Expert Panel Question???
“What could be the cause of medial calf pain? I strained my left foot about a year ago and when I started running again my right calf hurt. It went away in about a month; now it is back. Is there something I can do to ease the pain and make it go away?”
Calf pain is not an uncommon problem in runners because the muscles included in the calf are key to propelling us forward. The calf actually comprises 5 muscles with 2 of these in one “compartment” (a compartment is a bundle containing one or more different muscles) and 3 in another. It is important to know which specific muscle or muscles are injured in order to determine the best treatment options.
The most commonly injured muscles are the two in the compartment closest to the surface – the gastrocnemius and its deeper partner the soleus. These are the “foot to the accelerator” muscles. They are the main muscles working when a runner gets up on his or her toes to push off, run up hills or sprint. As a result, they are most commonly injured during interval, hill or faster paced workouts. The typical injury involves a tear (known as a strain) of the muscle. Strains are often graded on a scale of 1-3 with a 1 being a severe stretch of the muscle fibers, a 2 being a partial tear and a 3 a complete tear.
The higher the grade of strain, the worse the injury, the more likely bruising and swelling will accompany the injury and the longer it will take to recover. Typically, grade 1 strains take between 1-3 weeks to heal, grade 2 strains 4-6 weeks and grade 3 strains 8-12 weeks. Many runners are not patient enough to wait out the healing time required resulting in recurrent strains between periods of inadequate rest. Recent research suggests that calf strains may result from weakness of a specific phase of the muscle contraction. The “concentric” phase is when a muscle shortens like when we do a series of heals raises. This is not the phase the research is focused on.
Instead it is a weakness of the lengthening or “eccentric” phase that seems to be the culprit. This phase is strengthened when, once up on our toes, we then lower ourselves slowly back down past neutral. This is most easily done off a stair allowing our heel to drop below the level of the stair. It is suggested that once the initial soreness goes away from a calf strain (which may take several weeks in itself) one start on an eccentric strengthening program with 3 sets of 15 done at least twice daily.
Initially this may be difficult but if persistent will reap big benefits. Coupling eccentric exercises with deep tissue massage/facial release and the appropriate interval of rest for the grade of strain will often result in healing and more importantly avoidance of recurrent injury.
Of course, it is possible to sustain an injury to any of the 3 other muscles that comprise the calf or to have issues involving blood flow or nerve input to the calf but these are not as common but could be topics for another day.
by Steve Scharmann – MD, Sports Medicine, Family Practice | Competitive Runner/Triathlete