Calf Strains in runners
We are now well into the running season, with some having just completed the Gold Coast marathon or Half Marathon, and the Brisbane marathon festival happening this Sunday. Others are preparing for the Bridge to Brisbane, the Noosa Triathlon and a host of other running events in the coming months.
As a preparation for an event picks up, runners will increase the length of their runs and the weekly mileage starts to creep up. One very common running complaint suffered by nearly all runners at some time is calf soreness or calf strains.
Usually runners complain of a dull aching pain, but in severe cases a sharp intense pain is felt and the person will find it difficult to walk. A runner’s worst nightmare is to pull a calf muscle during a race or during the last few weeks of preparation. The calf muscle is a group of 3 muscles at the back of the lower leg. The gastrocnemius muscle (which has 2 parts, an inside and outside portion) is at the top of the lower leg and is stretched with the knee straight. The lower, deeper soleus muscle is stretched when the knee is bent. Both these muscles attach onto the heel via the Achilles tendon.
Common causes of calf strain:
- Overload and fatigue
- Speed or hill training
- Ineffective warm up and warm down routines
- A sudden increase in mileage
- Dehydration and cramping
- Calf tightness from back and sciatic pain
- Inappropriate footwear
There are 2 quick measures Physiotherapists use as part of an overall assessment of a clients calf. You can use these as a guide to see how your calf stacks up.
- Knee to wall measure – To assess the flexibility of the calf and ankle we get the patient to place a ruler perpendicular to the wall. The patient stands with their big toe on the ruler and keeping their heel down, bends the knee to touch it to the wall. You continue to move the foot back until you are no longer are able to touch the wall with your knee while maintaining your heel on the ground. The last point you can manage this is the measurement. For most people we would like have a measurement over 10cm.
- Single leg calf raises – The patient stands on one leg and rises up and down onto their toes as many times as they can. The magic number we are looking for to indicate adequate strength in the muscle is the ability to do 30 calf raises on each leg.
If you have injured your calf, the early treatment aims at reducing inflammation and strain on the muscle. This may include:
- Ice massage over the muscle several times during the day.
- Compression to limit bleeding and swelling in the muscle.
- Elevating the leg whenever possible.
- Stopping running and limit all activities that aggravate the condition.
- Using a heel raise/shoe insert that helps take the pressure off the muscle as it heals
- Potentially using anti-inflammatory medication (if advised by your doctor or treating therapist).
- Early mobilisation and pain free strength work as advised by your physiotherapist.
As the rehabilitation progresses your Physiotherapist will guide you through the necessary steps to get you back to running. These may include,
- A graduated calf strength program
- Calf flexibility and mobility
- Plyometric exercises such as jumping, skipping and hopping.
- Addressing other predisposing factors such as lower limb and foot biomechanics, decreased ankle range, and weakness in other muscle groups
- Advice on safe activities to keep your fitness going whilst you work through your rehabilitation
- Technical advice on running technique, and running drills
- A detailed return to running program
- An ongoing home exercise program to minimise the chances of recurrence
When treating runners one of the most difficult things is to convince them of, is the need to take time out from their running schedule to let their injuries heal. We as a runners know how mentally hard it can be, feeling like you are going to loose all your fitness and undo all your hard training. The good news is that research points to the fact that endurance training doesn’t disappear overnight. In fact, the benefits of those long runs last upwards of 6 months! Also cross training, and particularly water running have been shown to maintain your fitness while you are out of action. The key is to get better so you don’t re-injure yourself or change your running style and suffer continued injuries and problems.
As always prevention is the key! Ask your Physiotherapist for the specifics that relate to you, but some strategies that may help include,
- A good warmup and cool down routine.
- Avoid dramatic increases or changes to training.
- Address small injuries quickly – don’t make them big injuries!
- Modify your training when fatigued.
- Wear good quality, supportive shoes appropriate for your feet.
- Keep well hydrated
Hopefully this keeps you on track for your running goals this year and aids your preparation for this running season. If you have any questions about your personal running technique, niggling injuries or are in need of a strength and conditioning program, contact our friendly reception team on (07) 3891 2000 or email firstname.lastname@example.org for booking your next appointment with a Physiotherapist or Accredited Exercise Physiologist.