Calf muscle injury.

I injured my left lower leg in August, with pain just below the large calf muscle. At the time, I had raced four weekends in a row at 6:15 mile pace and was doing speedwork on Wednesdays. I didn't see a doctor but rested from running for three weeks. I recently started racing again but my lower leg still feels tight and can sometimes remain tight for the rest of the day after a morning run. I don't feel pain while running; it's always afterward. I'm 57 years old, 5' 10", and 162 pounds. Do you have any suggestions for dealing with this pain and tightness?

Gary Scott

Midland, WI

It seems as though you may have developed Achilles tendinitis in your left leg. The Achilles tendon, which is the largest tendon in the body, connects the calf and the heel and is responsible for pushing off during running (plantar flexion). The tendon can develop microtears and inflammation (Achilles tendinitis)--a common injury in middle-aged males. The tendons lose elasticity and tensile strength with age, and men tend to be less flexible than women.

You probably need more specific stretching for both the Achilles tendon and the plantar fascia. Gradually add strengthening exercises for the muscles on the front of your leg (dorsiflexors) as well. Sometimes orthotics can be beneficial. Ultrasound, soft tissue mobilization, or massage can relieve pain and help the healing process. Make sure your running shoes are not overly worn.

Stretches:

Hold for a count of 15 to 30. Repeat two to three times twice a day.

Achilles tendon: Stand on a step on the ball of your foot and allow your heel to drop.

Plantar fascia: Place your hand underneath your toes and forefoot and pull backward so that your toes and forefoot are pointed up (dorsiflexed).

Strengthening exercises:

Hold for a count of 10. Perform two to three sets of eight to 10 reps.

Dorsiflexors - anterior tibialis: Using a theraband or weight on your forefoot, bring your toes and forefoot upward.

Carol Zehnacker, DPT

Frederick, MD

You may have injured the muscle-tendon interface of the gastrocnemius (calf), or your stride may have become too dependent on your lower leg. The first scenario usually occurs at a point in time and is pretty easy to recall as an "incident." Usually rest, recovery, and rehabilitation heal it. It sounds as though you rested for a few weeks; if you did not incorporate strengthening with any post-injury stretching, you may not have rehabilitated the injury properly. You might try single-leg squats with heel rise, lunges, single-leg knee drives, bounding, and skipping. These are all functional strengthening exercises related to the biomechanics of running.

In the absence of an "incident," you might be sinking into your lower leg during the stance phase of your stride, which loads your knee and calf excessively with each landing. Racing four weeks in a row could certainly predispose you to such an overload by causing fatigue, which leads to sloppiness in your stride. The answer is to run tall. At stance phase, remain upright with your chest over your hips over your feet, not flexed at the knee with your hips behind you and flexed at the waist. This tall posture necessitates being strong in the hips, particularly the gluteus medius.

John Cianca, MD

Houston, TX