A Puzzlement

A Puzzlement

A Puzzlement


Muscle strains in runners are certainly not uncommon. In fact, I would venture to say that it would be unusual for any runner to make through his or her entire “career” without having some problem with a hamstring or two.

Most muscle strains, if dealt with properly, heal without complication. Most do not re-emerge repeatedly, after they have apparently healed, for no apparent reason.

The muscles in the back of the lower leg between the knee and ankle, the gastrocnemius and soleus, are responsible for flexing the foot downward, as in when you rise up on the ball of your foot. Obviously, jumping movements place the greatest amount of stress on this muscle group, but running also requires activity in the gastrocsoleus complex, especially sprinting or uphill running.

Why one stride can be completed without a problem while the next step causes a tear in a muscle remains a mystery, but this is the usual scenario for calf strains. Unlike hamstring strains, which more often in distance runners seem to come on over time, starting gradually and increasing in intensity, calf strains commonly occur suddenly and surprisingly, for it may not seem that there was any difference between the two steps. Those who sustain this injury are consistent in their description of the event as feeling like a “gunshot” or hot poker. Depending on the extent of the damage, the wounded athlete may have considerable difficulty even walking without assistance; the pain can be that intense. Certainly running is out of the question for some period of time.

The puzzling thing about calf strains is the high rate of recurrence of this injury. Oftentimes, patients appear to make a complete recovery, are able to resume training, and run along nicely for a few weeks or months without difficulty, only to experience a return of the problem just as suddenly and mysteriously as the first time. And this will happen over and over, despite regular stretching, careful training, etc. Why??

The usual speculation focuses on the healing process, which may not take place as it should. A torn muscle goes through typical stages of healing – damage control, repair, and remodeling. If the process is short-circuited at the repair stage (not an uncommon occurrence), what remains is a mass of scarred, fibrotic tissue that lacks flexibility. Such tissue can easily be re-injured if the stress applied is significant enough.

While this conventional wisdom may be valid, it raises another question: why does this one muscle seem to be so much more prone to re-injury than, say, hamstrings, which probably sustain strains at a much greater rate overall than the calf muscles? I don’t know the answer to this for certain, but I will offer one possibility based on my experience over the past few years.

In interviewing patients who have recurrent calf strains, I’ve recently noticed a common thread among these runners. Very often, I have found that these folks have been supplementing their running with a strength-training program that includes heel-raising exercises with weights. I have even seen one patient who routinely tried to purposely walk on the balls of his feet. On stairs, he would accentuate his ascending movements by pushing upward on his toes with each step. He did so because he thought that this would strengthen his calves and improve his speed when running. After I saw him multiple times for calf strains and discovered this “habit” I advised him to stop doing this. I haven’t seen him for a calf strain since.

Why would these activities cause recurrent calf strains? The most likely explanation in my mind resides in the fact that for distance running, the calf muscles play a relatively minor role. (Take a look at the best distance runners – their calf muscles look almost non-existent relative to the quads and hamstrings.) My suspicion is that the weight-lifting or high-stepping movements are not only unnecessary for better performance, but may actually make one more susceptible to injury by overly fatiguing the muscles, creating an environment ripe for trouble.

Once again, the principle of “specificity” of training appears to be validated. If you want to run farther and faster … run farther and faster. Don’t waste your time and energy on other exercises that may not do you any good and may in fact cause harm.