Calf strains - The old man's running injury
What is the Old Man’s Calf injury?
Running along, enjoying yourself with not a problem in the world and then without warning your calf muscle just grabs and brings you to a stop. Sound familiar. Two days later you feel like you could run again when you do it feels fine for a while. Does this rings bells, you are probably suffering from what many call “The Old Man’s running injury”.
What you have in fact done is suffered a strain to your deep soleus muscle. Your main calf muscle in your body is called your Gastrocnemius but believe it or not very few distance runners actually strain that. Power athletes and sprinters may get a true calf (gastroc”) strain but rarely a distance runner. Poor calf muscle strength endurance is a very common cause of many overuse injuries of the lower leg including chronic muscle strains.
Signs and Symptoms
As stated above the main symptom is a pain/tightness, usually in the upper inside part of your calf or in the middle where the muscle meets the start of the achilles tendon. The most important thing to note is it takes much longer to heal than you think. From my experience I tell people not to run for a month no matter how good you feel. You need to progressively strengthen the healing tissue by doing harder and harder exercises that more closely replicate running. As an example start with double leg raises then progress to single leg raises, followed by single leg over a step then double leg jumps such as skipping and finally hopping. If you are unable to hop comfortably on that leg 30 times without it feeling the same as the other leg then it is almost certainly not ready to run
How Does It Happen?
There are various thoughts on why the older athlete tends to have more issues with calf muscle problems. Basically all muscle groups become less resilient to high level stress as we age meaning soft tissue injuries generally are more common in the older athlete at lower intensity levels.
Our calf muscle works a lot when we run, working both to absorb shock on foot strike and to help in propelling us off the ground at toe off. The cumulative effect of this over years of running may leave the muscle with scarring from little micro tears that have occurred over that time and it is these weak points that fail in the chronic calf problems.
Others have questioned whether it is in fact related to the sural nerve that runs through the lateral head of the gastrocnemius muscle. This can be mobilised by a sports physiotherapist.
Below are some common factors that may increase your risk of experiencing chronic calf injuries.
· Training errors, particularly returning to running too early after an initial incident
· Pronating feet (flat feet) or uneven leg length.
· Running on a slanted surfaces or uneven terrain
· Calf muscle weakness. Especially strength endurance
· Calf Muscle tightness
· Ankle Joint stiffness ( Decreased knee to wall test)
How Do I Manage Old Man’s Calf?
The most important thing is to come back slowly. The number one mistake we see with anyone coming back from muscle injuries, especially in the case of calf strains, is coming back too soon. Calf / soleus strains have a real tendency to re strain and certainly aren’t ready to absorb the load of running until well after they first start to feel fine with normal daily living. If you can’t hop / skip for a couple of minutes you almost certainly aren't ready to absorb 5 kilometres of running
When ready to start doing some load definitely start with a reduced load. There is no bullet proof formula but run / walk about half the pace and distance to normal and increasing approx. 10 percent a week should be fairly safe. As a general rule if you can get through half a dozen runs building up to non stop running then you should be ready to increase toward full load. You certainly shouldn’t do any fast work in those first 6 -10 runs.
With your hands against the wall, place your leg to be stretched in front of you as demonstrated (figure 1). Keep your heel down. Gently move your knee forward over your toes until you feel a stretch in the back of your calf or Achilles tendon. Hold for 30- 45 seconds and repeat 4 times at a mild to moderate stretch pain-free.
With your hands against the wall, place your leg to be stretched behind you as demonstrated (figure 2). Keep your heel down, knee straight and feet pointing forwards. I often find this even better if standing on a ramp. Gently lunge forwards until you feel a stretch in your calf / knee of your back leg. Hold for 30-45 seconds and repeat 4 times at a mild to moderate stretch pain-free.
Slow sustained raises work best. Start doing double leg raises and progress to single leg raises once you can do 30 holding each one for 5-10 seconds. Walking around on your toes can also work well to build calf endurance. Just make sure you give your calfs a good stretch after holding the muscle in a shortened position for any period of time (figure 3).It is also important to do some raises with bent knees as well as straight knees ( figure 4).
Article written by Rob O’Donnell, Physiotherapist and Director of Southern Suburbs Physiotherapy Centre and former Australian distance running representative. Southern Suburbs Physiotherapy has clinics in 3 locations: 705 Centre Road East Bentleigh, 100 Lower Dandenong Road Parkdale and 99 Bay Street Brighton and there are physio’s with special interests in treating runners at all locations. For more details go to www.sspc.com.au