With the changes in activity associated with COVID-19 restrictions, most of us have become less active. While we are at less risk of injury, being less active can pose problems as well. The most common change that is associated with a decrease in physical activity is tightening of the two calf muscles that become the Achilles tendon. Tightening, or contracture, of the gastrocnemius muscle can lead to what is called “start-up pain.”
When pain occurs with the first few steps after arising in the morning or getting up from a chair and resolves after a minute or two of walking, this is referred to as “start-up pain.”
How the calf works
To understand what’s happening below the surface, a quick anatomy lesson is helpful.
The two primary muscles that join together to become the Achilles tendon are:
- Gastrocnemius: It’s closer to the surface and starts at the thigh bone, just above the knee.
- Soleus: It’s the deeper muscle, and connects to the top of the shin bone, just below the knee.
“When the gastrocnemius is tight,” Dr. Michael Castro explained, “the position of the knee can affect how the ankle moves. Since the gastrocnemius crosses the knee, it is typically slack (loose) when the knee is bent for extended periods of time. Most commonly this happens when sitting or in bed for the night. When the gastrocnemius muscle is slack, it will slowly tighten to take the slack out and apply a slight tension to the Achilles tendon.”
“Start-up” Pain
When one gets up from bed in the morning or from a prolonged period of sitting, the gastrocnemius is typically at its tightest. “This prevents the ankle from accommodating the body going over the foot. As a result, the heel must come off the ground sooner, applying greater stress to the foot and ankle,” Dr. Castro said.
This stress can cause “start-up pain” in a variety of places:
- Ball of the foot
- Top of the foot
- Front of the ankle
- Bottom of the heel
- Back of the heel (where the Achilles tendon connects to the heel bone)
- Achilles tendon itself
We know that gastrocnemius tension is the cause of “start-up pain” because it is the only thing that changes significantly as that muscle warms up and stretches out while walking. “This scenario can be amplified by the significant decrease in activity we are experiencing,” Dr. Castro said, “In the face of this change, we feel that stretching the calf on a regular basis can prevent the development of a number of foot and ankle problems associated with calf tightness.”
Dr. Castro’s Recommended Stretch for Calf Pain
Watch the video above of Dr. Castro demonstrating the calf stretch.
As with any pain, it’s important to pay attention to changes in your symptoms. With time, the discomfort may become more consistent and not resolve after walking for a bit. In such cases, we encourage you to set up an appointment to talk with a foot and ankle specialist on therapeutic and surgical alternatives to address the pain.