Depressed with calf pain

[ambiguousnature]

hello forum,

i have never used one of these before, but i am anxious to see if i get any reply that may help me. i run in the mountains here in scottsdale. trail runs of 5 -10 miles at a pretty heavy pace. i DO push myself to hard, long time problem, but i have learned SO much recently about how to prevent something like this from happening again. ok, so i have had a nagging pain in my lower left calf for 3 1/2 months. directly in the middle in the back of my calf about 4 inches above my ankle. i dont recall any specific pop or pain that triggered it. i am in good shape and i am not overweight. i never had swelling or bruising. i have done RECIEPT for many weeks. it seems to vary in pain, but always is there nagging me. i have done an extensive search through the internet. i have no problems stretching it. i have taken vitamins, bananas all the time, arnica, etc. i have had 3 massages targeting the area and reflexology. i am a server at a restaurant and i am on my feet about 35 hours a week. i have not ran since this occured and i am very depressed because of it. running is my favorite friend as sad as that sounds. i cant think of anything else to add at the moment, but if you have any questions about my injury please ask. thank you soo much for your time.
bobby

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[physiobob]

Sounds like a calf strain. Probably at the musculotendinous junction and most likely from the deeper muscle soleus. Try some calf raises on a step with a bent knee (about 10 degrees) as this hits that muscle. Focus on control of the down movement more than the rise onto the toes. Progress to rising up on straight knees, then bend them ad lower bent, repeat. 15-20 reps. Then reverse, up bent knees, then straighten and lower straight. Basically get used to swapping ebtewwn the two.

If you must run try a heal lift or running shows with a higher heal section to reduce the stretch. If there's no progression go see a good sports PT.

[junglejim]

Hi there,
I'm not a qualified physiotherapist so I wont be able to give you such advice as to diagnose your problem.
As a Personal Trainer and runner myself, my only help I can give you is to maybe assess your running style and what footwear you are using. If you are continuing to run with the pain, make sure use the RICE method straight after.

Sorry I cant be of much more help to you

James

[ambiguousnature]

Thanks physiobob,

i have already started the exercise. i was worried weight lifting could further injure it. i wonder though, how long before i should notice a progression. i ask, mainly, because i don't have health insurance and unfortunately cannot afford a PT. also, are there any other exercises you could recommend? and are there any that are unsafe? again, thank you for your time! i wish i could express through this keyboard how grateful i am for your help!

bobby

[physiobob]

In terms or frequency do this routine at least twice a day. Use body weight initially and then, a pain resolves, progress to loading the calf more, either in the gym with a calf raise machine or wear a back pack with something in it.

We could chat on forever with various gait retraining exercises, stabilization etc. etc. suffice to say that this is not really what this forum is for right now. It should lead you to some questions to investigate with a health care profession. Perhaps see if you can afford one or two massages, perhaps off yourself up as a guinea pig for a local massage school (a well kept secret out there for everyone).

It is normal for the first few days doing this exercise to feel like the area has been worked. You might still feel some pain however the sharpness of any tear should begin to resolve. One other thing you might do is some neural stretching for the nerves that ran down the back of you leg. Just sit on the floor with your legs straight out in front of you (straight knees). Loop a belt or strap around the feet so you can pull them towards you to pull/bend the feet towards you. You should feel a pull in the back of the knee and upper calf. This is a neural stretch. You can vary the amount of slumping in your spine and neck to further tension this as well. Have a play around with it and you'll see what I mean. On this exercise you can hold for about 20-30 seconds, don't bounce for now with it and don't do more than say 3 reps, once or twice a day as the nervous system can be a bit sensitive.

Lastly, the investment of one session with a physio for assessment and a plan for a 4-6 week period is well worth it. You don't have to commit to a series of treatments. Best of luck

[physiomitch]

Hi there

Firstly Physiobob ....no disrespect, but can you tell me how an injury obviously caused by overuse can be treated by further overuse/exercise. I fail to see the logic there. In one sentence you say it 'sounds like a calf strain' then you say do 'calf raises', like treating pain with more pain??

Ambiguousnature...Personally I think too mujch focus is being put on the calf, in the majority of cases calf strains/pain are a result of poor hip muscle balance, often a result of overuse. The overuse manifests in the sympathetic nervous system first, causing fatigue of the nerve cells, thus altered blood flow rate to the lower limbs. This results in hip muscle weakness and this weakness is compensated for by the calf muscles as they have to do more work to push off the load than normal. This leads to calf strain. My suggestion is to find someone who can assess your hip, knee and ankle strength, find where the weaknesses are and correct them with myofascial release massage as well as treating the sympathetic area related to this type of injury, namely T10 to L2. Calf strains are very seldom isolated, commonly victims of higher imbalance. Rest and treatment is essential at this stage, not more exercise...you wouldn't drive your car with one cylinder not working would you?

