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Below the calf pain

I was wondering if Dr. Jen or by any chance someone else could help me. Im going through my academy right now and when Ive been running, lately Ive been experiencing pain right below both of my calfs? It feels like shin splints but on the opposite side if that makes sense. (Ive had shin splints before and I know the pain). How how I make the pain go away? Thanks, djrj28

This sounds like Achilles Tendinitis; the following is copied directly from at 13:25 hours on December 3rd. It sounds reasonably similar in onset and symptom.

"Achilles tendonitis is an inflammation of the Achilles tendon (see Tendonitis). It is generally precipitated by overuse of the affected limb and is more common among athletes training under less than ideal conditions. It should not be confused with xanthoma of the tendon, which is the accumulation of cholesterol in patients with familial hypercholesterolemia.

The Achilles tendon does not have good blood supply or cell activity, so this injury can be slow to heal. The tendon receives nutrients from the tendon sheath or paratendon. When an injury occurs to the tendon, cells from surrounding structures migrate into the tendon to assist in repair. Some of these cells come from blood vessels that enter the tendon to provide direct blood flow to increase healing. With the blood vessels come nerve fibers. Researchers believe these nerve fibers to be the cause of the pain.

Treatment is possible with ice, wearing heel pads to reduce the strain on the tendon, and an exercise routine geared towards strengthening the tendon. Seeing a sports medicine clinician, a podiatrist, or a physical therapist as soon as possible is important, because this injury can lead to an Achilles tendon rupture with continued overuse. Treatment may include non-steroidal anti-inflammatory drugs, such as ibuprofen, ultrasound therapy, manual therapy techniques, a rehabilitation program, and in rare cases, application of a plaster cast. Steroid injection is sometimes used, but must be done after careful, expert consideration because it can increase the risk of tendon rupture. Severe cases may require surgery from an orthopedic surgeon.

High load eccentric contractions have recently been shown to be very effective at decreasing the pain and strengthening the tendon.

Prevention includes following appropriate exercise habits and wearing low-heeled shoes. An athletic trainer or physical trainer can prescribe safe exercise methods."

Take Care,
Matt Fullerton

I am so sorry it has taken me so long to answer!
This does not sound like shin splints OR achilles tendonitis! It sounds like anterior compartment syndrome! If it is not gone, at this late date of my reply, I am very concerned! I wrote an article on this stuff. It was for lacrosse players. BUT- anyone who runs can have these problems.

Go to this web site: or I wrote the below article:

What are ?Shin-splints??

Shin-splints appear on the medial (big toe side) and posterior (back side) of the shin bone. This is when the tibialis posterior muscle pulls away from the back of the tibia (shin bone). This shearing happens when the arch starts to fall, and the muscle is repetitively over-stretched with the pounding of running. It can be very painful and lead to worse injuries.

Who gets them?

People who run a lot get them?like lacrosse players. It usually happens when they increase their running and the body suddenly cannot repair itself fast enough for the tearing down of the tissues caused by the increase in training.

An anatomical description:

The tibialis posterior runs from the top back of the tibia, down, through the top of the foot on the interior of the ankle, to attach on the bottom of a small bone that makes part of the arch of the foot. As pounding/running increases, each time the foot hits the ground, the arch gives a little. Each time this pulls on the muscle, it pulls it down along the back of the shin bone. This shearing or pulling can actually start to pull the muscle off of where it attaches there. This causes pain, inflammation, and weakening of the covering of the bone (periostium). If this is let go long enough, the bone can become weakened and lead to stress fractures as well as complete fracture.

What else could it be?

Doctors need to have 3 differential diagnoses when they look at the problem. When looking at shin pain, some things that need to be ruled out are:
1. Fracture (stress or frank)
2. Anterior compartment syndrome
3. pathology- neoplasm?the big C. Rare, but possible.

X-ray Findings:

The doctor may take an x-ray. Not a bad idea. Make sure the pelvis is covered with a lead shield. Fracture and shin-splints, many times, can be seen on x-ray. So can neoplasm. Anterior compartment syndrome cannot be seen on x-ray. It is a potentially very dangerous problem, and should not be left to ?go away on its own?. That needs a pressure releasing procedure. See a doctor. Neoplasm, well, would be a very sad thing, but luckily it?s pretty rare.

Tell the difference between Shin-splints and Compartment Syndrome:

Shin splints are on the big toe side of the shin bone. This hurts when you first start to run, and, in the early stages, the pain goes away once warmed up. I will talk, later, about how you can take care of a lot of this yourself.

Compartment syndrome is on the outside of the shin bone, toward the pinky toe. It will give you a feeling of fullness, heat, and tearing pain. This needs immediate medical attention. Call me if you are unsure 925/858-4375.

Is Shin-splint pain harmless?

Should I encourage my daughter to tough it out? No! If she?s tough enough and it?s left long enough, it can lead to a weakening of the bone? leading to micro fractures, stress fractures, then outright breaking in 2 of the tibia! Ouch!

Take Time Off from Play?

That depends on how far it?s gone! Ask me. If we catch it early, then no, you don?t have to stop playing. I have some great ways she can help herself get through this, playing all the while.

