Yet another calf issue
Last year I had a full release of the gastrocnemius (sp?) of my right calf. That one was an acute issue- I fell, I felt the tear, I couldn't run more than 10 steps without it screaming at me. Took something like 8 weeks off with no running (hello pool running) did some PT exercises, and gradually got back to running again. No recurrence, all is good.
This time, it's the left calf and things are different. I don't remember a specific incident when this all started. But the calf feels fine for about 20 minutes of running and then suddenly tightens up, tugs, and feels like it's gonna pull. It doesn't really feel like it has torn, it's more like it has spasmed into a tight ball and if I run another step I will tear it. I took a little over a month off from running and recently returned very slowly. Last week I was elated to run 4-5 miles 5 out of 7 days with absolutely no twinges. Today I went out for what was supposed to be my vDot test and sure enough, about 18 min into the run I feel that twinge again. I had to walk home (well, limp is probably a better word) - I knew that one more step of running would have been disaster.
I'm sitting here now with it in a compression sleeve and I can feel it sorta spasming. Any stretching is painful. The pain itself is up in the meaty section of the calf, inside the left leg and more towards the front of the leg.
I know RICE is probably something I should be doing, but somehow heat sounds better (maybe it's the weather). I'm kinda at a loss for what to do next. My options for PT/ART/Sports Doc are super limited down here so any self-help ideas you guys can give me would be greatly appreciated.
Comments
Nemo, I'm no doc/PT/chiro, so take what I'm saying with a big 'ole grain of salt, but I have dealt with calf probs in the past.
It seems to me that a lot of calf issues fall into the category of "muscle went into spasm in order to protect you from actually hurting yourself". Usually, that spasm hurts like he!!, but not as much as it would have had it not spasmed.
If that hypothesis is true in this case, the best remedy is trigger point or foam rollering the spasm out. If it hurts to the point of causing tears, you're probably doing it right. But once the spasm is massaged out, I've had instances where I've literally been fine the following day.
I had one of those days two summers ago where 6 miles into a 9 mile run my calf went into spasm, and I walked a mile, and couldn't even contemplate the next two (had a neighbor drive me home to my house). A bunch of time with the roller and The Stick, and two days later I was running pain-free. Of course, my wife thought I'd lost my mind, but that's a different story
YMMV, since what you have may not be the same as what I did, but the similarities are close enough that it sounded like it might be worth a shot.
Mike
First, you should just move to New England already! I know this goofy PT...
Second, in between patients at the moment so will have to fully respond later. sounds more complex than a simple bad luck calf strain so will have to problem solve as we go to see where it's really coming from.
what kind of stuff do you have at home: roller? stick? tp ball? anything else??
Leigh- I've got the full armament of TP stuff (quad roller, TP ball, calf roller), a calf compression sleeve, tons of different ice strapping devices, and several Thera-bands. That combined with the Swiss Ball and I could practically open my own PT shop if only I had a Stim!
From a causation standpoint: you have mentioned more than once that you are freakishly small. Small people/women like to do cute things when they sit that screw with knees, hips, ankles and spines. Stop sitting on your feet! Short people cannot touch the floor with their feet often on couches, etc so they pull both legs up to one side and sit in a modified George Costanza pose or they pull one leg under their butts, sitting at the computer they rest their feet like they are in a swimming with fins on (plantar flexed....Matt A)... All of these can cause shortened calves, slightly misaligned talus in the ankle and lead to calve issues. Of course there are many, many other causes but shorter people seem to have a habit of these with shorter women even moreso.
OK Leigh...fix Nemo up will ya! :-)
Vince
OK Vince, where did you hide the camera in my office?
I've removed the right foot from under my butt and have taken the left foot off the leg of the chair. Both are now firmly planted on the floor.
Vince
Vince, you crack me up. nice call on the pretzel sitting!
Nemo, considering the fact that you've been having calf issues on/off for the past year now in both legs, I'm going to say that the real root cause is either form related or structure related.
Things to think about as we figure this out:
1) ankle mobility. are there restrictions? is there too much mobility (overpronator/underpronator/normal arch but overly flexible foot)? Lots of lateral movement can strain the calf muscles as much if not more than a stiff ankle joint.
2) Feet change over the years and adapt to the stresses on them. If memory serves you're coming from a distance running background and then took up the tri-game and biking? Running gets a bad rep for achilles/calf stuff, but the bike can be just as lethal on that front, especially when you add intensity. Combine tight muscles and joints with stiff shoes that restrict that motion further and you load up the lower calf muscles (soleus) in particular. Those are your shock absorbers, so if they're cooked before you even start running, the larger gastroc muscle can get in trouble.
3) This will sound weird, but- where are the callus's on your feet?? be specific. are there any on the big toe? where on the heel (side/size)? where on the ball of your foot? (certain toes?). I find callus patterns far more helpful in determining what's going on than actual shoe wear and tear.
