Calf Pain; can I keep running?
This time of year we start seeing a lot of runner's in our clinic as the Auckland Half and Full Marathon approaches, and around about now, as the Km's start increasing so does the calf pain and the question is asked....can I keep running?
Let's look at the calf anatomy...the "calf muscle" refers to the gastrocnemius muscle and the soleus muscle. The gastrocnemius muscle is the more superficial muscle and has a medial and lateral head that arise from the femoral condyles (above the knee).
The soleus muscle is deeper and arises from the upper fibula and medial tibial border. These two muscles have a joint tendon: the Achilles tendon which inserts into the calcaneus (heel).
There are of course other smaller deeper muscles that can not be ruled out as causing pain such as: tibialis posterior, flexor digitorum longus , peroneus longus etc... but we will only be looking at the two main muscles.
The most common cause of calf pain is injury to the musculotendinous junction (the area where the muscle joins the tendon), for example a sudden burst of acceleration may cause injury to this site. Some people may experience intermittent episodes of cramping which may be due to recurrent minor calf muscle strain, which are the result of inadequately rehabilitated scar tissue. We cannot rule out referred pain from the lumbar region as well as neural structures should always be considered.
Grading of calf strains can help distinguish treatment protocol and time it may take to return to running or to your sport. Remember this is a guide only, some people take less time to heal and others may take longer. Often it depends on how you treated the injury at the beginning...did you ice it? Did you stop running when you felt it "go" or did you try to continue? Did you seek professional help early on?
Grading of Calf Strains (Clinical Sports Medicine, Brukner & Khan 2002)
| Grade |
Symptoms |
Signs |
Average time to return to sport |
| I |
Sharp pain at time of (or after) activity, may be able to continue |
Pain on uni-lateral calf raise or hop |
10 - 12 days |
| II |
Unable to continue activity |
Active plantarflexion pain(point toes)
Significant loss of dorsiflexion (toes up)
Bi-lateral calf raise pain
|
16 - 21 days |
| III |
Immediate severe pain at musculotendinous junction |
Thomson's Test positive
Defect palpable
|
6 months after surgery |
Treatment of Calf Pain
- How you respond to the initial pain or strain may well determine your recovery time.
- Make sure you ICE as soon as possible to reduce pain and swelling, and keep icing over the next few days.
- Depending on the Grade of strain, gentle stretching to the level of a feeling of tightness is ok after 24 hours.
- Seek professional help (Physiotherapy) within a couple of days if the pain hasn't subsided; they will be able to diagnoise what Grade strain it is or if there is anything else happening and advise you of the best rehab protocol.
- If it is only a Grade I, massage therapy can be started after a few days. This may be only light but the increased blood flow and re-aligning of muscle fibres will help with the healing process.
- Muscle strengthening should start after 24 hours (Grade I, no pain), which involves a progression of exercises starting with bi-lateral calf raises, moving on to uni-lateral calf raises then adding weights then progressing on to eccentric calf lowering over a step.
It totally depends on the Grade of calf strain as far as the amount of activity you will be able to do, you may be able to have the calf strapped to continue running or you may go on to aqua-jogging or cycling in the early stages of rehab just to keep you moving. Anti-inflammatories may help also.
Having regular massage during your training is extremely beneficial because it keeps the muscle fibres aligned and we can often catch small niggles before they become injuries. Massage also flushes out the metabolic waste such as lactic acid which then keeps the legs fresh for training and your next big event!
If you have any questions please don't hesitate to call us here at Balance!
For the ultimate package for runner's...go the Athlete's Pit Stop 4 x 40 minute massages (one a week) for only $255 (pre gst rise)
Reference: Chris Bradshaw; Clinical Sports Medicine 2nd Edition, Bruckner & Khan.
|
