Medical

Severe calf pain during fun run — exercise-induced muscle cramp

Foundation

Adult · 38yr · female

Patient Information

Dispatch	You are called to a 38-year-old female (Lauren Osei) who has collapsed to the ground at the 9km mark of the city fun run, clutching her right calf. Course marshals report she was running and suddenly stopped, crying out in pain.
Patient	Lauren Osei — 38yr (62kg)
Incident History	Patient was on track for a personal best when she felt a sudden, severe, cramping pain in her right calf at approximately 9km and was unable to continue running. She went to the ground immediately. No trip or fall. No impact to the leg. She is visibly distressed by the pain.
Emergency Contact	Sam Osei (Husband) — 0412 667 443

Initial Rapid Assessment

Response	Alert
Airway	Patent. Speaking between waves of pain.
Breathing	Increased rate settling from exertion. RR 20. No respiratory distress. SpO2 98% on room air.
Circulation	Radial pulse strong and regular. Skin flushed and sweaty from exertion. CRT <2s.
Disability	GCS 15 (E4V5M6). Alert and orientated. Anxious and distressed from pain.
Exposure	Right calf — visibly tense and hard on palpation (muscle in spasm). No bruising. No skin discolouration. Skin intact. Pedal pulses present bilaterally.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	98% (RA)	Nil	20	102	128/76	<2s	15	4 4 ++	37.4	–	9
10 mins	99% (RA)	Nil	16	88	118/74	<2s	15	4 4 ++	37.4	–	2

History Taking

Treatment Response

Diagnosis

Exercise-induced gastrocnemius (calf) muscle cramp secondary to dehydration and electrolyte depletion during prolonged exertion. This is NOT a deep vein thrombosis (DVT). Key differentiating features: sudden onset during intense exercise (not gradual onset at rest), palpable muscle in full spasm, rapid and complete resolution with passive stretching, no calf swelling prior to the run, intact bilateral pedal pulses, and absence of significant DVT risk factors (note: OCP is a risk factor but cramp mechanism and rapid resolution make DVT very unlikely). The rapid resolution with stretching is the clinching differentiator — a DVT does not resolve with passive stretch.

Facilitator Triggers — if trainees miss a critical step

! (If trainees do not ask about how the pain started — specifically whether it was sudden vs gradual, and whether it occurred during or after running — prompt: 'Can you describe exactly when the pain came on?')
! (If trainees raise concern about DVT before completing assessment — patient asks 'Could it be a blood clot?' Prompt: complete the full history and assessment, including timing and response to treatment, before deciding on escalation.)
! (If trainees do not attempt passive dorsiflexion (calf stretch) — prompt: 'Is there a simple intervention that often relieves a muscle cramp?')
! (If trainees do not offer oral hydration — prompt: 'She mentions she hasn't eaten or drunk much today. Is there anything you can offer?')
! (If trainees correctly identify exercise cramp and it resolves rapidly — note for debrief: the dramatic and rapid resolution with stretching is the key diagnostic differentiator from vascular pathology. Completing management before escalating avoided unnecessary intervention.)

Treatment Objectives

1. Ensure scene safety — assess roadside environment; ask course marshals to maintain distance and block traffic if required.
2. Don appropriate PPE.
3. Perform Primary Survey — confirm airway, breathing, and circulation intact; no life-threatening emergency.
4. Obtain history — establish onset character (sudden during running, not gradual), prior DVT or clotting history (nil), dehydration status, last oral intake (nil food, minimal fluid).
5. Inspect and palpate right calf — note firm, tense, contracted muscle belly (muscle in spasm); no bruising, no skin discolouration, intact skin.
6. Assess pedal pulses bilaterally — confirm normal distal circulation in both feet.
7. Assess sensation and movement of the right foot and toes — confirm intact.
8. Document pain score — 9/10 at initial assessment.
9. Attempt passive stretch — gently dorsiflex the foot (pull toes toward shin) to stretch the gastrocnemius; this should provide significant relief of exercise-induced cramp within 1–2 minutes.
10. Offer oral hydration — water and/or electrolyte solution if available; patient is dehydrated from exertion without adequate intake.
11. Observe the response — cramp pain reduces significantly and rapidly with stretching and hydration; pain score 2/10 at 10 minutes.
12. Reassess after resolution — confirm normal neurovascular status, normal vital signs, pain has resolved.
13. Reassure patient — explain this is consistent with exercise-induced muscle cramping from dehydration; no emergency escalation is required given rapid and complete resolution.
14. Advise patient — she should not continue the run today; she should rehydrate with water and electrolytes and eat; she should seek GP review if the calf becomes swollen, discoloured, or painful at rest in the coming days.
15. If pain does NOT resolve with stretching within 5–10 minutes, or if swelling, skin discolouration, or neurological deficit develops — consider escalation to CSP for further assessment.
16. Scenario ends when cramp has resolved and appropriate advice has been given.
17. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Primary Survey · Secondary & CNS Survey · Pulse & Respirations · Blood Pressure

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Signs/Symptoms	Sudden onset severe right calf pain during running. Calf felt 'rock hard' and locked. Pain almost completely resolved by 10 minutes with passive stretch and hydration.
Allergies	NKDA.
Medications	Oral contraceptive pill. Nil other regular medications.
Pertinent History	Recreational runner, completed two half-marathons previously. No history of DVT or clotting disorder. No recent long-haul travel. No prior calf swelling before today's run. States she skipped breakfast and only drank 500mL of water this morning due to pre-race nerves.
Last Oral Intake	500mL water this morning. No food. Last meal was dinner the night before.
Events Leading	Patient is competing in a fun run event and was targeting a personal best. She had felt fine until 9km when the cramp struck without warning. She believes dehydration is a factor as she did not eat breakfast and drank less than usual before the race.
Treatment Prior	Nil prior to EHS arrival — has been lying on the ground in pain.

Onset	Sudden, at approximately 9km during competitive running. No warning. Not gradual.
Pain	Severe cramping, knotted pain in the right calf (gastrocnemius muscle belly). Felt like the muscle 'tied itself in a knot.'
Quality	Cramping and vice-like. Involuntary muscle contraction — she could not relax the calf.
Radiates	Nil radiation.
Severity	9/10 at onset. 2/10 at 10 minutes following stretching and water.