Self care:

? Make Dixie cup ice cubes. Yes, get a box and make a dozen, and stick them in your freezer
? Grab 2 on your way to practice. Use on the way there, and one on the way back. Put the second one in a cooler so melting is minimul.
? A towel? hand size is fine
? Traumeel ointment:
It is something you should keep in your lacrosse bag! Amazing stuff for boo-boos! A good deal is $28. It will last all season long.
? Get arch supports!
I recommend Spenco Full Length soft arch cushion insoles:
Go to:
Scroll down to:
Spenco Full Length Arch Cushion Insole
You?ll take out the regular insole, and put this in. If there?s room, you can put the old one back in ontop. They should not cost more than $15.

What to do in the car on the way to practice:

Bring 2 dixie cup ice cubes in the car on the way to practice. Save one in a cooler for after practice. Take the other, and peel away the lips of the cup so the top of the ice cube is exposed, and you can grip the cup, and not the actual ice cube.

Place a towel flat on the floor of the car. Place your bare feet on top of the towel.
Use one Dixie cup worth of ice? about half on each shin. Rub up and down on the area of pain. It will drip all over the place. First it will feel cold. Then it will throb. Then it will go numb. This should take 3-5 minutes per side. Just use half the ice cube on one side and go to the other.

The entire time you are doing the icing, do toe taps. That is: While you rub the ice cube up and down, tap your toe as if you are impatient. You should do no less than 100 toe taps, and no more than 200 on each side.

Now, make sure the towel is flat on the floor. Use your toes to try to scrunch up the towel into a wad. Make sure the whole thing is all wrinkled up. It will take some work. Do it 3 times, straightening out in between each ?scrunching?.

Now use the Traumeel. Use about an inch of the ointment. Divide it in half, and rub half on each shin.

Repeat this after practice on your way home.

Do it again before bed!

If you do all of this every day before practice, after practice, and before bed? your shin splints should be gone in 2 weeks. If they are not, please contact me for further ideas.

Honor the Game!

Dr. Jen Milus, DC

Staff Coach/ Triple Threat Lacrosse

Dr. Jen Milus, DC

djrj28, I hope Dr. Jen didn't scare you. It is not and cannot be anterior compartment syndrome, because by definition anterior (front) compartment syndrome is on the front of your lower leg. That fleshy part on your pinky toe side as Dr. Jen stated. You described your pain as being just below your calf, posterior (back of the leg)I assume. Without looking at you is hard to say what it is... but all the treatments that Dr. Jen mentioned are all very good. The first and best one is get arch supports...good ones made by a Physician, or someone who specializes in them.

There are 2 types of anterior compartment syndrome. Acute and chronic. Acute happens when you receive a direct bl*w to the fleshy part of the lower leg (pinky toe side, or outside) That Muscle is incapsulated in a compartment, so if it swells, that swelling has no where to go...bad... nerves and blood vesseles get pressed on and then the tissues lose function and die! That is why it is an emergency. But you don't have it, so don't worry.

Chronic Ant. Compartment syndrome, as the name implies, occurs over time or chronicly. I have seen this once in my career and it was in a runner who was anorexic/bulimic. The physicians said that because she was malnourished her body could not deal with the inflammation that was going on in her lower legs with the daily running that she was doing.

Some background on me so you don't think I am some quack. I have B.A. in Physical Education a M.S. in Sports Medicine and was a Certified Athletic Trainer at the Collegiate level for 10 years before I became a firefighter. I also own and operate my own personal training business.

Do your best even though nobody is looking.

I beg to differ, cbutrainer, but he does not say that the pain is in the back... which is where the achilles tendonitis would be. He said is was on the opposite side. The opposite side would indicate the other side of the shin bone. He said: "right below both of my calfs? It feels like shin splints but on the opposite side if that makes sense"

I was listening. He did not ever use the word BACK. Nope... not the word back in there once. I was listening. I listen for a living. That's how I diagnose... mostly by listening. I posted that article based on what I read/heard. I was offering him some information... not trying to scare him. But, either way, he should not run on it, and he should see someone... so we were both correct.

I don't think you are a quack, cbutrainer. I just think you have heard something different than I did. And I think your comment was based on the way you heard it, and not the way I heard it. Then you offered your opinion, in which you made an assumption, which is purely human. I made a different assumption. A diagnosis is just an opinion based on what a doctor (or nurse) knows. An exam would be in order before a diagnosis could be issued- as you stated. I never said he had anything, or didn't have anything.

Most people (especially emts and medics) know what the achilles tendon is. I might have been assuming (see? another assumption) too much in assuming that he would have said achilles tendon if he meant that.

I hope I didn't scare him either. And, by the way, chronic anterior compartment syndrome is sometimes a surgical case... to drain the fluid. And he certainly COULD have that. I have seen it alot more than once in my 13 years of private practice... at least a dozen times. Athletes get it, runners in particluar. Its very common in people who are new at running alot, or or suddenly up their mileage. They forget to lift at the hip flexor, and instead, pull up their toes on the swing through phase of their gate. And I have not ever correlated it with bulemia. I think that might have been a coincidence. Seeing one case where that happened in a bulemic does not tell me the degree to which her running form/gate was analyzed, nor how much over training occured due to a possible over exercise/body dismorhpic disorder in that patient. There is always more to the story...

In saying I was concerned, it was because it had been so long since he wrote that, and it was directed to me and I had not answered him.

Dr. Jen Milus, DC
This message was edited by DrJen on 12-22-06 @ 9:42 PM