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Yet another calf issue

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  • just checking out this thread for the first time, and want to pick up kinda where it was left off earlier regarding biking possibly contributing to the calf problem. question for Nemo: do you use your orthotics in your biking shoes? Was just thinking that depending on your foot structure, if the bottom of your foot is naturally turned inward slightly even at rest, then when you put pressure on the pedal instead of the static foot/ankle structure limiting the motion it would be the posterior tibialis dynamically having to limit it, causing it to take a beating with every pedal stroke. So either orthotics or maybe a bit of a medial wedge in the shoe would be helpful.

    oh, and I can tell you from personal experience that even a few millimeters of change in cleats can have a significant impact on injuries in the lower leg and knee, so just be sure to adjust them in small increments. image

    i heart TP massage products!

    I can't view videos from the computer here at work, so looking forward to watching Leigh's vid at home later...
  • @Leigh- self torture continues daily- but I simply don't dig nearly as much myself nearly as much as I'll let someone else dig. So the weekly massage I'm hoping will get those spots I can't get. I'm doing easy stretching each day as well (nothing crazy) and yoga. Haven't really don't any strength stuff yet- been too worried about re-injury. But I think it's healed up enough that it could finally take some strengthening. Any ideas on that front? As I mentioned, balance stuff seems a little risky still to me so I'm hesitent to do any one leg stand stuff. But I have bands I could use for some calf extension stuff.

    @Michele- I don't use the orthotics in my shoes, but I'm gonna guess if anything my feet sorta roll to the outside edges rather than the inside (kinda like with my running, I don't think I push off enough on the big toe side). In 2008 training for IMWI I remember my feet/toes getting hot spots all the time. I just wish I could remember which part of the foot it was that was getting hot!
  • Posted By Nemo Brauch on 15 Jan 2010 09:11 AM



    @Michele- I don't use the orthotics in my shoes, but I'm gonna guess if anything my feet sorta roll to the outside edges rather than the inside (kinda like with my running, I don't think I push off enough on the big toe side). In 2008 training for IMWI I remember my feet/toes getting hot spots all the time. I just wish I could remember which part of the foot it was that was getting hot!



    That's actually what I meant, I apologize if my wording was confusing...  So when you push down on the pedal, it's not an even amount of pressure between inside/outside borders of the ball of the foot.  The orthotic might help to "bring the pedal surface up to your foot" along the inside border (since that border of the foot isn't adequately pushing down against the pedal currently), to more evenly distribute the pressure across the entire fore/midfoot and take some of the strain off the lower leg muscles.  Just some thoughts.  image

     

  • Ahhh- thanks for the clarification Michele! That certainly is another possibility I need to think about.
  • great points Michele! very likely that the bike contributes to the issue. the shoes may be stiff and hardbottomed but you can still move around plenty in them (especially if you have a system with lots of float). the problem with the bike is that it's typically not as symptomatic (hurts while actually riding) because it involves less weightbearing than running. image

    @Nemo- bands are a good starting point. here are some additional ones versus just dorsiflexion. key is to work all sides. image remember- keep your knee straight and relaxed. don't let your leg roll around for the in's and out's. prop a small pillow under your ankle or hang it off the couch for clearance. start easy-  3 sets of 10 all the way around.

     

     

     

  • Hi There! I wanted to provide a quick update. First, my calf is feeling MUCH better. I can stand on my toes with no wobbling or pain and I can even do one leg squats without worrying about it. That said-I know I'm not out of the woods and if I give the calf any real work I can tell it's still on the edge (for example, at the end of 3x15 sets of the band exersizes it's a wee bit tender). So I'm still doing the RICE thing, the massage deal is working well (seeing him 1x per week), using my TP stuff, and going to Yoga 2x per week.

    With the calf feeling good, temptation to add biking back is huge- but I've been able to resist temptation thanks to support from my fellow injured athletes. Next week will be a little easier because I'll be traveling on business and thankfully the hotel has a decent pool- so believe it or not- water running is preferable than a gym bike machine!

    I've also made an appt with the PT/Sports Specialst guy at UVA for Feb 1 to get an analysis of what is going on (find the root cause). I'll take a guess the answer is going to be something to do with a lack of stability in my feet/hips and the need to work on core strength (pretty much what you guys have been saying). I'll report back again when I get the results from that visit.
  • Glad to hear things are on the mend, Nemo. Have to get you 100%! image

    Keep us posted and good luck with your visit.

