Why Do My Calves Hurt After a Workout?

Symptoms of delayed onset muscle soreness (DOMS) may include: 

• Pain that ranges from muscle tenderness to severe debilitating pain
• Swelling of the affected limbs
• Stiffness accompanied by temporary reduction in range of motion
• Tenderness to the touch
• Temporary reduction in strength of the affected muscles that may last for days

Rhabdomyolysis may not cause any symptoms in some people. When symptoms of rhabdomyolysis occur, they may include:

• Muscle pain, cramps, or aches
• Muscle tenderness, swelling, and bruising 
• Muscle weakness
• Tiredness
• Feeling unwell (malaise)
• Inability to complete job tasks or finish a workout
• Dark urine (red, brown, or tea-colored)
• Not urinating
• Fever
• Nausea
• Vomiting
• Confusion
• Agitation
• Delirium

Calf pain after a workout doesn’t always need medical intervention. See a doctor if calf pain becomes debilitating, if the limbs experience heavy swelling, or if urine becomes dark, as these may be signs of rhabdomyolysis. 

Rhabdomyolysis cannot be diagnosed by a patient history or physical examination alone. Tests used to diagnose rhabdomyolysis include: 

• Blood tests for creatine kinase (CK or creatine phosphokinase [CPK]), a muscle protein
  • When muscles are damaged, CK levels increase
  • Repeated tests are needed to determine if CK levels are rising or falling
• Urine dipstick tests to check for myoglobin, a muscle cell component

For the most part, calf pain after a workout does not require medical treatment and it technically cannot be treated. Reduction of pain is not the same thing as recovery. Treatments may be used to ease pain and discomfort, but any underlying muscle damage and reduced function may persist for up to three to five days.

To reduce symptoms of calf pain, when the pain first occurs, use the RICE method: 

• Rest: keep weight off the leg
• Ice: to decrease pain, swelling, and redness
• Compression: to prevent inflammation
  • Use elastic wraps such as Ace bandages and do not wrap too tightly
• Elevation: prop up the affected leg to help reduce fluid buildup in the injured tissue
  • Try to raise the calf above the level of the heart

Other home remedies for calf pain after a workout may include: 

• Activity changes
  • Stop activities or sports that cause calf pain 
  • Reduce intensity and duration of exercise for one to two days following intense DOMS-inducing exercise
  • Exercises targeting less affected body parts may be performed to allow the calf muscles to recover
  • Reintroduce eccentric exercises or new activities progressively over a period of one or two weeks 
• Foam rolling
• Massage
• Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) 
  • Ibuprofen (Advil, Motrin) 
  • Naproxen (Aleve)
• Topical analgesics (pain relievers) such as Icy Hot
• Lose weight if overweight for the long term

Treatment for rhabdomyolysis depends on the cause and severity. The underlying cause of the rhabdomyolysis needs to be treated when possible. Hospitalization is frequently needed. 

Treatment for milder cases of rhabdomyolysis may include: 

• Rest
• Drinking fluids
• Getting out of the heat

Treatment for moderate to severe cases of rhabdomyolysis includes:

• Intravenous (IV) fluids to help the body flush out the substances from muscle cells
• Medicines to correct salt levels 
• Treatment to support the kidneys until they can function normally again
  • Diet changes
  • Medications 
  • Renal replacement therapy
    • Hemodialysis: a machine to moves the blood through a filter outside the body to remove waste
    • Peritoneal dialysis: the lining of the abdomen is used to filter the blood inside the body to remove waste
• Kidney transplant, if kidney function does not recover
• Emergency surgery to cut open muscles and relieve the abnormal build-up of pressure