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Slumped form can overload the calves.

I am a 62-year-old male who has been running for over 40 years, and over the past two years I have been experiencing calf strain, mostly on the left side. I had to cancel a half-marathon last week due to this. I'm running around 20 to 25 miles a week and I also work with a trainer three days a week; I lift weights, do Pilates, and stretch. I wear orthotics, work with a sports doctor who does Active Release, and change my shoes at 200 miles--nothing works. I'm fine for a few months and then out on a simple run, suddenly the calf starts to go. What should I try next?

Russell Mendes

Fairfax, VA

It appears you are doing everything appropriately for prevention and wellness. One of the missing puzzle pieces is diagnostic testing for your spine. Often etiology of lower extremity problems can be found in our lower back or lumbar spine. So, I would recommend an MRI of the lumbar spine. If this test fails to provide reasonable cause then dynamic view x-ray (standing lateral, flexion, and extension) should be ordered to rule-out instability.

Brian Kim, MD

Germantown, MD

I have a practice in physical medicine and rehabilitation and I have a keen interest in running injuries and biomechanics. I have seen your problem before. I would ask you to consider a couple of different angles given your age and perhaps your running style. I am sure you have been through the usual suggestions for calf cramping and calf strain.

Possibility #1: I agree with the notion that this may be coming from your back. You are 62 years old and in a typical age group to have a back that does not move like it once did. Do you have pain with sitting or transitions from sitting? Do you have calf cramps at night or tingling in your toes at times? These, in addition to your frequent strains, may be the result of nerve compression occurring in your lower back. This may be present even if you have an MRI of your back that does not support this hypothesis.

Often posture that does not support extension of the spine can contribute to functional narrowing of the outlets of nerve roots from the back. These supply the muscles of your legs. If they are not putting out optimal current under high demand, the muscles may be unable to support that demand. The result is recurrent strain.

Try this exercise: lay on your stomach, feet dangling off the edge of a bed or mat. Place your hands in a position as if you were going to do a push-up. Arch your head backward (up), then your upper back, then your mid-back, and finally your lower back. Your arms should be fully extended. Ideally your pelvis would stay flat on the mat or bed, but it may lift some. Try to do most of the work with your arms and let your back passively extend. Exhale at the end of the extension and let your belly sag downward, then return in reverse sequence to the mat. You may be quite stiff at first. Try doing a set of ten of these several times per day. Also, whenever you sit, place a towel roll or pad in the small of your back, especially in the car. Even if this does not solve your calf problem, doing the press-ups two times per day is a great preventive exercise for your back. If it seems to make your back hurt or creates other symptoms, stop doing them and see a specialist to help modify the exercise.

Possibility #2: What pace do you run? If it is slower than 9 minutes per mile or if you tend to develop slumped posture, you may be overloading your calf muscles differently than you think. When you land and load your foot and leg most of the weight bearing should be up in your hip, particularly by the time your foot is flat on the ground. This posture will allow you to load your hip and proceed to hip extension as you toe off and drive forward. This is where your stride length and your power come from. If you tend to sink into your knee when you land on your foot such that you have a bent knee and your hip is sitting back behind your knee, you will not load your hip properly and most of your body weight will remain loaded in your lower leg and calf.

When this occurs over and over again it can cause eccentric fatigue in your calf and result in recurrent strains. The solution is to make sure your gluteal muscles are strong and that they are loaded properly when your foot hits the ground. Simply said, practice running tall, as if there is a string tied to your chest pulling your upward. This assumes your gluteals are strong. If they are not, you will need to strengthen them first.

You also may want to work on the eccentric strength of your calf muscles. Stand on a low step with your heels hanging off the edge, using a handhold to remain steady. Raise up on both toes so your heels rise off the step. Next, lift one foot off the step so you are supported only on one foot. Slowly lower your heel below the edge of the step to a five count. Repeat this in a set of 15 reps once per day for each calf. You may not be able to do 15 right away, so work up to it and keep the repetitions clean and in good form.

This is great therapy for your Achilles tendon as well.

John Cianca, MD

Houston, TX
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Title Annotation:THE CLINIC
Publication:Running & FitNews
Geographic Code:1USA
Date:Jan 1, 2015
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