Here's a little video I put together to better explain how I look at the lower leg. What can I say- I'm a visual learner.
In the mean time, continue standard R.I.C.E. and put that calf sleeve to use!
Nemo - I could literally write a novel about calf injuries as I have been dealing with this since 2004. Have tried multiple ortho docs, PT, ART, STIM, dry needle therapy (don't ask), compression socks, RICE, heat, mulitple shoes, etc. (Break out the violin
)
The latest solution to my calf injuries (which happen very similarly to yours, except I run through the spasm and actually tear the muscle) is orthotics. I had my gait and foot analyzed by a running guru (here in Va Beach if you want to see him) and he fitted me with some orthotics. My foot composition caused me to roll my foot to the outside. So it has worked to some degree over the last year. Not perfect but I have run more in the last year than I had in the previous years. Worth a thought.
Good luck
Nemo-
What Vince said is very applicable to many of the L'il Peeps. I keep a small step stool under my home desk or prop a foot on an open desk drawer. At work, I used to have a step stool, but have adjusted my chair so that my feet at least touch the tops of the rollers. It's not the floor, but my feet are reasonably flat, assuming I use it properly. Just caught myself with my R foot "toeing" the floor.
If you used to get regular body work, this may have been an area that always caused you to wince. Not having that specialist for body work is a bummer. Need a second career? With as many athletes in your area, you'd probably be very busy. Or maybe DH needs a new job?
Leigh- first, AWESOME VIDEO!!!! I hope everyone reads this post and watches that vid. That was super helpful. In fact, I can now tell you that it's certainly the Posterior Tibula that is currently unhappy. I'm still limping today and I can feel it sorta spasm every now and then- like a pinball machine with different spots lighting up at different times. I've got a compression sleeve on it and that does help it feel a little better.
Second- thanks to Vince I've caught myself at least 10 times this morning sitting on the tops of my feet back behind me (like the fins he mentioned) or wrapped around the chair. I've realized that when I moved down here last year and started working from home that I now go bearfoot all the time "at work" and perhaps keeping my Dansko shoes on my feet while I'm at the computer would help me put my feet on the ground the way they should be (that little extra height in the show helps too).
Here are some answers to your questions.
1) ankle mobility. are there restrictions? is there too much mobility (overpronator/underpronator/normal arch but overly flexible foot)? Lots of lateral movement can strain the calf muscles as much if not more than a stiff ankle joint. RESPONSE: I have a normal-to-high arch and I can turn over on an ankle by stepping on a pebble. I don't have any ankle restrictions that I know of, but I'd say my ankle and feet are pretty instable (balance tests are always pretty bad). I've also noticed that when I run my foot turns upright (inside of the foot facing up towards the sky a bit) as the leg moves forward.
2) Feet change over the years and adapt to the stresses on them. If memory serves you're coming from a distance running background and then took up the tri-game and biking? Running gets a bad rep for achilles/calf stuff, but the bike can be just as lethal on that front, especially when you add intensity. Combine tight muscles and joints with stiff shoes that restrict that motion further and you load up the lower calf muscles (soleus) in particular. Those are your shock absorbers, so if they're cooked before you even start running, the larger gastroc muscle can get in trouble. RESPONSE: Yup- mainly a distance runner who learned how to bike later. Interesting note is that I took 4 weeks off from running and biking (thanks NZ trip) and when I returned it was just to running & biking at easy paces. I was having good luck with my running with no issues. Then on Monday I did my first real interval work on the bike and Tuesday- twang with the calf on the run. Hmmmmm. Oh- and I've recently moved the cleets back on my shoes & lowered my seat slightly based on another discussion we've had about calf issues.
3) This will sound weird, but- where are the callus's on your feet?? be specific. are there any on the big toe? where on the heel (side/size)? where on the ball of your foot? (certain toes?). I find callus patterns far more helpful in determining what's going on than actual shoe wear and tear. RESPONSE: I may try to get Joe to take pics I can post for you later (is that weird) but here's what I can see. Left Foot: Thick heavy callus's on the back and left edge of the heel as well as on the left side of the ball of the foot. Less thick callus's on the right edge of the heel and right side of the ball of the foot. No callus's on the toes (except the big toe which has a thick callus on the right side. Right Foot: Thick heavy callus's on the right & left side of the ball of the foot as well as on the left side of the big toe. Less thick callus on the heel and no callus's on the toes (except the big toe).
Loved the tatooed lower leg! I only had a moment to watch some of the video but thank you for drawing out the anatomy like that and the review.
