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8002 Views 6 Replies Latest reply: Nov 28, 2009 11:10 AM by offseid
offseid Rookie 4 posts since
Nov 23, 2009
Currently Being Moderated

Nov 25, 2009 7:01 AM

Calf Strain or Achilles Tendonitis? Marathon 3 Weeks Out

Hey everyone! I'm training for Charlotte (December 12), my fourth marathon (but my first three were in 2001). Near the end of my second 21-miler this past Saturday I started getting some pain in my lower left calf. Later in the day it was surprisingly tender to the touch; however, the next day the pain was all but gone. Went for an easy 30-minute run on Monday and the pain was back within a mile.


Frantic googling makes me think this is either achilles tendonitis or a calf strain. Most of what I read about calf strains make it sound like a sudden, kicked-in-the-leg-type injury. So maybe this is achilles tendonitis?


I've been icing the leg some, and having it wrapped during the day, which helps. But how much time do I take off? I suppose I could take off until the marathon and just take my chances, but I'd rather keep running if I can. I've got a 12-miler on Saturday - should I just give it a shot, and stop the second I feel anything? Can you run with your calf wrapped up? I assume so...


What would you all suggest? I can't really afford to go to a doctor or sports therapist, so that's not an option. Thanks for any advice you might have!

 

[EDIT: I don't have any pain in the calf right now when walking or stretching.]

  • PhysioAdvisor Expert 36 posts since
    Aug 27, 2009

    Thought you might be interested in checking out the following links for detailed information on a calf strain and achilles tendonitis. Be aware that although most calf strains have a sudden onset, they do occasionally occur insidiously.

     

    Calf Strain

    Achilles Tendonitis

     

    Sometimes a heel raise (wedge) can help to take the strain off the calf and achilles tendon.

     

    Hope that helps and good luck,

     

    PhysioAdvisor

    www.PhysioAdvisor.com

  • JamesJohnsonLMT Legend 1,164 posts since
    Aug 23, 2009

    The good news is you are officially in your 3-week taper now, so all repairs to your muscle will be accelerated over the usual healing time, even without a lot of rest. I would advise you at this point to switch some running days to upper-body or core x-training (to preserve your aerobic fitness while balancing your posture) rather than just cut mileage on each day, and cut the speed in your running to ease strain on the calf and achilles. You've already done the hard work of training your muscles for the event because it takes weeks to see the benefits. Right now the priority of any marathoner is to let the body adapt and heal. Because of your injury, you need entire days to rest and repair the torn tissues.

     

    All running produces tears - or at least micro-tears - to the running muscles. Mileage tires the muscles (leading to injuries from loss of form), Frequency of workout determines recovery time, and Speed tends to shred things, including tendons and their sheaths. That's why marathon training is usually done upside down - strength and speed first, stamina (tempo) second, and endurance (long runs) last (when you are fully conditioned). My money says you pushed too hard in your 21 milers, which should have started to taper down markedly in speed at least 6-8 weeks out (1-2 minutes per mile slower than goal pace). Otherwise, you are just doing back-to-back marathons in training which nobody can do to maximum effect, other than injury.

     

    The Achilles Tendon is shared by the Gastroc muscle (high, superficial, and prominent on the rear calf) and the larger, flatter Soleus underneath. But the Gastroc crosses the knee to the Femur bone, and is most active when the leg is straight. This means you can isolate a muscular injury by placing a load on the suspect Achilles with the leg bent and with the leg straight to see which hurts the most. If it hurts more with the leg bent, that focuses the load onto the Soleus, because the Achilles is used equally by both muscles. If the pain is equal both ways, it implies an injury to the Achilles. We already know the pain is not located high in the Gastroc, although tightness there would predispose the tendon to overuse injury.

     

    Another sign is how the area feels when you cross the affected leg over the other while seated, alternately plantarflexing/dorsiflexing the foot the move the tendon. Inflamed tendon sheaths will often vibrate during this movement, sometimes audibly. Place your fingers on the tendon to feel for this.

     

    If I had to take a guess, I'm willing to bet there is some inflammation or microdamage along/within the tendon from the increase in mileage toward the end of your program, which is normal for marathoners. However, it is highly likely you have latent trigger-points in the Soleus from running the long runs, or something else, too fast. Latent trigger-points sometimes precede tears and are often overlooked (even rarely discussed) by most medical personnel. Seasoned athletes know what they are, and regularly scan for them before actual injuries occur.

     

    A Latent Trigger-point is a mini-spasm in a small portion of the muscle fibers that does not register pain constantly, but responds to touch and overuse. You need to rub these out because they are involuntary muscular spasms that you cannot simply rest, strengthen, or stretch away. In radical cases, injections are given to trigger-points to force them to relax, but a simple technique called Ischemic Compression can work just as well without needles. Simply find the area and put a thumb (or similar blunt object) on it until the pain is about a 7-8 on a scale of 1-10. You can use a little circular movement to home in on the exact source of the pain. Hold this for several seconds and you should feel a release of tension (release immediately if you feel throbbing because you are too close to an artery). Blood flow to that small area will be temporarily stopped (ischemia) and the muscle should release accordingly. While that is sometimes all it takes, the trigger point should come back later, each time a bit more weakly after successive treatments. They are usually history within 3 weeks if you avoid irritating them too much. That happens to be about the time you have left.

     

    PhysioAdvisor is spot-on about the heel-lift. It will cut the necessary range of muscle/tendon motion for each foot strike, allowing a little more potential for healing while you continue to run - not only while training, but in your target Marathon. I've used them to great effect myself. Trust me, if your long runs have peaked at 21 you will need the extra support in the last 5 miles. Could be a game-saver. Also, resist the temptation to wear ultra-light marathon flats in favor of a good light trainer with some heel to it. It will more likely improve your chances than slow you down.

     

    I have often had issues like yours this late in the training season. Same thing this year. I completed my 26.2 trainer a couple weeks ago and hope to finish my 28-29 this weekend before my taper. Last year, I did the 29 easy, walking through sips of water every half mile. Since I qualified for Boston (and nearly took an A/G trophy) in my Marathon 3 weeks later, it didn't hurt to take a load off. You can too. Just remember that if there is actual damage to muscle or tendon that is severe enough, you just might have to take a bye 'til next year, as I have also done (6 months off '03-'04). Patience is key for the successful marathoner.

     

    Good luck with your taper for Charlotte!

    http://www.medicinenet.com/muscle_pain/article.htm

    http://www.triggerpointbook.com/plantarf.htm

  • JamesJohnsonLMT Legend 1,164 posts since
    Aug 23, 2009

    You're welcome, and thanks.

     

    If you resort to an over-the-counter wedge instead of a professional athletic orthotic, try to find the stiffest gel-type you can find (especially considering your size). Most are too soft for running, minimally slow achilles motion, and do little to limit it. I have layered a super-stiff gel sole with a softer heel lift before. In any case, you should probably lift both sides to avoid asymmetrical compensation injuries.

     

    You sound like you are on it. Good luck!

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