PS about the depression if this is a serious comment you made, you may find you have an underlying circulatory fault and thius again lies in the sympathetic nervous system> Generally if someone says they 'need' to run, then there is a fundamental fault, the running being the 'drug' to get the blood flow rate up. Have the sympathetic nervous system assessed and see if there is fault there, maybe you will not havt to push yourself too hard in the future.

Cheers

[physiobob]

Hi there

Firstly Physiobob ....no disrespect, but can you tell me how an injury obviously caused by overuse can be treated by further overuse/exercise. I fail to see the logic there. In one sentence you say it 'sounds like a calf strain' then you say do 'calf raises', like treating pain with more pain??

Hi there, thanks for the further comments. In response:

I believe this individual is a regular runner who has been pretty much running injury free for sometime. To assume it is an overuse injury would be to simple (although in part might be accurate in terms of the biomechanics). e.g. Fatigable weakness in one area of the gait cycle causing the calf to become strained and therefore injured. Having not seen the client I can't really say suffice to say that this would indicate there's actually nothing actually wrong with the calf, it just reacted to the problems elsewhere.

This injury is also 3 1/2 months old and so it is not an acute injury at all. He rested and iced etc and perhaps unfortunately did not perform and calf exercises during the few weeks after the acute phase. Muscle and tendon trauma does not tend to heal particularly well, in any form of elastic/flexible type alignment, unless gentle tension along the normal line of force is applied during the healing phase. This is not a notion of overuse but rather one of normal use. e.g. body weight calf raises rather than 400m hill repeats. Once this is pain free the weight can be increased. It is still no where near and overuse level of exercise as it is still much less of a load than light jogging would be.

The majority of calf issues I see result from poor mechanics. Importantly in that is the ability for the gastrocneuius to 'hand over' to the soleus during eccentric ankle flexion. This imbalance of control leads to jerky movements often within the achilles tendon structure and also to the musculotendinous junction. It is therefore important to assess this and treat this as part of the initial and ongoing treatment plan. Even if it is perfect it is still a useful training exercise to build strength in that movement synergy.

If one neglects this assessment in the early rehab phases then it is likely that the repaired tissue will be inextensible under load, some of the causative factors will remain and the individual will retear sometime again soon.

The overuse manifests in the sympathetic nervous system first, causing fatigue of the nerve cells, thus altered blood flow rate to the lower limbs. This results in hip muscle weakness and this weakness is compensated for by the calf muscles as they have to do more work to push off the load than normal.

This is of course a good point and as I mentioned the assessing of the biomechanics and their rehabilitation are beyond the scope of a forum. Discuss it yes however this needs a hands on and visual approach to assessing and working out what is missing for that individual..... no recipies there without seeing first. For example - He might consider the stability on the opposite hip for example in relation to how heavy a landing he gets on the injured side, or how externally rotation he lands on that side due to overactive gluteus max on the opposite side, which is due to fatigued or poor glut. med activity. i.e. his problem on the right calf could have everything to do with a problem on the left and vica versa!? We could all go on like this for hrs as it's a great area to be involved in.

Please do discuss biomechanical considerations if you like but please don't say they definately apply to this individual. All discussion information placed on this forum should serve only as a guide and idea generation pool for the people reading them. They should then take this information with them to an appropriate health professional in their local area for assessment and a treatment plan.

[linbin]

hi
i feel the contributing factors for this calf pain could be overactive medial hamstrings
calcaneal everted position etc.according to the description of the site,its seems in the muscultendinous junction of calf.
i also agree with physiobob of the probability of involvement of soleus.

[physiomitch]

Thanks for the feedback Physiobob, I agree with your comments, however, I would put my you-know-what on a block and stick by my diagnosis as much as it is difficult not having any more details. I have just seen so many of these cases and the bigger biomechanical picture is commonly missed. Anyway I will refrain from making positive dignoses, as generally it is not my way, but having lectured to many Physios in the past I know what the common approaches are and they commonly miss out on basic biomechanical and physiological foundations, which are the initial cause of these types of injuries, where the injured area and its nearby areas are focussed on to the detriment of a possible original imbalance somewhere else.

Thanks again for the great forum

Cheers