Everything you need to know about Calf injuries for runners

A common site of pain that can take us off the road is in the lower leg known as the Calf. Perhaps the most obvious and familiar injury considered at the calf is a muscle strain. However, there can be some alternative culprits for this disturbance which are explored here.  
Muscle Strain
What is it ?
Muscles are made up of many fibres, each fibre is programmed to shorten and lengthen (contract and relax). It is this contraction and relaxation mechanism that drives a joint to move. A strain of a muscle is when there is a tear in a portion of these fibres causing pain and a degree of functional deficit.
What causes it?
A muscle is most at risk of tearing when it is over stretched. This might be following a sudden movement like a sprint start, a jump or a slip. A muscle strain also has a greater risk of occurring if the muscle is fatigued or over-active.
Symptoms
The severity of a strain has three classifications:
Grade I – is where a small portion of muscle fibres have been disrupted. This often presents as mildly painful. The muscle continues to function with no loss of strength.
Grade II – Is where a moderate portion of the muscle fibres are torn. This presents as moderately painful. It can limit range, strength and function of the muscle. There may be evidence of swelling and bruising. 
Grade III – Is where all fibres are torn, resulting in a complete rupture. This is significantly painful and will result in a complete lack of function of that muscle. A pop or snapping sensation is often experienced. The muscle may look distorted with a large lump or depression where the muscle fibres have recoiled. This will be accompanied by significant bruising.
How to treat it?

• All muscle strains irrespective of their classification benefit from following the R.I.C.E (Rest, ice, compress and elevate) protocol. This is most beneficial in the first 24-48 hours of injury.
• Gentle stretching of the calf, staying short of pain. This helps to Maintain full available range of movement.
•  NSAIDs (anti-inflammatory drugs) may help manage pain.
• Appropriate strengthening exercises to be progressed as pain allows.
• Alternative non-weightbearing/non-impact activities provide the opportunity to cross train without compromising the calf injury. 
• A gradual return to running will depend on the grade of strain. This should be led by pain free daily living activities. If it is still too sore to walk, then running would not be wise.
• It would be advisable for any suspected ruptured muscle to be examined by a health care practitioner. It is common practice for these injuries to have a period of immobilisation. A more careful considered return to activity should be executed.

 
How to prevent it?

• Ensuring a suitable warm up and cool down helps the muscles to prepare and recover from activity.
• Introduce a gradual progression to the running programme, allowing for endurance to develop.
• Carrying out a suitable conditioning programme can promote running technique, support posture and enhance resistance to fatigue.
• Consider a running gait analysis to highlight the effects of individual running stride.
• Carryout regular soft tissue maintenance in the form of stretching, massage/myofascial release.

 
Chronic Compartment Syndrome
What is it and what causes it?
Major muscle groups are housed in a sheath of tissue known as ‘Fascia’ these create compartments and are found in the arms and legs. During activity, muscles increase in volume, ordinarily these compartments are large enough to accommodate this natural adaptation. However, occasionally the swelling creates an increase in pressure in the compartment causing discomfort.  This is known as Chronic (exertional) compartment Syndrome. This condition can be experienced in the calf and can commonly affects both legs.
Symptoms
Symptoms are generally reported as a gradual onset of stiff, tight aching pain.  This may include numbness, tingling, or change in sensation. Symptoms usually get worse as the activity continues and settle shortly after the activity has stopped.
How to treat it?

• Restricting pain eliciting activities such as running. Consider adapting training activity to non impact exercises such as swimming or cycling.
• NSAID may offer some benefit.
• Soft tissue massage.
• Gentle stretching of the calf
• Occasionally the implementation of insoles or orthotics can help by offering support to the foot altering the stress on the calf muscles.
• Running on softer surfaces can sometimes have a positive effect.
• If symptoms persist it is advisable to seek the assistance of a health care professional.

 
How to prevent it?

• Ensure a gradual introduction and progression to any running training programme.
• Consider cross training activities to offer variety of training load.
• Maintain supportive footwear most suitable for your posture and gait.
• Carry out a complimentary conditioning programme to promote trunk stability and optimal postural alignment.
• Vary the running surface. Softer surfaces often provide the opportunity for some of the impact from the stride to be absorbed.
• A general stretching routine of the lower limb promotes the opportunity for a greater range of motion for a free running gait.

 
Deep vein Thrombosis (DVT)
What is it?
A deep Vein Thrombosis is a blood clot in the deeper layers of veins. These will most often occur in the lower limb and pelvic area and are more prevalent in the calf. The danger of a DVT is that the clot which is initially lodged in the vein can break away and travel to the lungs risking the occurrence of a Pulmonary Embolism (PE). A PE is a serious condition as it can be potentially fatal.
Symptoms
A DVT can feel insignificant and can often be miss interpreted as a muscle strain or cramp. It often presents as a dull ache deep in the calf which gets worse with activity. There may be the experience of swelling, redness or discoloration to the affected limb. The area may feel warm to touch, tender or present with bruising.
What causes it?

• There may be the presence of an injury, trauma or surgical intervention.
•  Long periods of immobilisation can lead to blood pooling in the deep veins.

 There are also known risk factors associated with the occurrence of a DVT. These are;

• family history of blood clotting disorders,
• hormone treatment such as birth control pills and hormone replacement therapy,
• smoking,
• obesity,
• certain serious medical conditions.

There can be a misconception that if you run you are likely to be fit and healthy and at less risk to this condition. However, these risk factors continue to be relevant. In fact, there are additional risks to be considered in long distance runners, such as marathons and ultra-running. These types of activities often require long journeys which require long periods of sitting. If an individual has just completed a strenuous marathon, they are most likely suffering a degree of physiological stress and inflammation within the muscle tissues. They are also likely to be in a state of dehydration. Combining these factors puts an individual like this at risk of forming a DVT.
How to treat it?

• This must be examined by a doctor. If a DVT is indicated appropriate tests will be carried out to confirm.
• The Doctor would likely prescribe medication or suggest alternative intervention appropriate to the findings of the investigation.
• Often compression stockings are prescribed.
• Gentle exercise at a steady progression may be appropriate
• Gentle stretching maybe advocated.
• Remain hydrated.

 
How to prevent it?

• In the consideration of a traveling long distance runner – ensure that you rehydrate following the event.
• When traveling long distances – ensure that you remain mobile at regular intervals. Get up and move about where possible. Where this is not so easy ensure you keep your ankles circling, your calves and thighs moving gently.
• Wear compression stockings on a flight.
• Maintain a healthy weight
• Abstain from smoking.

The take home is to listen to your body. If you are experiencing pain and discomfort whilst running, there is likely an action to be taken. Continuing to run without appropriate adaptation is likely to put the injury at more risk. It is always s worth understanding your symptoms and adopting the appropriate action!