging (like an x-ray).

If a nerve or nerve root is irritated, then there are neurological symptoms such as radiation (including calf pain), along with the other typical neurological symptoms (tingling, numbness, weakness, etc.)

To know everything about spondylolisthesis and its management, I invite you to consult the following article: Spondylolisthesis: What is it, and what is the treatment?

Narrow lumbar canal

In the narrow lumbar canal, the size of the Spinal canal is seen shrinking. This channel is formed by the juxtaposition of vertebrae lumbar (L1 to L5), and contains the spinal cord and the spinal nerves.

If the nerves are irritated by this reduction in size of the lumbar canal, then neurogenic symptoms can be observed depending on the irritated nerve root. This can lead to calf pain.

To know everything about the narrow lumbar canal and its management, I invite you to consult the following article: Narrow Lumbar Canal: The Complete Guide

Sacroiliac pain 

The sacroiliac joint connects the bones of the pelvis (called the iliac) to the sacrum, a triangular bone located below the vertebrae lumbar. The main function of the sacroiliac joints is to absorb shocks, and to increase the stability of the trunk.

Lower back and buttock pain is the primary sign of sacroiliac joint dysfunction. On the other hand, it happens that the pain can radiate in the lower limb, and in particular in the calf. It is generally aggravated by prolonged static postures, walking and exertion.

To learn all about sacroiliac pain and its management, see the following article. 

4 other causes of calf pain

Certainly, calf pain sometimes comes from the lumbar region. But it also happens that other anatomical structures are responsible for your pain.

Here are 4 causes of calf pain that are not of lumbar origin:

Muscle pathology of the gastrocnemius and soleus muscle

Obviously, a traumatic event can be responsible for calf pain. We then think of elongations, tears, breakdowns, etc.

This may occur during a sports practice (jogging, contact sport, etc.), or even after a prolonged effort (long walk).

The most affected muscles are the gastrocnemius and soleus (especially the musculotendinous junction, ie between the muscle and the tendon).

If the calf tends to be the site of frequent cramps, we can think of dehydration, or even a more serious attack (kidney problems, diabetes, hypothyroidism, etc.).

Phlebitis

A phlebitis corresponds to the formation of a blood clot (thrombus) in a vein, which causes an obstruction of blood flow. It mainly affects the lower limb, and often causes calf pain.

In addition to the pain, there is a feeling of heaviness, swelling of the calf (edema), a bluish coloring of the region, and/or a feeling of heat in the calf. In more severe cases, a pulmonary embolism may develop.

Depending on the obstruction, it may be a medical emergency. Do not hesitate to consult a doctor if you ever observe the signs and symptoms mentioned above.

Piriformis syndrome

The piriformis muscle is a muscle that starts from the sacrum and attaches to the greater trochanter (the side part of the femur bone). The sciatic nerve passes just below this muscle, and can even cross it in 7 to 21% of cases.

In the piriformis syndrome, the sciatic nerve would be affected by pressure applied to the injured or irritated piriformis muscle. This is a scientifically mixed condition that can be overlooked with a simple trigger point (mini-contracture) in the gluteal region.

Anyway, it is possible that a contracted piriformis (or gluteal) muscle causes radiation to the thigh, and sometimes even to the calf.

For more information on piriformis syndrome and its management, see the following article.

neuropathy

La neuropathy is characterized by disease or dysfunction of one (or more) nerves. These can be motor and/or sensory.

In addition to the sciatic nerve, damage to a peripheral nerve in the lower limb can also cause calf pain.

This pain (often electric shock type) can be accompanied by tingling, tingling, numbness, weakness and even paralysis in some severe cases.

Differentiate between lumbar involvement and local calf involvement

There are 2 ways to determine if your calf pain comes from the muscle itself, or from the lumbar region.

1. Clinical tests

The first consists of clinical tests (including a neurological examination). A qualified professional can perform certain maneuvers to clarify the diagnosis. It should be noted that no test is 100% reliable, and that the practitioner's clinical reasoning will allow conclusions to be drawn based on the overall picture.

Nerve tension

Certain nerve stress tests such as the Slump or the Lasegue test (SLR) can determine if there is potential nerve irritation.

By putting tension on the nervous system, we can differentiate local pain in the calf and pain from the lumbar region, for example.

Reflexes

If we observe a reduction (or even an absence) of a reflex in the lower limb, we can suspect an attack of the nervous system compared to a local attack of the calf.

Myotomes

The spinal nerves allow the contraction of certain muscles of the lower limb (this is called a myotome). If we observe weaknesses in certain key muscles, we can then think of an impairment of the lumbar spine by nervous irritation.

Calf stretch

A passive and isolated stretching of the calf will determine if there is local stiffness in this muscle. Obviously, this stiffness must be associated with a traumatic event (such as a breakdown or a long jogging session). These elements will give clues to the cause of the calf pain.

Calf contraction

The contraction of different types (isometric, isotonic or eccentric) will give information on the contractile components of the gastrocnemius and soleus muscles (which make up the calf).

In other words, a local muscle tear may be suspected based on the symptoms following an isolated muscle contraction (and taking into account the medical history of the injury).

Homan's test

Homan's test is used to diagnose the presence of phlebitis. Although not completely reliable, it may indicate to the treating professional that the circulatory system should be further assessed (especially if there are other symptoms such as swelling, discoloration, etc.).

2. Medical imaging examinations

The second way to determine where the calf pain is coming from is to perform blood tests.medical imaging. These examinations may be carried out at the lumbar level if it is suspected that the pain is referred, or even at the calf if local involvement is suspected.

For example, a scan or a lumbar X-ray will identify spondylolisthesis, a narrow lumbar canal or even lumbar osteoarthritis.

