Good afternoon everyone! Well that was just a crazy day today! A 5hr ride that just got hotter and hotter out there today. The killer was a 40 min run off the bike afterwards at 12.30 in the arvo. Now I am at home after an ice bath, a good feed, with my feet up and as promised I thought I better start work on the blog.
Now this blog is on a complex one, the problematic calf. Over the last month I have had at least half a dozen of them come into the clinic. So I want to highlight to you the interactions of various components in your body and the potential development of calf pain. I am currently finding that a lot of people are suffering calf tears doing activities that they have normally done thousands of times before. Or experiencing calf tightness or pain while running. For some strange reason their calf muscle couldn’t cope with the activity on that day and bang – a calf tear, or ongoing niggles and concerns that just will not go away.
So let’s break it down. When someone comes in with a calf tear under the circumstances highlighted above, I like to break down possible causes into the following:
- Are there any proximal contributing factors (i.e. from the sciatic nerve/lower back/piriformis etc)
- What is the hydration state of the muscle (i.e. ow hydrated was the athlete at the time of the tear)
- How regularly is the athlete doing self massage/myofascial release
- What stage of training is the athlete at (i.e. how much/volume/what intensity)
- What shoes are they wearing (i.e. are they different to previous/what state are the shoes in?)
- How strong is the calf muscle?
- What is their ankle mobility like?
Proximal contributing factors
A commonly overlooked factor is the contribution of factors above the calf leading to ongoing calf concerns. Now the calf is innervated, which means the nerve that gets the muscle to contract comes from a branch of the sciatic nerve. This is a large nerve that come from the lower portions of your back, passes underneath your buttock muscle, behind the knee and to the calf. If you have a disc bulge, or prolapse or if you have inflammation around part of the nerve root that forms part of your sciatic nerve then this can clearly lead to calf pain and ongoing concerns.
Additionally, it is common for to have a lot of neural tension, which is partly due to tightness in the nerve sheath (similar to the insulation around electrical wires) being tight. Athletes with this struggle to touch their toes. Now there is a clear difference between hamstring tightness and sciatic nerve tightness. I need to expand on this one as it is important to know the difference.
This is a classic example of a sciatic nerve stretch.
As the athlete has the hip close to full flexion, the knee is straight and she is pulling the toes back towards his body.
Alternatively to stretch the hamstring the feet need to be relaxed, the knee bent and placing the foot lower onto a chair is usually adequate. Have a try of them both, you will notice a very different sensation. Now, I am not usually too worried about hamstring tightness in runners as it helps with running economy. The only time I intervene with management of hamstring length is if someone has very tight hamstrings and frontal knee pain, as the tight hamstrings can interfere with the tracking of the kneecap.
The neural tension is more what is I look at. Generally I believe that runners should be able to achieve close to a 90 degree angle at the hip in a straight leg raise position. To test this on yourself you can look at the picture to the left and you should be trying to get your buttock to the wall and have your legs against the wall with the ankles at a 90 degree ankle. Harder then you think!
Hydration state of the muscle
Now this one is super important for this time of the year. You must be constantly checking the colour of you pee/urine. It needs to be clear or just of it as often as possible. Effective muscle function needs adequate hydration. Muscles have a tendency to get tight and lose their elasticity with dehydration and hence they are far more prone to tearing.
So monitor you urine colour all the time during the day, it is the best way to check the physiological hydration status of your body. During the last week, which has been very hot here in Melbourne, I have sometimes been drinking 4 litres a day after my 2 workouts. This is super important and commonly overlooked!
Now I know that I have talked about this one a lot before, but I keep bringing it up as it is critical! Now you are busy doing a lot of training, your muscles are working hard. Give them some TLC! Try to get on your foam roller at least 3 times a week, or even better do yourself a favour and buy yourself a trigger point therapy kit from the trigger point therapy Australia. Their products are first class and are widely used in the NFL, NHL, NBA and by professional triathletes worldwide. Check them out at – www.tptherapy.com.au
The best time to do self massage is either prior to a session – flush the muscles where you know you get tight, spend 5 or so minutes then, warm up and get into the session. Additionally after the run or the following morning is a good time to work through the muscles a little more deeply.
Other clear links involve training volume, frequency and intensities. Commonly if these are not in balance, then that can lead to fatigue or muscle tightness where potential tears can come about. The harder you train, the more TLC you need to give your body. That means self massage, good sleep, cold water emersion, cold shower, good nutrition, hydration etc. If you neglect this then all the training that you are doing is just trashing your body, but you are not refuelling the tank so to speak.
Shoes can play a big role. A common mistake that many runners make is either running their shoes into the ground, by not checking or keep a log of the kilometres they have done. Another potential link is moving to a more minimalist shoe too quickly. With a reduced heel drop the calf works a lot harder. So if you don’t do your TLC work then over a few sessions the calf can eventually become overworked and a tear can come about. Additionally, Achilles Tendinopathy is common in this example. So gradual adaptation is the key.
Calf strength is big factor. Many runners have weak calves and compensate in other areas. Stand on a step, hold onto a railing or wall and do a set of single leg calf raises to fatigue. I am happy as a Sports Physio if my runners can do at least 30 reps, if not…. work on them!
Ankle mobility, is another clear link. If you lack the ability to bring your knee over a fixed foot with the heel firmly placed on the ground. Generally I am happy if you can achieve about 8cm. That is your foot must be 8cm back from the wall when your knee touches the wall. The picture below highlights the movement. Focus on the front foot.
Now that’s all for today! I need to get the dinner up and going!