Training & Racing

Running Injury Redux: A Calf Strain Raises Old and New Questions About How to Recover and Whether to Run

14 Comments Posted by: Sarah Lavender Smith, August 3, 2011

I ran only twice in the past week, and both times felt great—for about four minutes.

I loosen up my stiff lower leg, get into a rhythm and think yes, it’s OK! I’m back! Half-mile warmup, so far so good. And then, my calf starts protesting. While my right leg feels light and springy, my left calf feels extra heavy, as if someone implanted a five-pound weight under my skin. The heaviness feels like cement starting to harden and then the cement starts contracting, like a phantom reaching up from the ground to grab the back of my leg. It’s not exactly painful in a sharp ouch! kind of way. Rather, it’s a dull yet distinct discomfort that radiates and hurts the way a bruise would hurt if you whacked it repeatedly. It hurts less when I heel strike, more when I land on my midfoot, so I start running in a low-impact, heel-striking way that makes me feel like a duck waddling. It hurts more anyway. Ten minutes into the run, I give up, convinced I’m doing more harm than good and pissed that I may have erased any progress I’ve made in healing what has been diagnosed as a Grade 2 calf strain.

I’ve been running a pretty long time, and I’ve been through a lot of injuries (see previous post 5 Truths About Running Injuries). I’ve got a sports doc and physical therapist advising me. And yet, I remain confused about how exactly to work through this and return to running. And I’m frustrated as hell because I feel motivated to train hard and had a favorite 50K scheduled this weekend. Those plans are on hold, and my fitness diminishes a bit more each day.

That’s why I’m reaching out here for advice. My past injuries were bone, joint, foot and tendon related, so I’m puzzled and discouraged by this garden-variety pulled muscle. I’d really appreciate tips in the comments below on how and when to return to training.

Here’s the timeline of what happened and how I’ve treated it so far:

June 9: I line up at the start of the Woodminster XC 9-mile trail race, the last event in the East Bay Triple Crown Series. It’s a tough, hilly course. I’m pumped, I want to go all out. I take off. Twange. About 200m in, I feel a tweak in my calf that distracts me. Uh-oh. I ignore it and it doesn’t bother me. I have a super race and cross the finish line celebrating that I won the series. And then, a couple of minutes after I finish, I experience a spasm in my calf like I’ve never felt before. My muscle seizes up so badly and painfully that I can’t walk—I have to hop on one leg and then limp.

This shows me June 19 celebrating with my friend, Christine Chapon, after I won the open division of the Triple Crown trail series and she won the 50+ division. At the time, I could barely put weight on my left leg because of a calf spasm.

I ice it, take Advil and take two days off. Thankfully, the problem seems to melt away. Three days later, during our trip to Ashland, I enjoy a pain-free tempo trail run followed by a 20-miler the next day.

June 27 – July 18: Three great weeks. Weekly mileage is 45, 52, 40, plus gym workouts. A little speedwork. Lots of mountain running/hiking while pacing at Hardrock in Colorado. Strong and steady 22-mile trail run July 16.

Tuesday, July 19: Midway through an early-morning easy run around our neighborhood, my calf seizes up again. It starts gradually as a stiffness and then suddenly cramps and spasms as badly as it did at the Woodminster race. I walk and limp a mile and a half back home.

Wednesday, July 20: I have a running date I can’t break. I’m working on a freelance piece about the one and only Dean Karnazes, and I plan to interview him while running. No way I’m gonna break that date. My lower leg feels good enough to go. We run for just over an hour up and around a hill next to Mt. Tam. My calf starts screaming but I ignore it. By the time I stop, I’m limping but pretend I’m not.

I ran on my bum calf because I couldn't miss the chance to run with Dean Karnazes.

I take a couple of days off and cross train. I think I’m OK.

