CHECK 01
Where it hurts, and when, tells you more than how much.
Most running niggles below the knee live in the back of the leg: the calf, the Achilles, the heel. Same rough area, different problems, and two of them need opposite advice. Get the wrong one and you can spend a season managing the tissue next door. The pattern is the first clue.
My pain is mostly
Write your pattern down. Where it is, when it bites, what eases it, and whether it is trending up or down across weeks. That single paragraph is worth more to a good assessment than any scan.
CHECK 02
The single-leg heel raise. Compare the two sides.
Nearly everything at the back of the runner's leg runs through the calf and Achilles, and this is the one test that reads them. Stand near a wall for balance. On one leg, rise slowly onto the ball of your foot, then lower with control. Count quality reps until the height drops or the pain climbs. Rest, then test the other side.
You are not chasing a magic number. You are comparing left to right.
A clear gap between sides, reps that fade fast, or pain that builds as you go all point to the same thing. The tissue is not tolerating the load your mileage keeps asking of it. That gap rarely closes on its own, and it is exactly the shortfall that flares the moment you build back up.
Note both numbers. This is the most useful thing to track, because you can retest it every couple of weeks and watch the weaker side climb back to match.
CHECK 03
Watch the load. Steer by the next morning.
The rules you have heard, the 10% a week, the training-load ratios, are useful for one thing: they flag when you are about to spike. And spikes are where trouble concentrates, the big single-week jump you make coming back from a lay-off far more than the steady grind. Worth watching. As a red light on their own?
A number that tells you exactly when you will get injured.That is the part that does not hold up. When the 10% rule was tested head-to-head, it injured just as many runners as ignoring it, and the popular load ratio predicts injury no better than a made-up number in its place. Treat them as a rough heads-up that a jump is coming, not a verdict you can trust to two decimal places.
Then steer by the signal your body actually gives you. Discomfort up to about a 5 out of 10 that has settled by the next morning, and is not creeping up week on week, is usually load you can keep working with. Pain that climbs session on session, or lingers into the next day, is the plan telling you to ease back a step.
Watch the load to see the spike coming. Steer by the next morning to know if you got away with it. One flags the risk, the other reads the result. You need both.
Anything that stirs it has settled by the next morning, and the trend across weeks is down, not up.
WHY IT KEEPS COMING BACK
Rest settles it. Rest does not rebuild it.
Here is the loop most runners are stuck in. Rest, settle, build, flare. Rest calms the tissue down. It does not raise what the tissue can handle. Those are two different jobs. The mileage that flared it is still the mileage you come back to, and if nothing has closed the shortfall underneath, the same gap is waiting on your first week back.
The numbers on this are blunt. In calf strains, two of the strongest predictors of the next one are your age and the fact you have had one before. And around one in five re-injuries happen before the first is even fully healed.
1 in 5of calf re-injuries happen before the original has fully recovered. Coming back on the calendar, not on the capacity.
The same story runs through recurrent ankle sprains, grumbling Achilles and stubborn heels. It is not bad luck. It is a shortfall that never got closed before the load went back on.
What breaks the loop is finding why it keeps happening, then rebuilding load tolerance so it holds when the mileage does.
Worth getting checked before you load it: most running pain down here responds well to the right loading and a bit of patience. A few patterns deserve a prompt look rather than training through:
- A sudden pop or snap at the back of the heel or calf, then struggling to push off
- A deep, pinpoint bone pain that climbs with every session, especially after a jump in mileage. Bone stress does not always show on an early X-ray, so the pattern of the pain matters more than a clear scan
- Pain that wakes you at night or aches at rest
- An ankle that keeps giving way, long after the original sprain
- A calf that is swollen, hot or tender for no clear reason, especially one-sided
- Numbness, tingling or pins and needles spreading into the foot
And one that is easy to miss: in runners who are training hard while under-eating, or whose periods have stopped, the bone cannot keep up with the repair it is being asked to do. Recurrent stress niggles in that setting are a signal to get fuelling and bone health looked at properly, not to push through. None of these are panic buttons. They are reasons to have it assessed before you build back.
Stuck in the loop, or not sure what your pattern means? That is exactly what the initial Movement Therapy appointment works out.
90 minutes. A full assessment of how you move, what you load, and what has been building across your training. Hands on treatment where useful. An individualised plan and clear aftercare, built around your running and your goals, so you leave knowing exactly what to do next and why.
Sports massage, rehabilitation and Movement Therapy for runners and endurance athletes in Sheffield, South Yorkshire and North East Derbyshire.
Book your assessmentOr DM MOVE on Instagram if rest keeps settling it and mileage keeps bringing it back.
This guide is general information, not individual advice, and nothing here is a diagnosis. It is written for foot, ankle and calf pain that behaves mechanically: pain that varies with movement, position and load.