  • This is great...sorry about all the probs but the info has given me something to work on. I have been lucky to be relativly injury free in the last year. I was running last week doing my vDot 5k test and at 2.85 miles I had a sharp bite on both outer edges of my right calf. It was strange since I had been feeling fine through the entire run and it was very sudden. After reading through the posts I see some ideas that may help me. The outer corners of both shoes wear out first. I tend to drag my feet and shorten my stride by coming down on the ball of my foot when I get tired. I recently bought a new pair of shoes, maybe there is something wrong with this pair since I have bought the same size and style of Mizuno's for 8 months now. Sitting all day at a desk with just a break to get my lunch and bring it back to the desk is my usual day. Though I did ride my bike very hard at lunch for an hour the same day my calf gave me trouble. Maybe I over worked it on the ride then stressed it on the run? I will give the calf a few more days rest then go for a jog. Thanks for all the good input! Good luck Nemo.

  •  Hello folks.  I wanted to report in with the latest update on my calf issues.

    I headed up to Charlottesville on Monday to see Jay Dicharry at the UVA Speed Clinic.  These folks do 3D gait analysis and can help diagnose the root cause of issues going on with injuries (amongst other things).  They also do 3D bike fit with power analysis and they work on a lot of elite cyclists- so they know that gig too.   I visited Jay 3 years ago when I was having issues with my butt (which had been diagnosed as Periformous Syndrome)  Jay was able to help me correctly identify the issue as being a back/spinal issue and with the prescribed PT and exercises I was able to run pain free for the past 3 years.  Jay also happens to  be one of the guys who worked on the barefoot running study that's currently getting a lot of attention.  Because of the success I had working with him last time I decided to return for another visit in hopes he could help the calf issue.  He asked me to bring my bike shoes as well as my running shoes and we'd work on it all from there.

     

    The visit was enlightening.  I spent 3.5 hours with Jay both doing the gait analysis as well as doing a bunch of mobility & flexibility tests.  Finally, Jay spent a lot of time working with me on teaching me the correct form for the exercises I need to do as well as the images I need to focus on once I return to running so that I correct my form.  But rather than try to  explain it in my own ineffective way- I'll let Jay's written report that I received after the visit tell the story:

     


    Great to see you again. So you are dealing with calf issues on the left, and have also had them on the right (although a different cause). Your current running style does a lot to cause very  very high loading rates. Basically:

    1.        Instead of finding lumbar neutral and aligning your spine, your tight hip flexors and your poor glut stability allow your pelvis to roll forward.

    2.        Anterior pelvic tilt prevents you from really extending your hip since hip ext occurs at your lumbar spine (BAD for your lumbar spine!!!!)

    3.        Rolling the pelvis forward into anterior tilt shifts your center of mass forward.

    4.        Center of mass forward causes you to contact farther in front

    5.        This shift causes you to have VERY high loading rates – honestly some of the highest I’ve seen.  High loading rate means that the peak strain levels on the muscles occur very very fast.

    6.        On top of this issue of posture described above, you’ve got a lack of control in your foot. Learning to balance better with the muscles inside your foot will go a looooong way to improving your balance and proprioception.

    The wrong thing to do is freak-out! The right thing to do is to realize that this is a time to fix things for good. The goal is to identify the issue, advise exercise to correct the dysfunction, and then cue the use of this strategy into running gait. The goal is to develop a better organized stabilization response to counter the forces you see in running.

    In a nutshell, Jay told me that based on my current running form,he is not surprised at all that my calf's are having trouble.  I'm landing mid-foot and my cadence is good- but everything from the waist up is out of alignment and causing a lot of stress on my calf.  What is really interesting to me is that 3 years ago when I saw Jay, the basic prognosis was the same (tight hip flexers, major pelvic tilt, all causing lower back problems).  What was different then however, was that I was heel striking and had a lower cadence.  

    Soooo- seems I "fixed" my back issues by "fixing" my cadance & footstrike.  But I didn't really fix the real problem (the pelvic tilt, tight hip flexers, & weak stabilizers) so all I really did was move the problem from my back to my calfs.

    Are ya still following all of this?  'Cause my head was spinning by the time Jay was done with me!

    The good news is, I know what the problem is, I have a plan to fix it, and I can bike again.  In fact, Jay said that if I could just magically fix the form issues and run correctly right now- that I wouldn't have any calf issues- they'd all be resolved immediately.

    The bad news is, I've got a lot of work to do so that I re-learn the right habits and get that for correct before I even attempt to run a single step again.

    Step 1 is to work on my posture in 3 areas: Mobility (stretching the hip flexers- nice part here is Joe was with me for the visit and Jay gave him some instructions for how to help get me stretched out.  bonus!), Strength (core & glutes.  Lots and lots of clamshell & bridge exercises), Habit- basically I have to make my improved supported posture just part of every day life so that it becomes natural- and then when I run again, it will come easy.