Sunday, July 24: I’m stoked to get in a four-hour training run with my buddy Dave La Duc. We meet at Big Bear staging area in Chabot Regional Park and head up the MacDonald Grade. Right away, my calf starts bothering me. We walk up the hill to warm up more slowly. Running down the backside of the hill, each footstrike bothers it more. On the flat stretch of the Brandon Trail, we pick up the pace. My calf starts to seize up. Four miles and 40 minutes into it, I’ve gotta stop. I’m so mad—at myself and the situation. I leave Dave and walk the four miles back to my car. Walking is OK—the calf stretch on the uphill feels good—but the second I start to run, the impact hurts the whole calf area.

Monday, July 25: My sports doc Melvin Huie in Orinda feels a lump almost the size of a golf ball in my calf where an accumulation of traumatized tissue has formed an adhesion and is restricting the normal movement and elasticity of the muscle. He diagnoses it as a Grade 2 calf strain in the gastrocnemius—partial tearing of the muscle fibers—and gives me a referral to the PT I’ve seen many times in years past and highly recommend, Tammara Moore at Oakland’s Sports and Orthopedic Leaders.

Tuesday, July 25 – Tuesday, Aug. 2: I see Tammara three times. She performs Active Release Technique—a therapy that involves very deep, specific massage to break up the knotted scar tissue and get the blood flowing to the area to promote healing. She tells me my muscle is like a stale piece of Bazooka bubble gum that needs to be chewed until it’s smooth and elastic. It hurts like hell, and I don’t think I’ll ever want to chew a piece of Bazooka again. She also puts black SpiderTech tape up my calf, which looks ridiculous, like I’ve been tattooed with a pitchfork symbol.  I don’t feel like the tape does anything, but she swears it helps.

Throughout the week, I also do lots of icing and PT exercises, with a focus on my butt. Tammara tells me my glutes are the king of the core system, and if they’re not doing their job, then the calves and other muscles work overtime. I typically do lots of core work, at least three times a week, but I tend to focus more on abs than glutes. OK, I get the message—now I’m working my ass off. I’m also riding the stationary bike and lifting weights as much as I can stand, which isn’t much. (Why is it that I can go out and run for four hours blissfully, but riding a stationary bike for 40 minutes feels like pulling teeth?)

So here I am on Wednesday, Aug. 3, confused about when and whether to try easy running again. The spot on my calf where the tissue was knotted up still feels very tender to the touch. Sunday and yesterday were the two days I did a 10-minute test run and quit. What more can I do that I’m not already doing to speed the healing? When should I test out running again? Tammara says I have to wait until I have full range of motion, can do standing single-leg heel raises pain free, and can push off and land while running without pain. Makes sense. But “pain” is a relative term. Returning to running after time off always feels “uncomfortable” to a certain degree. The tricky part is gauging when discomfort crosses to a level of pain that is detrimental.

I know I need to be more patient and take the long view, but that’s not something I’m good at. Objectively I realize that injuries are part of the learning process—part of the trip—on the road to becoming a better athlete once they’re healed. But I just want to speed through this lesson and pass the test.

Postscript

After writing that this morning, I saw Tammara at PT and she gave me more guidance about when and how to return to running. No running–zero–for at least three weeks. I need to be able to hop on my bad leg repeatedly (which I can’t do now) before I can even think of high load-bearing exercise like running. Then, when I start running, she recommends intervals of one minute running, one walking, gradually building up. She says I likely re-tore it on my test runs and I face the risk of this injury becoming chronic. Lesson learned.

Your Comments

14 Comments so far

  1. Jenny says:

    There’s nothing a PT loves more than a stationary bike. And I might have to join some gym in order to make use of one for the next couple of months. Although we have different injuries, much of the advice is identical: bike, ice, Advil, and somehow develop J-Lo’s capacious ass for more support.

    As for the impatience, I completely relate even though we’re enthusiasts of different exercise genres. I feel like my body (and, for some reason, brain) is turning to mush and there’s nothing I can do.

    So hang in there. It will get better. Just take it one day at a time and try not to think about the stuff you’re missing while you’re healing.