Again, I haven't watched the entire vid yet so you may have covered this but my double espresso kicked in and I have to do my track workout...brain is at a high frequency of firing right now:
ENer's when we sit we recruit that soleus moreso as the knee is bent. Then, as many people do (esp shorties) we toe the floor or our chairs at our desks. That chronically contracts/shortens that gastroc/soleus, soleus especially. Then as we run and begin the toe-off phase we get that lower calf pull/strain. Stretching the soleus is so important and many people only stretch their "calves" with a straight knee. You must stretch the calf complex also with a bent knee to get to that soleus.
Finally....the posterior tib is involved in almost every case of plantar fasciitis I see. It is an incredibly overworked muscle also. I will watch the rest of the video post run.
Thanks again Leigh!!!
Vince
5 years old!!!! Nemo- you need to get in and have them checked. Mine are 2 years old, only used for running, and last month I was told that they were "OK for now, but next time..." I will need a new pair. Mine are hard plastic as well.
bingo! the most important thing you said was that you've noticed that your run with your feet supinated (arch up towards the sky).
What that really means is that when you land on the outside of your foot, you aren't fully landing on your foot (meaning you never come all the way onto the inside of your arch and then push off your big toe/ball of your foot). That means you're using the post tib more than the other calf muscles and explains why it's so sore.
This might sound crazy...but it might be time to ditch your orthotics and opt for a cushioned stability shoe that will give you the support of the orthotic but allow your foot to move fully through it's motion. This will also help you work on how your foot lands and how you push off.
A second thought is goes back to your bike cleats. I know we had talked about sliding them back a little to ease up on the calf, but...my guess is that there are also some rotation changes that need to be made. Have you ever noticed if you're heel moves around when you ride? or your knee?
Give up my orthotics?
Well, my current Asics GT2150's should fit the bill for stability/cushion without too much motion control if I can just find the original insoles that came with the. I also have a pair of Zoot Trainers/Racers (meant to be used during races sans socks) that would also work when the weather improves. I'd want to build back into these VERY gradually of course- so many years with the orthotics make me nervous to take steps away from them.
I have noticed my right knee (not the leg with the calf problem) tends to pull outside. I've worked on correcting that issue by just staying alert to it. I've never noticed the heels moving around much. However- I have Speedplay peddles and really like the "float" in them. It drives me nuts when I go to a Spin class and have to use those peddles that just lock your foot into one position. I'm never quite comfortable on those Spin bikes.
I'm currently not biking or running until the calf feels ready for some work again (it's still agitated). I hit the pool today for aqua running instead (woo hoo- oh joy). Is there anything I should be doing (or not doing) in the mean time to promote healing?
I don't mean give them up cold turkey.
I meant it more as a tool on your easy runs to help dial in your form and get some muscle/joint cues to use on longer/more intense runs.
Another alternative would be dial back the level of stability in your current set up...meaning. use the orthotic but bump down to a cushioning only shoe so that the orthotic can do it's job. There is such a thing as too much stability and motion control. The more advanced shoes get the more and more I see of it. People just can't move, joints get stiff, and muscles get smoked in no time at all.
does that make more sense?
In the mean time, here are some other ideas to help calm down the symptoms:
1) keep digging out your calf and be sure to trigger ball the arch of your foot as well (those tendons run right under your arch)
2) no barefoot/sandals/slippers around the house! wear good shoes with full support. helps minimize any side to side motions in the ankle and will let things call down a bit.
3) will sound goofy but try it- if working seated all day. trying alternating standing. start easy 30 min up/30 min down. will prevent things from stiffening up all day + keeps the blood moving and flushes out the leg. good idea to keep wearing your sleeves.
How does it feel overall? has the pain moved around to any other areas? any weird stuff- bruising etc?
Also funny you should mention the standing. I was thinking about getting Joe to put in a standing height desk to put the computer on so I could stand a bit and minimize the amount of time I stick my feet behind me on the floor (seriously- I've caught myself like 100 times already today- really bad habit).
Should I be icing at this point?
Dig every day! Ice 2-3x/day everyday.
If it's still really tender when you start digging, what I do is start on bigger muscle groups and let things loosen up some before going after the main culprit. Try rolling your gastroc and soleus. Then try working on those guys and then go after the post tib. Some gentle stretching afterwards is also a good idea. Try to hold 20-30 seconds and repeat 3-4 times (there are some ideas in that calf/hammie thread in the wiki).
Hi everyone,
Just finally got to read all the info in this thread and watch the video. LEIGH, YOU ROCK!!! 'nuff said.
Sorry I have not been helping much in this forum lately( as another PT) but it looks like Leigh is doing a phenominal job along with Mr Vince
.