    Step 2 is working on foot balance and increasing the stability work- lots of single leg balance stuff, deadlifts, more bridge stuff.

    Throughout all this I need to keep working on the Posterior Tib (trigger point, massage, etc) to promote recovery because it's still pretty stuffed with fluid and unhappy.  When the calf finally feels good, and after a good 3-4 weeks of the core work described above, I'll be cleared to run again.  But only as a run/walk routine.  Run 5 min with good form, then walk, & repeat.  I can start to build up from there- but the most important thing is that I must keep the right posture.

     

    Soooo, that's where I am.  I've got a long road ahead, but at least now I know what I'm up against!

  • Nemo,

    You might try Lynn Crummy at Albemarle Hospital Physical Therapy.  He has worked with Olympic athletes and did wonders for my ITB.  If you are interested call me during the day at work: 252-384-4615  or PM me and I'll give you the number to make an appointment.

    George

  • Very good analysis. I know I have some similar weaknesses that manifest differently. Hmmmm, lots of food for thought. Thanks for sharing!

  • Nemo- Sounds like you got what you went for which was an answer. Even better it appears to have a fixable cause!! Now, just find someone that can get you there!

  • Thanks for sharing, Nemo! I seem to have similiar posture problems too. It's really good to have a clearly defined "problem" that one can fix. You're on the comeback train, chica!
  • Nemo - doesn't it feel sooo much better to know what's going on and to have a specific plan to fix it? That's awesome and thanks so much for sharing your experience. You have plenty of time to fix it and be ready for a strong IMWI. This definitely gives me some things to keep in mind as I come back to running.

    BTW, what exactly is the "clamshell" exercise?
  • Posted By Jim Hansen on 03 Feb 2010 09:19 AM



    BTW, what exactly is the "clamshell" exercise?





     

    An evil set of movements created by physical therapists to torture people like me!  Much harder than it looks- especially when you've been told to do 100 reps!!  Here is a link to a website with a pretty good description.

    http://www.dailymotion.com/video/xa...-fo_school

     

  • Ahhh, got it. Looks like something I need to incorporate into my core work sessions. 100 reps?! YOUCH!
  • very cool stuff indeed. image

    it's all connected as the saying goes. thanks for the update and keep us posted!

  • Nemo-

     Thanks for the update! Sounds like a good start. I was telling my ART/chiro today about this clinic, maybe I didn't describe it well enough, but he doesn't think I am ready for it yet. Based on your report, though, it sounds like even though I can't run yet, he can precribe some strengthening/stretching exercises that will move me in the right direction? 

    I know my whole right side is weak, tried to do just single leg extensions the other day, after both legs. My right leg went to failure pretty quickly

     Keep us posted on your progress! Enjoy your bike workouts

  • Nemo,

    Thanks so much for sharing your experience.  As many other women have said, I have very similar issues that manifest themselves all in my hips and low back.  This UVA clinic sounds very intriguing...I have spent a small fortune on PT (to see a really good one around here, insurance won't pay for it), ART, chiropractic, and massage.  All of these help, but no one has figured out a way to really correct my problem.  Maybe this UVA speed clinic is where it's at??

    I wish you the best of luck in your recovery and am so happy you can bike again!!! That must be such a boost for you after you've been so patient for so long!!  3-4 weeks will be here before you know it and pretty soon you'll be running again.  Keep us posted...

    Melanie

  • Update and more help requested!

    OK folks, my calf is feeling really good and I'm ready to test it out with some real running. But I'm a little scared and intimidated at this point on how to get there. I read Leigh's advice to Jim in another thread and that stuff looks good- (walk 10min, then run 5/walk 1 for 2-3 times, increase to 10' run the following week, etc) but I can't figure out how to work it all in! My original thought was to just skip my pool run next week and substitute in a run/walk, but having read that other thread I'm now thinking perhaps I need to stay in the pool (ugh) a little longer.

    With this calf injury- I've hacked the OS plans and have done something a little more "bike focused" that looks like this:
    Mon: Yoga(pm)
    Tues: Bike(am)
    Wed: Pool Run(am)
    Thurs: Bike (am), Massage (pm)
    Fri: Rest
    Sat: Bike
    Sun: Bike
    With about 20 min of stretching/core work every day- sprinkled in throughout the day whenever I can fit it in.