    • Sarah says:

      Thanks Jenny [my friend from college who just tore her meniscus on dismount from static trapeze during a circus show] — I wish you were up here so we could work out together and you could laugh at me as I look like a dork trying to aqua run in the pool!

  2. Andy Black says:

    Hey Sarah,

    I can relate to your current injury–2 years ago I experienced my first calf strain, from out of the blue. I’ve been running ultras for more than 10 years, and never had anything like it before.

    My Kaiser doc pronounced it a gastroc strain. Unfortunately, I didn’t find any therapeutic modality that helped very much. Lynn Schankliess (now Lynn Hartnell) was my PT (she’s an ultrarunner); she used Graston Technique, and assigned a lot of hip strengthening exercises–she said muscle imbalance was the root cause of the injury. On my own, I also tried ice, self-massage, and EMS. (I never had a big knot in the muscle like you describe.)

    I tested the calf every few days, but the “pulling” sensation would start after a few minutes, and I simply could not run after that. Power-walking and hiking, and long bouts on the elliptical trainer were my main exercise.

    Anyway, slowly, VERY slowly, the pain and pulling in my calf eased, and I was able to run again, after more than 2 months. I definitely lost some running fitness during the layoff, despite the cross training.

    Prior to this, I had been able to train through most every injury I had, at least a little bit. But I simply was not able to run with a calf strain.

    The worst part was that I suffered the same injury, with a similar layoff, about a year later. In my case, the calf strains have come on without warning, and don’t seem to correlate with particularly heavy training or racing.

    I hope you have a much quicker recovery than I did, but if your experience is similar to mine, it will require a long rest before you are ready to run. I’ll be watching to see if you get any good advice, or discover any miracle cure. Maybe I’ll see you out in the East Bay hills or on Mt Tam…

    best regards

  3. Sarah says:

    Andy, I so very much appreciate your perspective and advice, as sobering as it is. You’re echoing what my PT told me today. BTW she does Graston too in addition to ART.

  4. John Nguyen says:

    My injury was different from yours, but you might benefit from the treatment that finally resolved my problem – a tear in the soleus. I had gotten some ART treatments and then electro-myopulse/ electro-acuscope in Palo Alto, but my injury kept coming back. Then I found a Chiropractor who did about 4 Graston treatments on it before referring me to Amol Saxena, a well known podiatrist at the Palo Alto Medical Foundation. He ended up giving me 3 ESWT (Extracorporeal Shock Wave Therapy) treatments over a few weeks, which seems to have helped me fix my injury for good. Good luck with your healing and recovery!
    John Nguyen recently posted..Grace Report: A Birth ReportMy Profile

  5. Phil Slimko says:

    Oh man…in my mind a calf injury can be the biggest pain in the…some injuries you can muddle thru but not a calf muscle.
    Shoes an issue?
    Don’t let the impatience influence you to come back before you’re really ready.
    Good luck and get betteer soon

  6. Robert says:

    I’m going through the same process and it has now been 4 months. I was coming off my first first major running injury in May when my calf seized up during a run. It starts with a dull pain and a slight tightness. Usually it seizes up completely within the first 5 minutes.

    Through trial and error I have found a way to run after a day or two. I get on a treadmill and put the incline at 6+ and run sound 20 minute at 4mph (hard to run at that speed but try to run with good form). I take it up to 5 mph for 10 minutes and stop. Every day I increase the speed by 1 mph and increase the length of the run. With any luck within 10 day I can hold a 9 mph for 1:30.

    I’m currently on my third cycle of rehabbing the calf and hope to be running tempos in a week. I’m convinced long trips of over 7 hours are causing the relapses. Every occurrence was preceded by a long trip. Just last week I was feeling great and hoped to be in 33 min 10k shape by years end when it hit me again after an 8 hour bus trip.

    The best of luck and I’m sure we will both be running fast again.

