All older runners (but especially men) are at an increased risk of calf strains.  This week, I noticed that my left calf was feeling a bit ticklish, so I thought it was prudent to talk about how to avoid this catastrophic injury.

Okay, “catastrophic” might seem like a bit of hyperbole but it isn’t.  A calf strain can pretty much destroy a season if it comes at the wrong time.

My Tale of Zofingen

Last year, I qualified for TeamUSA in the ITU Long-Course Duathlon, which was hosted by the world’s premier long-distance duathlon series championship, Powerman Zofingen (or “PMZ” for the Powerman cognoscenti).  PMZ is to duathlon what the Ironman World Championship in Kona is to triathlon.  It’s also ridiculously hard.  It starts with a 10K trail run that opens with a sprint up a 15% grade hill.  Then on to a 90-mile bike, which comprises three 30-mile loops of climbing (including the famous Bodenburg), and ends with a 20-mile super-hilly trail run.  Search Google for “top 20 triathlons to do before you die” and PMZ is invariably on the list– and it’s not even a triathlon.  The race is legendary.  Mark Allen called it the hardest race he ever did.  Kenny Souza bailed out on the Bodenburg and had to be nursed back to health.  Yeah, it’s that tough.

I had trained all year for the rigors of the race.  For those in the Seattle area, this included brick repeats that included a six-mile run up Montreaux in Issaquah, two bike loops (60 miles total) that included Zoo Hill on each loop, and a closing 6-mile run that ran up Montreaux again.  For those of you not familiar with these hills, let’s just say they’re “challenging” with good long stretches at 15+%.  I went to Switzerland for the race.  Then, I took a run around the opening 10K course at a stupidly easy pace (barely more than a walk).  The course was pretty badly marked so I had to guess about where to go next.  I came to an open park, looked to my left for the next turn, and BAM!  My right calf had gone from “fine” to “not fine” in the space of two strides.  I had to limp all the way back to the hotel.  I called my PT back in Seattle and discussed my symptoms.  I had a grade 2 calf strain and, unless some miracle could save me, my race was done– three days before it even started.  I kicked myself for not having my Compex EMS and there was no way I would be able to get one in time (even though they’re made in Switzerland).  So for the next three days (including race day), I studiously avoided anything to do with the race and became a tourist.  I was super-disappointed but I have to say Switzerland is a great place to be disappointed.  The trains run everywhere and I got to see some amazing sites I would have never seen had I done the race.  Not exactly the end of the world.  Here’s a panoramic shot that I took on race day from Gornergrat with the Matterhorn on the right side playing peekaboo with a cloud.  Nevertheless, my hopes and dreams for a year were smashed.  So, yeah, calf strains can be catastrophic.

Getting a Little More Specific

Simply knowing that you have a calf strain is about as informative as saying “my leg hurts.”  Calf injuries can occur either in the achilles tendon (for a future post), the gastrocnemius, or the soleus.  The gastrocnemius is easy to identify– it’s the two large lumps (one medial and one lateral) at the top end of the calf.  Below that is the Achilles tendon (center) and the lower portion of the soleus muscle fanning out to the sides of the Achilles tendon.  The soleus muscle also runs under the gastrocnemius muscle, thus complicating a diagnosis of the injury.   In general, if it’s above the “lump” and it came on suddenly (no ticklish feeling before the run), it’s likely a gastronemius injury (soleus injuries tend to come on more slowly).  Gastrocnemius injuries tend to come on suddenly and heal fairly quickly but are at a high risk of re-injury.  In the case of my PMZ calf strain, I definitely had a gastrocnemius strain– it came “out of the blue” and was in my upper calf.  While it (eventually) healed quickly enough for me to race Duathlon Nationals a month later, it wouldn’t heal in three days for PMZ.

At first glance, you might think that calf injuries happen during the toe-off phase of running.  After all, this is when you’re plantarflexing (pointing) your foot the most and tightening your calves.  This turns out to not be the case at all– in reality, EMG studies show that the calf muscle is most active when the foot first hits the ground and in mid-stance as the foot begins to sweep backwards.  In some senses, this finding makes a lot of sense.  Most of the energy that our legs put into running is reactive energy return– they are like springs that absorb energy and release it later in the running cycle.  A major component of that involves the calf muscles, which goes through an eccentric contraction (muscle is simultaneously lengthening and resisting that lengthening) and then a concentric movement (shortening and tightening) energy return.