    If I keep that Wed Pool Run, that really limits my available time to add real running back to the plan (and not give up the extra weekend ride). Sooo, do I add these new "runs" as Bricks to the Tus/Thurs/Sat rides? That sounds good- like I'd be all warmed up- but then again maybe I'd be tired and not able to keep good form. So then I think maybe I do them later in the day (or maybe on Mon/Fri?) when I'm totally fresh? Ugh, HELP!
  • I'm no expert... but I was thinking about the bricks just as you said it... since your plan (which as a fellow injured athlete, I feel duty bound to try to keep you to) was to run-walk  and the bricks are 10-20 minutes, that night work.  That's how I started to re-introduce the running back into my routine... You'll be "forced" to keep your time/mileage down - a good way to ease back into it.  You'll have the walking time to ease into a 5 minute jog so hopefully your form on the jog won't be too bad.  Good luck!

  • How you incorporate the runs is really more a matter of what your goals are as far as the bike focus is involved. By that I mean, would you rather keep your 4x as you build towards ToC or would you be willing to ditch a bike and add a day of running instead to begin the move back towards a more balanced plan??

    The reason I say that is because using just bricks as the way to get back to running could be misleading (especially considering if they are a OS-esque workouts) as far as how the leg is really feeling and any form work you may be encorporating/planning. It's not a bad a idea, but might be worth swapping some of the days for more of a reverse brick (run first as a priority and then bike?).

  • Leigh- you are brilliant.   Yes- I'd like to keep the 4x per week bike to build and be ready for TOC, but of course I need to return to running gradually too.   That said, Sundays actually would work out quite well with your reverse brick idea.  I could "run" in the AM before church- and then do my bike ride in the afternoon when it's a bit warmer anyway.  So that easily takes care of one day- I just have to figure out where to squeeze the other short runs.

    How does this plan look (understanding "Run" really means walk/run until I get to 30 min of running)?  I want to be careful to not have 2 days running back to back. 

    Mon: Yoga(pm)

    Tues: Bike(am), Run(pm) (or do both in the AM with run first)

    Wed: Pool Run(am)

    Thurs: Bike (am), Massage (pm)

    Fri: Rest

    Sat: Bike

    Sun: Run(am), Bike(pm)

    I'll only run 2x per week in the beginning (starting with 2x 5 min of  easy running).  I'll gradually increase the time of the run interval until I can run 30 min strait without any trouble.  Once I can run 30 min strait I'll drop the pool running and substitue regular running again.  By that point I should be able to go back to "normal" bricks on Tues/Thurs too.

    Does this make sense?  I think I just need a conservative plan to get started and then I'll check in with you as things go along to make sure I'm not doing too much too soon (if you don't mind!!!)

  • Nemo - You're latest post looks almost identical to my current weekly training structure. For the bike/run days (Tuesday and Sunday) I bike in the morning and run later in the day (run not done as a brick). For those runs, I've been using Leigh's advice of slowly ramping up to 30' of continuous easy running (I'm up to 2 x 15' this week!) and then simulating the prescribed EN OS Sunday run workout in the pool on Fridays. Up until now I've been doing 2x/week of easy running and 1x/week of long, interval runs in the pool. Starting next week I'll probably increase the frequency of the easy runs to 3x/week but still keep the Friday pool runs for a couple more weeks until I'm up to comfortably running 30' continuously 3x/week. Not sure if any of that makes sense???
  • Thanks Jim!! Yes that makes sense to me. So nice to have another rehab buddy to work through all of this!
  • the plan looks great. hang in there. the comeback tour is officially underway. image

  • Ohh good Nemo! Fingers crossed that you are well on your way! BIG SMILE!
  • I wanted to report in on how the first day went. I did 5x 2' easy jogs yesterday as my first time running again. I focused on form, my hips, etc the entire time and that was actually much harder than I thought it would be! Anyway- the run went well, I felt good, no pulls or twangs. Afterwards I did some easy stretching and later in the day I rolled out my calfs on the trigger point ball. All was going good.

    I woke up this morning to find my calfs with a modest amount of DOMS. Enough to make those first steps out of bed a little awkward, but after a little stretching I was walking normal again. The DOMS is still there- that basic achy feeling you get. I'm wearing my compression socks now and hope to get to Yoga tonight (work permitting). Nothing else is sore- just my calfs (both by the way, not just the left).

    So- I'm wondering if I should continue to ease back into running (sloooooowly) and just be really good about my post run recovery or if I should back off again and wait to try later. Frankly, I have this little nagging fear that this might be compartment syndrom, but I'd think that would present differently (like actually having pain during the run- not a day later) and it seems odd it would be in both legs. Any thoughts?
  • I say stay the course. DOMS isn't a bad sign at all. image

    Use that as your guide for when the next run should be. if the legs are feeling smoked and you have a run on the schedule, hit the pool instead. that or spread the runs out (which may be tougher from a scheduling/time standpoint). make sense??

    technique work is tought stuff on the mind and body. stick with it and your legs won't know what hit them!

  • Thanks so much for that vote of confidence Leigh! I needed it!!
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