Calf strains in runners are common, with many a runner suffering from this affliction. Not only can it result in extended time off running, but re-injury is common. This blog is a collection of our personal observations after seeing many an injured runner, and the mistakes often made in managing these calf injuries!
Luke also featured on the Peak Endurance podcast discussing this topic, so see link below to the live recording & podcast episode.
Often those experiencing a calf strain will feel a sudden pain during activity but sometimes there may not be a pop or tear, it may just gradually feel “tight” or sore during or after an activity. The pain is often aggravated by raising up on the tiptoes. Higher degree tears will often make walking difficult, with some unable to bear weight on the leg. Unfortunately older runners (40+) are at higher risk of calf injuries, and this has led to this injury often termed “old man calf”.
Now we should preempt this list by firstly saying it’s vital to actually get a DIAGNOSIS! There are multiple things that may imitate a calf strain, for example, low back & hips issues affecting the nerve down the leg. So ensure you consult a health professional that is confident treating runners to diagnose this issue.
MISTAKE 1: Doing NOTHING.
Yep, just sit down, but the feet up and give it a few weeks complete rest, then start where you left off. Sounds kinda silly but this is an attitude many runners have to calf injuries. When you injure your calf, there is damage to the muscle & potentially tendon, to heal this the body will lay down scar tissue. If you sufficiently stress the scar as it forms, it will heal stronger. If insufficiently stressed, you will have a poorly healed scar, in addition to weakness in the surrounding area due to disuse. Commencing rehabilitation IMMEDIATELY can also hasten recovery time as we have previously discussed here
MISTAKE 2: “Just a few calf raises will fix it”.
Calf raises are an important part of rehab but the issue with just sticking with calf raises are:
They are not heavy enough. The calf muscles are responsible for doing a lot of work: the larger of the calf muscles, the soleus, is highly important for running taking 6.5-8 times bodyweight of force, whilst the other calf muscle, the gastrocs, takes 2-3 times body weight (Dorn 2012). Therefore to achieve 6.5-8 times body weight through the calf and Achilles, you need to be able to perform a single leg calf raise with an ADDITIONAL 60% - 100% bodyweight.
They don’t replicate the speed of contraction needed for running. Distance runners have a ground contact time averaging from 250-300ms even at slow speeds. Performing a 3-second calf raise will not get anywhere near the demands placed on the calf & Achilles during running. A single leg calf raise only reaches 25% of the loading rate of running, so to match the loading rate needed for running, we turn to plyometric exercises. We’ve previously written here and here about different exercises that can be performed to replicate this rate of contraction.
MISTAKE 3: Time-based versus Criteria based return to running.
“I’ll just do these exercises for 2/4/6 weeks then I’ll start running”. The problem with just simply going off a set time, is how do you know if you’re ready to run? Having measurable criteria to meet before to return to running is important.
In order to begin to run, here are the criteria that can be used to progress:
Pain-free walking
Seated and standing calf raise on AxIT within 10% of the uninjured side
25+ calf raises, <10% asymmetry (see here for this test)
Calf raise height & bent knee calf raise height within 10% of the uninjured side (see here for these tests)
Bent knee soleus raise endurance within 10% of the uninjured side (see here for this test)
Double leg jumping: pain-free
Once the above has been passed, you can resume jogging and slow running. But before progression to higher speeds, you should fulfil the following criteria:
Submaximal hopping on the spot: pain-free and equal quality vs other side
Single leg jump onto 30cm box x 10 reps
Single leg landing from 30cm x 5 reps
Single leg hop for distance within 10% of the uninjured side
Reactive strength index (drop jump) within 10% of the uninjured side
Striding at faster speeds 50-90%
Fast change of direction running & cutting: increasing speed and cutting angles
Sprinting: 100% effort for 20m
For more on the criteria to return to running, head to our previous blog here
MISTAKE 4: Too much too soon
“Now I’m good to run, I’m just going to start running where I left off 2/4/6 weeks ago”
Obviously with missing a few weeks of running there is a loss of fitness & strength, so picking up where you left off is generally not a great idea. Depending on your running history & how long you've had off will determine how quickly you can rebuild.
Some tips for returning to run post calf injury:
Avoid long slow continuous running initially, especially for soleus injuries as they don’t like long periods of time on feet
Run throughs of 60-80m distances are best for building early running capacity, using passive rest between reps and sets
Will usually resume running later than a hamstring muscle injury, do not try and run as early
Avoid "junk time" on legs, especially when skill-based training has been introduced
Always program running before strengthening
Don’t run on consecutive days for a calf (even in low volume), and control "time on feet" as much as possible on off days