Q: I am a 48 year old triathlete. In the 80’s and 90’s I was a runner. I was training heavily running up to 200km per week and my marathon PR was 2:25. I had no real injury problems, just the occasional pulled muscle now and then. In 1996 I had a knee operation to remove a cyst and then turned to triathlons shortly after. I competed in Ironmans and trained without many injuries until 2005 when I had another meniscus operation. A few months later it began.
I was out running and my right calf muscle kind of clicked or popped. There was no pain just a click feeling. But I had to stop my run and walk home because it got painful after that. Because I had similar injuries in the past I knew I just had to stop running for some weeks and it would be okay, and it was. I started training again and was doing hill sprints, track work and lots of tempo work, no problems. And then one day while I was just jogging to the track it clicked out again. Being only a few days before a race I was so frustrated I packed it all in and stopped sport completely for the next 4 years!! I did nothing and got fat and unfit.
Then in January 2009 I started to run again, very slowly, more like shuffling really. And in the next 3 or 4 months it happened three more times, twice in the right calf and once in the left calf. After 4 years of no running you would have thought it had healed, wouldn’t you? Anyway each time it happened I let it heal for a couple of weeks and started again. I got back down to my former race weight and by October was full into triathon training again. Cycling and swimming no problem, but running was not like it should have been. In October my right calf popped again and I took action to get rid of it. I went to doctors but left unsatisfied because I had the feeling they just wanted me out of their office as quickly as possible so the next patient could come in. I got no real help, just creams to put on my calf, tablets, the offer of injections and usually “take a couple of weeks off and you’ll be right”, none of them really took the time to listen to my whole background.
While out cycling one day one of my training partners recommended a sports physiotherapist to whom I went. He diagnosed that my pelvis was a little crooked and was probably the reason for the injury and he bent me around and cracked my back and neck, lots of noise. I have been going to him now once a week for the last 6 months, mainly to get a sports massage but also to keep an eye on my back and injury. He bends and cracks me every couple of weeks. I felt I could run better because of it, but then my calf popped again. We tried heel lifts in the shoes, along with core strength training which I do three times a week and a decent daily dose of stretching. It popped again in February. More bending and cracking, now I also have orthotics in my shoes and have changed my running style to a more Chi kind of style. Three weeks ago it popped again, and today again! The funny thing is I can do fast running and it is either okay, or it may pop. Or it also may pop just doing slow running. I am at an end now, I do not know what to do. I love running and I don’t want to stop it. I want to run fast and to race hard. So this is my last hope to see if someone else is experiencing the same thing, and to find out exactly what it is and how I can fix it! Please can anyone help me???
Just a couple of additional points: After my calf pops I have to walk home, limping a little. The next day I am still limping a little, and the third day I am walking okay. Usually after 5 or 6 days I can jog again without any pain and after two weeks normal running is possible. The pain is only when I run. I can cycle without any problem or pain at all. There is no swelling or coloring of the calf muscle and it is always exactly in the same place, right in the middle of the fleshy part, rather deep inside. It is usually my right calf, although it happened twice in the past to my left calf.
I am so frustrated with this injury that when it happened again to me today whilst out for a run I was on the verge of quitting my sport altogether. I hate this so much and wish it would just disappear. I tried searching for some information on the internet and in some books but I wouldn’t even know really what to search for. I really really don’t want to stop my sport!
— Gary, Germany
A: An exact diagnosis cannot be made without examining you, but you most likely have strained the gastrocnemius and/ or soleus – the 2 big muscles in the calf. You probably were not fully extending (straightening) your knee following surgery. This would place stress on the calf muscles; a strain occurred due to this. This type of injury usually occurs at the musculotendinous junction – where the muscle starts to become tendon. In the calf this is near the bottom of the muscle bulge. Rest may allow the pain to resolve, but you have not described any type of rehabilitation exercises for your calf muscles. Due to persistent weakness, recurrent injuries occurred. Over time, your gait abnormalities can cause problems from the feet up to the back. This could produce the pelvic alignment issues that you are describing.
To strengthen the calf muscles, stand on a step with your heels hanging over the edge. Lower your heels (this should not be painful) and then rise on your toes. Perform 30-40 reps. Repeat this exercise with your knees bent. As your strength improves, increase the speed of the repetitions. You can then progress to performing these exercises on one leg at a time, starting slowly and increasing the speed over time.
Continue working on core and hip strength. A prolonged injury has produced strength deficits throughout your body.
Additionally, have your knee evaluated. The gastrocnemius begins above the knee. If joint motion is decreased, there will be abnormal stresses on the muscles.
— How to Better Pace a Marathon Based on Effort