An MRI can diagnose a protrusion or herniated disc, as well as the nerve irritation potentially responsible for the associated calf pain.

Un EMG can provide information on the nerve paths of the different nerves running through the lower limb, and identify neuropathy.

Un venous echo-doppler may identify phlebitis or other vascular disorder.

It should be noted that the results of medical imaging do not guarantee a clear and precise diagnosis. This is because there are many asymptomatic conditions despite changes seen on imaging. It is for this reason that medical imaging should never be interpreted alone.

Calf pain: What to do?

Regardless of the cause, calf pain is often bothersome and even incapacitating. Here are some strategies for relieving your symptoms:

Clarify the diagnosis

Obviously!

If you don't identify the real cause of your calf pain, you are definitely going to give it the wrong treatment. Indeed, it is not uncommon to see patients seek to relax their calf muscle - when the source of the problem comes from the back!

Once you identify the source of your calf pain, you will be able to provide specific treatments for your problem.

Heat/Ice

There is not really any scientific evidence demonstrating a superiority of the heat or ice to treat injuries.

In general, ice is applied when an inflammatory process is suspected (for example in the acute phase, and often associated with taking medications anti-inflammatories). In addition, heat is used when trying to relax stiff muscles.

In the case of calf pain, one can consider applying ice if one suspects a recent muscle strain. On the other hand, if it is estimated that the pain comes from a symptomatic disc herniation, it would be relevant to apply ice to the lumbar level to calm the inflammation at this level.

Apply compression

After a calf injury, it may be beneficial to apply compression to support the muscle and reduce swelling. The same is true if vascular damage is suspected (pain due to poor circulation).

In the case of lumbar involvement causing calf pain, there is little chance that local compression will reduce symptoms.

Soften and tone the muscle

In the case of calf muscle damage, it is not uncommon for a physiotherapist (physiotherapist) prescribes strengthening and stretching exercises to heal your injury.

These exercises will allow you to activate the circulation, soften the muscles, return to your normal activities and prevent recurrences.

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One can also use massage tools to relax his muscles in the comfort of his home. Among the recommended products we have:

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Mobilize the sciatic nerve

If the Lasègue tests and/or SLR are positive, we can think that the calf pain comes from nerve irritation at the lumbar level.

With this in mind, neural mobility exercises could help relieve symptoms, in addition to promoting recovery from your condition.

Here is a sciatic nerve glide exercise often given in rehabilitation:

Consult a healthcare professional

Un health professional can be more precise and effective in their treatment approach.

For example, an orthopedist may refer you for a lumbar MRI or local and determine if your case requires more invasive treatments (infiltration or surgery).

Or, a physical therapist (physiotherapist) could prescribe suitable exercises aimed at strengthening and relaxing your calf muscles.

An osteopath, on the other hand, might use manual techniques to relax your muscles, improve your mobility, and reduce your pain.

Here are some situations where it is imperative to consult urgently:

See also emergency if you notice any of the following symptoms:

  • Severe fever
  • Calf edema, associated with a bluish discoloration
  • Lower extremity temperature change
  • Symptoms that do not improve over time

What about natural remedies?

Although they are not supported by solid scientific evidence, several natural products and home remedies are used to treat various body pains, especially for their anti-inflammatory power.

Here is a non-exhaustive list of plants and essential oils that are effective in controlling pain and inflammation:

  • Turmeric : Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.
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  • Ginger : In addition to the special flavor it brings to the kitchen and its aphrodisiac properties, ginger is a root well known for its anti-inflammatory powers. THE gingerol gives it its anti-inflammatory action. It is an active component acting on the inflammatory pain related to chronic joint inflammatory diseases, including rheumatoid arthritis, lupus, rheumatic diseases, etc. It has been proven that this active element is also effective in acting on the inflammation linked to arthritis and sciatica. Ginger also has other benefits thanks to its high potassium content and its richness in trace elements (calcium, magnesium, phosphorus, sodium) and vitamins (provitamin and vitamin B9).
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  • Omega-3s : Omega-3 are polyunsaturated fatty acids that play a very important role in the functioning of our body. They are provided by food in three natural forms: docosahexaenoic acid (DHA), alpha linolenic acid (ALA) and eicosapentaenoic acid (EPA). Beyond their action on the brain and the cardiovascular system, omega-3s prove very effective against inflammation. Indeed, they have the ability to act on the inflammatory mechanisms in osteoarthritis by slowing down cartilage destruction, thus they reduce the intensity of osteoarthritis pain. Since sciatica is most often linked to inflammation secondary to a herniated disc, it can also respond to omega-3s if you consume them regularly. 

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  • Lemon eucalyptus: Eucalyptus is a plant most often used in the form of herbal tea or essential oil. She would have anti-inflammatory effects which give it the ability to act on the bone and joint pain in general and the pain of sciatica in particular.
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  • wintergreen : Wintergreen is a shrub from which a very interesting essential oil is extracted. It is one of the most used essential oils in aromatherapy. This oil extracted from the shrub bearing the same name, is used in massage to relieve sciatica and act like a analgesic. Indeed, it provides a heating effect thanks to its ability toactivate blood circulation locally.
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Are you looking for solutions to relieve your pain?

Discover the opinion of our team of health professionals on various products available on the market (posture, sleep, physical pain), as well as our recommendations.

Conclusion

It is essential to determine the exact cause of your calf pain, otherwise you will not see an improvement in your condition.

Whether clinical tests or medical imaging examinations, it is possible to differentiate between local calf involvement and referred pain of the lumbar region.

Once these elements have been clarified, the treatment approach can be adjusted, and you will thus have a much better prognosis for recovery.

Do not hesitate to consult a health professional to clarify your diagnosis, and benefit from an individualized approach.

Good recovery!

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