Why Calf Strength Matters for Running, Walking & Pelvic Health

Why Calf Strength Matters for Running, Walking & Pelvic Health

When you think about your pelvic floor, your feet and calf muscles probably aren't the first things that come to mind.

But your body doesn't move as a collection of isolated muscles.

Every time you walk, run, hike, jump, or lift, your feet and ankles help absorb and produce force. Your calf muscles play an important role in controlling your ankle and helping you push off the ground.

When one area of the body isn't contributing as effectively as it could, other areas may adapt to help you accomplish the movement. This doesn't necessarily mean that a weak calf muscle is the cause of your pain or pelvic floor symptoms—but it can be one piece of the movement puzzle.

Why Are Your Calf Muscles Important?

The two major muscles at the back of your lower leg—the gastrocnemius and soleus—work together to create plantar flexion, or pointing your foot downward.

Your calf muscles are involved in everyday activities such as:

• Walking

• Going up and down stairs

• Hiking

• Running

• Jumping

• Pushing off the ground

• Maintaining balance

They also help control the forces traveling through your lower extremity as you move.

Because we use these muscles so frequently, calf strength and endurance can be important for both everyday movement and higher-level activities such as running and sports.

How Strong Are Your Calf Muscles?

One simple way physical therapists assess calf strength and endurance is with a single-leg heel-rise test.

A 2017 study by Hébert-Losier and colleagues looked at 566 healthy adults between the ages of 20 and 81 and established reference values for the standing single-leg heel-rise test. Participants performed single-leg heel raises to fatigue while standing on a 10-degree incline. The researchers also found the test had excellent test-retest reliability.

The study found that performance varied based on factors including age, sex, body mass index, and activity level. Overall, men completed a median of 24 repetitions compared with 21 for women, although older women in the study outperformed older men.

Reference values by age

Age	Men	Women
20–29	37	30
30–39	32	27
40–49	28	24
50–59	23	21
60–69	19	19
70–79	14	16
80–89	10	13

These numbers are reference values, not a pass/fail test. Your performance can be influenced by your age, sex, activity level, body size, previous injuries, pain, balance, and how the test is performed.

More important than chasing a specific number is looking at the quality of your movement and how your two sides compare.

Try a Single-Leg Calf Raise

If you'd like to get a general sense of your calf strength, you can try a single-leg heel raise at home.

Safety first: Perform this near a countertop, wall, or other sturdy surface that you can use for balance. If you have significant pain, weakness, balance problems, or a history of injury, don't perform the test without guidance from a healthcare professional.

Here's how:

1. Stand on one leg while lightly holding a sturdy surface for balance. Try not to lean your body weight into your hands.

2. Keep your knee relatively straight and slowly rise onto the ball of your foot, lifting your heel as high as you comfortably can.

3. Pause briefly at the top.

4. Slowly lower your heel back toward the ground.

5. Continue until you can no longer maintain good form.

Single Legged Calf Raise Starting Position

Single Legged Calf Raise Ending Position

Pay attention to more than just the number.

How do your sides compare?

Is one side noticeably weaker or more fatigued?

How high can you lift your heel?

Does one side have a noticeably smaller range of motion?

Can you control the lowering phase?

Does your heel lower slowly and smoothly, or does it drop quickly?

How does your foot move?

Are you able to push through your foot evenly, or do you consistently shift your weight toward one part of your foot?

These observations can provide useful information, but they don't tell the whole story. A physical therapist can assess your calf strength along with your foot, ankle, knee, hip, and overall movement mechanics.

What Do Your Calves Have to Do With Your Pelvic Floor?

This is where the connection gets interesting.

Your feet and ankles interact with your knees, hips, pelvis, spine, and core as you move. Your pelvic floor is also part of this larger system.

For someone who experiences pelvic floor symptoms during running, jumping, or lifting, it can be helpful to look at how the entire body is handling the demands of the activity.

For example, an assessment might include:

• Foot and ankle mobility

• Calf strength and endurance

• Hip strength

• Trunk control

• Breathing mechanics

• Running or walking mechanics

• Pelvic floor muscle coordination

• How you manage pressure during exercise

• How your body responds to impact

This doesn't mean that weak calves cause pelvic floor dysfunction.

Pelvic floor symptoms are complex and can have many contributing factors. But if you're experiencing urinary leakage, pelvic pressure, pelvic pain, or other symptoms during exercise, looking beyond the pelvic floor itself can provide valuable information.

Should You Stop Running or Exercising If You Have Pelvic Floor Symptoms?

Usually, the answer isn't simply "stop."

Exercise is important for your overall health, strength, and quality of life. If you experience pelvic floor symptoms while exercising, the goal is to understand why those symptoms are occurring and how to help your body tolerate the activity better.

Sometimes that means modifying your training temporarily. Sometimes it means improving strength or mobility. Sometimes it means working on breathing and pressure management or pelvic floor coordination.

And sometimes the pelvic floor isn't the primary issue at all.

The right approach depends on the individual.

How Can Calf Strength Be Improved?

If your calves need more strength or endurance, there are many ways to train them.

You might start with:

• Double-leg calf raises

• Single-leg calf raises

• Slow eccentric heel raises

• Calf raises from a step

• Loaded calf raises

• Calf strengthening incorporated into your regular strength program

The appropriate starting point depends on your current strength, symptoms, activity level, and goals.

You don't need to be able to perform the maximum number of repetitions from a research study before you can start running, hiking, or exercising.

Instead, the goal is to gradually build your body's capacity for the activities you want to do.

Your Body Works Together

One of the things I love about pelvic health physical therapy is that we don't have to assume every pelvic floor problem starts with the pelvic floor.

Your symptoms may be influenced by what's happening throughout your body.

For one person, that might mean addressing calf strength and running mechanics. For another, it might mean improving hip strength, trunk control, breathing coordination, or pelvic floor muscle relaxation.

There isn't one exercise that fixes pelvic floor dysfunction.

Your treatment should be based on your body, your symptoms, and your goals.

At AnewU Physical Therapy, I take a whole-body approach to pelvic health and movement. If you're experiencing pelvic floor symptoms during running, exercise, or everyday activities—or you're dealing with persistent foot, ankle, hip, or back problems—I can help you understand how the different parts of your body may be contributing to the way you move.

Schedule a free discovery call or schedule an evaluation to get started.

Written and reviewed by Dr. Amanda Gotschall, PT, DPT

Research

Hébert-Losier K, Wessman C, Alricsson M, Svantesson U. Updated reliability and normative values for the standing heel-rise test in healthy adults. Physiotherapy. 2017;103(4):446–452.