I will speak just as another athlete with the never ending calf issues who also knows a few things( you know with college and PT liscence and everything but still very hard when it is on your own body)
Well I get sore and tight calves almost after every run. I have very rigid supinated feet. God made me with internally rotated hips and a bit knock kneed. I am a sight to behold running with my hips turned in and feet kicking out to the sides. But man can these legs go. Very weird. I wear stability shoes and need to change then every 2 months. I had a podiatrist suggest orthotics a few years back and got them but no freaking way. You can't stop the motion in an already rigid foot or the knees will get jacked. I could not push off at all. Wore them twice and that was it. My solution which is an evoltion really is to run frequently which seems to keep my legs strong and to massage and roll my peroneals and posterior tib and also gastroc soleus DAILY. Steve has actually taken on the full time gig of working out my lower legs atleast 5 x a week. My hope is as I get stronger and settle in to a frequency routine I will be able to manage my own massaging. POOR Steve. He is a trooper.
My thought is Nemo, maybe Joe could learn how to work these muscles for you and get you back in the game. I could video Steve working on me. I would need to bleep out my expletives though
. I would give the no orthotics thing a try. I also wear the 2140 ascics series.
I heart LEIGH. Thanks for all your info for everyone. I will try harder to get back in here to help.
Carrie
Maybe all of us "walking wounded" should chip in and get Leigh a pilot license and let her come work on each of us...
Also, here is what happens when the cats get the foam roller...
Carrie- the vid of Steve working on you would be great. I worked on my calves today and was trying to figure out how to show Joe so I could just cringe while he does the work
. If I tell him the alternative is moving to New England to see Leigh, I'm pretty sure he'd rather do the work! 
Just to chime in on the orthotics question. When I started running again like 5 years ago started getting heel pain. Went to a podatrist and he made me a custom set of orthotics. Ran in them for a few years with little to no pain. When I started ramping up my mileage for a marathon started getting super odd leg pain. I (unlike all of you
) am blessed to have Leigh to correct all my oddities, she suggested moving up to more supportive shoes and losing the orthotics.
I haven't looked back since then. I do wear them in my cycling shoes (I have a strange rotation in my pedal stroke that I just haven't addressed). However with running I have just moved from the neutral asics to the more motion controls (the 2130's were great). I am now in brooks Ravena's? I think. I do slap a pair of blue superfeet in them since I think they are better then the 'stock' insoles. However (quick knock on wood!) been completely pain free on the run since the move.
It was a gradual process, didn't just leap off the bridge and throw out the orthotics, but probably over 2 months completely removed them and focused on form. While I am still not totally efficient I don't have any of the lingering foot/leg issues.
I think the best thing I have done with all of this was standing at work. I used to sit all day, but probably 2 years ago swapped over to standing all day. That really helped keep my legs from screaming at me all the time.
-Dave
fwiw, Dave is also post tib dominant. so much so that he used to hit his ankles against each other routinely when he was running. he is also like Carrie, in that he had some pretty rigid feet. The big sx for him were chronic hamstring and outside knee pain. As I worked on the hammies, it was obvious that his calves were jacked up and that they were straining the knee out. Once we got those loose, the rest all fell into place rather easily.
Uh, did I ever tell you about the time I did the St George marathon where I had to stop at an aid station around mile 18 to get Vaseline and a band aid for my ankle because I was kicking myself the whole way? The downhill course seemed to exaggerate a problem I never knew I even had until that day. Man this is educational!
First training season with EN, I put Bandaids on interior ankles before long runs and carried extra in case I kicked them off. Focus on form has helped, but I still kick self on occasion. I am pigeon-toed as well. This is all good info.
Just a quick update on my progress.
I'm walking just fine now (no limping) but every once and a while something in the calf provides a reminder that things are not OK. For example, a simple balance pose in Yoga class (which I'm rededicating myself to) was simply impossible to do without causing more injury. So I continue to wear compression socks, ice daily, and roll on the triggerpoint roller.
I also made an an appt with a massage therapist who was recommended by another local triathlete. He's not an ART guy but the word was that he has a good grasp of sports massage needs and working out miofascial scar tissue.
When I made the appt, I told the guy I did NOT want any fluffy feel good crap- this was to be a work out the bad stuff session. Well, he took me at my word and when he said "OK- now this bruise by your knee was already there before I started". I laughed and said "what is this- a physical audit of the rental car to document all the scratches & dings before you take it out for a ride?". Yeah- I'mfeeling the "recovery" in my legs this morning!
Seriously, I think it's a good thing. There were tender/tight spots he found that I wasn't even aware of (oh, and the bottom of my foot- yowsa!). I've already made an appointment with the guy for next week too! 
I was just going to ping you for an update!
Awesome that you went for the torture fest. How goes the home abuse?? I'm pretty sure you said that you have the whole TP kit- break out the little guy (the foot baller maybe? I forget it's name). Stand on it and work the whole foot. Remember in the video where all of those tendons sneak under and actually reinforce your arch?? Can't forget to dig them out as well.
how about any stretches/exercises???