  7. Paul says:

    We are such addicts :) Injuries do suck and the best treatment i’ve found so far is rest and acupuncture. OMG. How i love acupuncture!
    Paul recently posted..More Cove HandjobMy Profile

  8. Ralph says:

    I’ve had this for 3 years in both calves and have tried everything. Everything…. Physio, 3 months rest, electroshock therapy, myofascial release (ART), orthotics, then threw those away and tried minimalist shoes.

    All this works. But then wham, it comes again.

    I have thought about compartment syndrome, but I don’t get any real pain, just that nagging strain (which is I think almost a constant now, but gets worse before I wake up one morning with knots.

    Latest: I’m going for an MRI on the 21st as I’m now thinking: sciatica…

    Will keep you posted

  9. Wendy Scott says:

    I am 3 weeks into a grade 2 calf tear, googling the topic when I ran across this post. This has been the most helpful posting I have found.
    I tore it playing volleyball, saw the doc and confirmed with an MRI. I was only on crutches one day, ice and advil. After a few days I was able to do the exercise bike. I was able to go on a 2 mile jog after two weeks, stopping every 1/2 mile to stretch. My only issue was “both” calves felt tight.
    Since I had been working out well with only a little tenderness and bruising I figured I was on track. At week 3, I decided to play in a softball game. The first play, I turned and my calf went haywire. I now realize it was seizing or a charlie horse. (another tear?) I couldnt run at all after that. I massaged it with biofreeze, took advil and went to bed. It was sore the next day, but felt like week 2 again.
    I have a 5k in 4 weeks and really need to train. (its an obstacle race)I also have vball and sball games scheduled. Do i stop all activity? Did you find that the spider tape worked? How about a calf compression brace?
    thanks for your topic posting and best of luck in your runs.

  10. Lynn says:

    Wow, everyone here sounds a lot like me, except I have been having recurring calf or soleus strains since about 2003… I cycle on/off running like a yo-yo dieter, and it kills me! I will be 50 this summer (female) and so need my running at this time in my life..for stress relief, for the joy and due to perimenopausal weight gain.
    The bad thing is, I have tried just about everything mentioned here and no one can tell me why this keeps recurring. I have found Repetitive Strain Injury(RSI) online and the concept is interesting. I get so stubborn abut it that I do walk/run intervals even when I have a full blown injury.
    I was set to run a half marathon this coming weekend when I got that little stab in my soleus while on a trip to Arizona on April 10. Since then, I am injured and had to back out of it.
    Some things that help me get better–soaks in a warm bath and stretching while in there, compression socks worn to bed at night.
    Other than that, I might try to find a PT who is also a runner who understands muscle imbalance and can see if that is the problem and how to fix it.

  11. Karen says:

    Yes I did mine 15 weeks ago, a soleus strain that I can’t shift. It’s so so frustrating as i love long 20+ miles at a fast pace off road. I can’t even bike or use the cross trainer. But it’s a good opportunity to build core strength and balance and upper body. I’m going to have to bite the bullet and go swimming.

  12. James says:

    37 days out from my first marathon and I’m running my first 18 miler (two days ago) and TWANG goes the left calf. I guess I’m glad it happened now and not during the big race. I’m going to get on the bike and stay off the roads, I think…
    James recently posted..18.2 MilesMy Profile


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Lake Chabot 30K, Feb. 22. Race report.
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Night Sweats Marathon, March 24. Related post
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My 2013 Race & Family Travel Calendar

mid-February: Telluride
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mid-April: exploring Vancouver for Spring Break
East Bay Triple Crown Series: Tilden Tough 10M May 19, Lake Chabot Half June 2, Woodminster 9M June 16. Short recap.
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6-day Maine biking trip, trip report.
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Pine to Palm 100M Sept. 14 Injured.
Berkeley Trail Adventure 50K Sept. 28. Finished 1st F!
Rio Del Lago 100 Mile Endurance Run Nov. 9 Injured.
Quad Dipsea, Nov. 30 Injured.

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