A Runner's "Calftastrophy"

author : AMSSM

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Calf injuries can occur from a sudden overload or from repetitive microtrauma. If not treated appropriately and promptly, an acute injury can lead to chronic pain.

(From questions submitted by globalnomad and QueenZipp)

By Jane T. Servi, MD
Northern Colorado Orthopedic Associates
Member AMSSM

The calf is a highly used muscle group in a runner. It consists of the gastrocnemius and soleus muscles. The role the calf plays in the running gait makes it very vulnerable to tightness, stiffness, and chronic pulls. If not treated appropriately and promptly, an acute injury can lead to chronic pain. Calf injuries can occur from a sudden overload or from repetitive microtrauma. Maintaining and updated shoewear can prevent injury.

An acute calf strain should be treated initially with gentle stretching and ice. A wall or stair stretch can be performed 6-8 times per day, each time performing 3 repetitions and holding the stretch for 30 seconds. The stretch should be performed with the knee straight and at a 45-degree bend. The stretch should be to the point of mild discomfort, not pain. At the point of pain, the muscle contracts to protect itself, shutting off blood supply to the healing muscle, which is counterproductive. Gentle early stretching will allow the healing tissue to have a more flexible state.  Otherwise, the inflexible scar tissue that develops can lead to an area vulnerable to chronic pain and recurrent injury.

Use of an anti-inflammatory, depending on the dose, can act as either a pain reliever and/or an anti-inflammatory.  Acetaminophen can offer pain relief without an anti-inflammatory effect.  Neither one offers increased healing potential; only time and avoiding re-injury allow healing.

Use of a heel lift/cup or walking boot will decrease the stress on the injured area and potentially decrease the pain felt with walking. Some people also find a compression sleeve to offer relief from pain. Forty-eight hours after the injury, heat can be added to increase blood flow to the area. This should be followed by ice to keep the swelling down and it is very helpful to perform some stretching between these two modalities. Ballistic activity and strengthening should be avoided during the immediate post-injury time frame.

After two weeks, ultrasound, electrical stimulation, laser therapy and/or massage can also promote blood flow and help to lessen pain. Not every individual responds to every modality, and treatment needs to be individualized.  As pain allows; a slow, low impact activity for a short duration of time can help to loosen up the muscle, promote blood flow, and maintain strength. Such activities include walking, light jogging, Nordic track ski machines, water running, swimming, flat biking, elliptical, etc.  After the activity, stretching and ice are beneficial. A calf-strengthening program should be initiated prior to return to running. In general, mild-moderate calf injuries resolve in 6-8 weeks, severe ones may take 6 months or longer.

Unfortunately, chronic injuries may require avoidance of the offending activity for up to a year and even then there is no guarantee of success. Many times a vicious cycle is initiated when a short duration of time is taken off and symptoms resolve, only to immediately return when running is re-started.  A more realistic goal might be avoidance of the aggravating activity for a 4 month period of time. During the time off, cross-training with any activity that does not reproduce symptoms is acceptable. A stretching and strengthening program should also be maintained. In addition to the modalities mentioned above, two others have been extremely helpful in chronic injury. Both Astym and Dry Needling with or without electrical stimulation have resolved chronic problems.  

Upon return to running, a very slow and gradual program, avoiding hills and sprints, needs to be followed. The 10% rule would be appropriate to institute and starting with distances of 1 mile every other day or two may be required. While a calf sleeve or compression stocking might feel good, there is no supporting evidence that they prevent re-injury. While a heel lift/cup will take some of the strain off of the calf, it can also transfer weight to the forefoot and care should be taken to monitor for a stress fracture of the foot. Again, time off from the offending activity seems to be the biggest predictor of resolution of chronic calf injuries.

Hopefully, these tips will get you both back to running pain-free. If symptoms persist, do not hesitate to consult a primary care sports medicine specialist.

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date: November 16, 2010