Entirely Different Theories on Calf Injury Treatment

Up to this point, we have general agreement on calf injuries.  Where we go from here is a different story.

On the one hand, the first idea that immediately comes to mind is to treat the calf as a part of the organic whole and consider preventing calf injuries by looking to the hips and glutes.  While I think that the hips and glutes are critical components of running, need to be addressed in any good injury prevention program, and are generally weak spots with most runners, I disagree with the idea of looking as a way to treat a calf strain or even prevent one.

Another theory is based on clinical observations.  Specifically, the guys over at Inform Running have noticed that most athletes with calf injuries tend to be weak at the high-end of the calf raising movement.  They found that some athletes would get calf injuries repeatedly even though they could do normal calf raises until the cows came home. If you fall into this category, you’ll definitely want to check out what they have to say.  Also, they found that, despite what most of us think, most of us have plenty of calf flexibility.  So, before you go and stretch your calves like crazy, check out their test to see if your calves are already flexible enough.  As useful as their high-end calf raise exercise is, however, I disagree that it should start from a level surface and focus primarily on the top end range of motion.

What’s My Take on What to Do

Knowing that the calf muscle in running engages primarily in an eccentric fashion, it makes sense to me that calf raises need to include the eccentric component in addition to just ordinary calf raises.  Also, calf muscles (particularly the soleus) have notoriously long endurance, so it helps to pre-exhaust them.  Lastly, during the stance phase, the ankle goes through more dorsiflexion than when standing straight up, so some heel drop is in order.  Here’s what I do.

• Put the ball of your right foot on a step and do one set of bent knee calf raises to exhaustion.  Be sure to drop the heel somewhat.
• Shake out the leg and immediately go into straight knee calf raises to exhaustion.  Again, drop the heel at the bottom of the movement.
• Shake out the leg.  Now use your arms on the rail and hold yourself up so you can point your right toe as much as possible.  Slowly lower down on the right foot until your heel drops.  Try to go as far down as you can comfortably go.  Repeat this at least 20-30 times.  Keep a tiny bend in the knee– a bit like when you’re actually running plus a little extra.
• Repeat with the other leg.

In a straight leg calf raise, the gastronemius and soleus are both involved, while a bent knee calf raise uses primarily the soleus.  Doing bent-knee calf raises first knocks the soleus largely out of the picture for the straight leg calf raises that follow– enabling better engagement of the gastrocnemius.  This routine serves to pre-exhaust the calves for the eccentric work that comes next.  While both the RunnersConnect site and Inform Running advise doing both bent and straight knee eccentric work, I prefer a compromised slightly bent knee.  I find that too much of a bent knee combined with dropping my heel too far causes some impingement of my talus bone (a vague pain felt at the front of the ankle joint).  In addition, the eccentric portion of the exercise really gets the source of the injury, so it makes sense to replicate the bodily position as much as possible to keep the exercise functional.

Another great exercise that I like to do gets at both upper-end calf weakness is “toe walking”.  While this is really an exercise geared towards plantar fasciitis, it addresses the eccentric contraction of the soleus muscle just fine.  As the Gait Guys point out, it can also be tweaked to assess the peroneal muscles and to help strengthen them in a functional ways.  Here is a video that describes these variations.

When Can I Return to Running?

If you’re unlucky enough to actually get a full-blown calf strain, recovery can be a real pain.  Calf strains, as mentioned above, can hit you completely out of the blue– and no where is this more true than during your calf injury recovery.  There are stories of folks who have this injury for months and months because they make the return to running too abrupt.

Here’s the safest quickest way to get back to running.  First, don’t even consider running until you are completely pain-free and have started your strengthening program.  Ideally, you want to have hit the injury as much as possible with an EMS machine on a recovery setting during this time.  Then, take short walks (less than a mile) with short running spurts built into them.  Lengthen out overall workout while also lengthening the running spurts and shortening the walking portion each day.  If you do this slowly enough, you’ll be back to running fine.  Here’s a great article from Running Times that describes the process.  I would highly recommend using an EMS machine during this time because, even though you may not feel it, you’re body is calf muscle is dangerously close to blowing out so you want to get as much recovery as possible.

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