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Posterior (Back) Lower Leg Pain

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Injury Information

Posterior Compartment Syndrome

This condition involves the compartment of muscles deep in the back of the low leg under the calf muscles. The deep muscles are encased in a thick, rigid layer of tissue. Compartment syndromes occur as a result of a buildup of pressure within this compartment that affects muscle, nerve and artery function. This problem may occur as a result of a blow to the leg, muscle rupture, overuse, poor warm-up or too much muscle training.

Posterior compartment syndrome results in pain and tightness that is felt as a chronic dull ache around the inner aspect of the calf. Pain will increase with exercise, to the point where exercise becomes impossible to continue. Coldness, pins and needles, and numbness may be felt around the inner aspect of the ankle and foot.

Gastrocnemius Muscle Strain

The Gastrocnemius is the outer layer of the two calf muscles. Strain or rupture is common in racquet sports such as tennis and squash and will usually occur around the attachment to the Achilles tendon on the inner side of the muscle. Gastrocnemius strain is more common in the middle aged than the young. A sudden pain will be felt in the calf, this pain will feel like a blow to the calf initially, with aching and throbbing following. Bruising and swelling are very common with this injury and may spread quickly throughout much of the calf. Pain may decrease with ice, compression and elevation.

If adequate strengthening and stretching is not undertaken before returning to sport, chronic gastrocnemius muscle strains commonly develop.

Soleus Muscle Strain

The deeper calf muscle, called, Soleus, is commonly strained or ruptures during the take-off phase of jumping. Pain will be felt instantly deep in the calf. Alternatively, soleus muscle strains may develop as calf tightness over a period of time. Pain may increase with loading and even worse when walking on ‘tiptoe’. Pain may be worse walking than when running. Bruising and swelling tend to occur late, up to 24 hours post injury. Pain and swelling may decrease with ice and elevation.

Injury Treatment

Early Injury Management

For approximately the first 72 hours following an injury, the RICE regime should be followed to ensure control of inflammation and pain relief.

R - Rest

I – Ice

C - Compression

E – Elevation

Rest from aggravating activity.

Ice should be applied in the first 72 hours or when inflammation persists. Ice should be applied for 15 to 20 minutes at a time. Ice should not be applied directly to the skin, but through a wet towel or cloth.

Compression can be achieved with an elastic bandage.

Elevation is used to help swelling to return to the heart through the blood stream.

The injured area should be elevated above the level of the heart.


Strengthening programs should only be commenced when:

Exercises should be 3 sets of 8-12 repetitions.