Help with Recurring Calf Strains/tears

[Chris Goodrich]

Doc Morris,

Could you offer some advice on overcoming recurring calf tears? I'm sold on barbell training as my primary focus, but I still have to do some amount of running for APFTs (and soon the ACFT). When I resume running I typically get DOMS and tightness in both calves, and have been prone to mild to moderate tears in my right calf. These typically occur with a wet pop when the ball of my foot strikes the ground, as the muscle is working eccentrically to absorb the load. Consultations with Dr. Google indicate it is the medial gastroc where I get the strains/tears, and they seem to reoccur in the same spot each time I pick up the running volume. I'm trying to apply the overall principle of progressively loading the muscle, but could use some help with the details.

1. Exercise selection and loading: Squats and deadlifts don't bother the injured calf, so I assume they are not working it in the range of motion where i have a problems. So far i have been using standing calf raise off of a step to increase the range of motion, and these definitely feel like they hit the injured fibers. Are there any other strengthening exercises you would recommend? On several running-focused sites i have seen recommendations to emphasize the eccentric, since running injuries typically happen during the eccentric phase of calf contraction. Example: performing the concentric phase of a calf raise bilaterally, but the eccentric phase unilaterally on the injured side only. Do you think there is any merit to this approach? Are there any set or rep ranges you find particularly effective?

2. Transitioning back to running: This is usually where I run into trouble, pushing the volume and intensity of running too fast. Besides hard-headedness, I think part of the problem is that walking doesn't load the calf in the same way as running; I have a heel-toe walking stride but a forefoot strike when running. The calf isn't really getting that eccentric, shock absorbing loading until I break into a run, and then the stimulus outpaces the rate of adaptation. I'm considering jumping rope as an intermediate way to load the calf. My theory is that this will load it in a similar way to running, but spread the load over both the injured and uninjured leg each step, lessening the load. Since I'm not very good at jumping rope, it will also curb my tendency to overdue intensity or volume. Can you give me an azimuth check on this plan?

3: Stretching/"soft tissue work": I see these recommended quite a bit on running sites for calf strains, and am generally skeptical. However, I see that tight fascia in the calves and runners compartment syndrome is a real thing. Do you think there is any value in these modalities?

Thanks very much for your time.

Stats:
M, 42, 205
Recent meet PRs: Sqt 177kg, Pr: 86kg, BP: 110kg, DL: 207.5kg

[Nick D'Agostino]

This is a great post, Chris. You clearly have done your homework and there is merit in all the approaches you have mentioned in your post. Doing calf specific work is a good idea. I would go from standing calve raises to the unilateral eccentric overload option you mentioned above once you can tolerate it. You can load these using a single dumbell if you want. As you get stronger and your load capacity increases, I would start to introduce dynamic loading. Jump rope, or pogo's (jump rope without the rope) are great introductory exercises for this. Lastly, I would start running. Lookup a basic plan online for running your first 5K. Google something to the effect of "training for 5K beginner plan." Look for something that is 6-8 weeks long. I'm sure the progression will be slower than you have been progressing yourself (this is why I'm recommending sticking to that plan, like a rev limiter in a car). That will be your running progression. When you reintroduce running, figure out what your natural cadence. I would focus on increasing your cadence by about 10%. There are apps that will make music to the cadence that you want. If this is a chronic recurring thing for you, switching to a heel strike might be an option.

[LimieJosh]

Are you purposefully using a front foot strike when you run or is that a result of your natural stride? If the former, surely simply eliminating this is the first and most obvious step to getting the calf problems to go away?

Secondly, do you ever wear flip flops? The thong type rather than the athletic locker room type ones? If so, stop.

Thirdly, I found soft tissue work of the lower calf and Achilles to have a lot of acute benefit in dealing with my recurring calf problems, even though the location of the actual injuries tended to be higher closer behind the knee. Sit on the floor and lay the affected leg between a loaded barbell and your other leg. While providing a little big of pressure from the top leg, move the foot around - up and down, side to side, in circles.

[Chris Goodrich]

Thanks for the very helpful feedback. i will swallow my pride and start looking at "Couch to 5k" programs and cadence adjustment.

[Nick D'Agostino]

You're welcome and good luck!

[Soule]

Prowler may be a good option for progressively loading the calves.

Do you get enough potassium from food sources?

A heel strike will slow you down big time. Perhaps more of a midfoot strike would help, but I really don’t know much about running.

Godspeed!

[Nick D'Agostino]

A prowler is another good option in the beginning stages of this rehab. I would not start worrying about potassium intake. Heel striking will make you slower as a blanket statement is also unfounded. Whenever you voluntarily override your natural tendency with internal thinking (in this example it would be thinking about what part of your foot makes contact with the floor), there will be a period of increased co-contraction, which will slow you down and make you fatigue faster. The co-contraction period is regardless of which direction you are switching. If the change in technique is a result of external thinking, the co-contraction period is eliminated. I outline the mechanism for this in my article for this site that I'll link below. The majority of studies looking at this use a metronome to focus the athlete externally to influence cadence. I don't know much about running either, but running-related injuries are the specialty of my mentor from physical therapy school. It is a peripheral interest of mine for this reason and the fact that so many people like to run and hurt themselves in the process (especially early on).

The Science of Verbal Cues | Nick D'Agostino

[Soule]

It is my understanding that a heel strike in running is the equivalent of “pumping the brakes” with every step because of the angle at which the foot meets the ground.

[Nick D'Agostino]

That is more along the lines of marketing from the running form people. A substantial percentage of high performing competitive distance runners heel strike. If you get into the weeds on this stuff, you find there are even different types of heel strikes. The mechanisms by which each foot strike propels you forward is different. The consensus is overstriding, regardless of foot strike, is more of a problem.

[Soule]

I read over the 2015 study which came out after any advice I received on running. You are correct about the stride length being the main factor. However, the advice to change from heel to mid/forefoot striking for me as a novice runner had an immediate and dramatic effect on my 1.5 mile PST times, but Its quite possible that this tip changed my stride length.