Running Injury Redux: A Calf Strain Raises Old and New Questions About How to Recover and Whether to Run

I ran only twice in the past week, and both times felt great—for about four minutes.

I loosen up my stiff lower leg, get into a rhythm and think yes, it’s OK! I’m back! Half-mile warmup, so far so good. And then, my calf starts protesting. While my right leg feels light and springy, my left calf feels extra heavy, as if someone implanted a five-pound weight under my skin. The heaviness feels like cement starting to harden and then the cement starts contracting, like a phantom reaching up from the ground to grab the back of my leg. It’s not exactly painful in a sharp ouch! kind of way. Rather, it’s a dull yet distinct discomfort that radiates and hurts the way a bruise would hurt if you whacked it repeatedly. It hurts less when I heel strike, more when I land on my midfoot, so I start running in a low-impact, heel-striking way that makes me feel like a duck waddling. It hurts more anyway. Ten minutes into the run, I give up, convinced I’m doing more harm than good and pissed that I may have erased any progress I’ve made in healing what has been diagnosed as a Grade 2 calf strain.

I’ve been running a pretty long time, and I’ve been through a lot of injuries (see previous post 5 Truths About Running Injuries). I’ve got a sports doc and physical therapist advising me. And yet, I remain confused about how exactly to work through this and return to running. And I’m frustrated as hell because I feel motivated to train hard and had a favorite 50K scheduled this weekend. Those plans are on hold, and my fitness diminishes a bit more each day.

That’s why I’m reaching out here for advice. My past injuries were bone, joint, foot and tendon related, so I’m puzzled and discouraged by this garden-variety pulled muscle. I’d really appreciate tips in the comments below on how and when to return to training.

Here’s the timeline of what happened and how I’ve treated it so far:

June 9: I line up at the start of the Woodminster XC 9-mile trail race, the last event in the East Bay Triple Crown Series. It’s a tough, hilly course. I’m pumped, I want to go all out. I take off. Twange. About 200m in, I feel a tweak in my calf that distracts me. Uh-oh. I ignore it and it doesn’t bother me. I have a super race and cross the finish line celebrating that I won the series. And then, a couple of minutes after I finish, I experience a spasm in my calf like I’ve never felt before. My muscle seizes up so badly and painfully that I can’t walk—I have to hop on one leg and then limp.

This shows me June 19 celebrating with my friend, Christine Chapon, after I won the open division of the Triple Crown trail series and she won the 50+ division. At the time, I could barely put weight on my left leg because of a calf spasm.

I ice it, take Advil and take two days off. Thankfully, the problem seems to melt away. Three days later, during our trip to Ashland, I enjoy a pain-free tempo trail run followed by a 20-miler the next day.

June 27 – July 18: Three great weeks. Weekly mileage is 45, 52, 40, plus gym workouts. A little speedwork. Lots of mountain running/hiking while pacing at Hardrock in Colorado. Strong and steady 22-mile trail run July 16.

Tuesday, July 19: Midway through an early-morning easy run around our neighborhood, my calf seizes up again. It starts gradually as a stiffness and then suddenly cramps and spasms as badly as it did at the Woodminster race. I walk and limp a mile and a half back home.

Wednesday, July 20: I have a running date I can’t break. I’m working on a freelance piece about the one and only Dean Karnazes, and I plan to interview him while running. No way I’m gonna break that date. My lower leg feels good enough to go. We run for just over an hour up and around a hill next to Mt. Tam. My calf starts screaming but I ignore it. By the time I stop, I’m limping but pretend I’m not.

I ran on my bum calf because I couldn't miss the chance to run with Dean Karnazes.

I take a couple of days off and cross train. I think I’m OK.

Sunday, July 24: I’m stoked to get in a four-hour training run with my buddy Dave La Duc. We meet at Big Bear staging area in Chabot Regional Park and head up the MacDonald Grade. Right away, my calf starts bothering me. We walk up the hill to warm up more slowly. Running down the backside of the hill, each footstrike bothers it more. On the flat stretch of the Brandon Trail, we pick up the pace. My calf starts to seize up. Four miles and 40 minutes into it, I’ve gotta stop. I’m so mad—at myself and the situation. I leave Dave and walk the four miles back to my car. Walking is OK—the calf stretch on the uphill feels good—but the second I start to run, the impact hurts the whole calf area.

Monday, July 25: My sports doc Melvin Huie in Orinda feels a lump almost the size of a golf ball in my calf where an accumulation of traumatized tissue has formed an adhesion and is restricting the normal movement and elasticity of the muscle. He diagnoses it as a Grade 2 calf strain in the gastrocnemius—partial tearing of the muscle fibers—and gives me a referral to the PT I’ve seen many times in years past and highly recommend, Tammara Moore at Oakland’s Sports and Orthopedic Leaders.

Tuesday, July 25 – Tuesday, Aug. 2: I see Tammara three times. She performs Active Release Technique—a therapy that involves very deep, specific massage to break up the knotted scar tissue and get the blood flowing to the area to promote healing. She tells me my muscle is like a stale piece of Bazooka bubble gum that needs to be chewed until it’s smooth and elastic. It hurts like hell, and I don’t think I’ll ever want to chew a piece of Bazooka again. She also puts black SpiderTech tape up my calf, which looks ridiculous, like I’ve been tattooed with a pitchfork symbol.  I don’t feel like the tape does anything, but she swears it helps.

Throughout the week, I also do lots of icing and PT exercises, with a focus on my butt. Tammara tells me my glutes are the king of the core system, and if they’re not doing their job, then the calves and other muscles work overtime. I typically do lots of core work, at least three times a week, but I tend to focus more on abs than glutes. OK, I get the message—now I’m working my ass off. I’m also riding the stationary bike and lifting weights as much as I can stand, which isn’t much. (Why is it that I can go out and run for four hours blissfully, but riding a stationary bike for 40 minutes feels like pulling teeth?)

So here I am on Wednesday, Aug. 3, confused about when and whether to try easy running again. The spot on my calf where the tissue was knotted up still feels very tender to the touch. Sunday and yesterday were the two days I did a 10-minute test run and quit. What more can I do that I’m not already doing to speed the healing? When should I test out running again? Tammara says I have to wait until I have full range of motion, can do standing single-leg heel raises pain free, and can push off and land while running without pain. Makes sense. But “pain” is a relative term. Returning to running after time off always feels “uncomfortable” to a certain degree. The tricky part is gauging when discomfort crosses to a level of pain that is detrimental.

I know I need to be more patient and take the long view, but that’s not something I’m good at. Objectively I realize that injuries are part of the learning process—part of the trip—on the road to becoming a better athlete once they’re healed. But I just want to speed through this lesson and pass the test.

Postscript

After writing that this morning, I saw Tammara at PT and she gave me more guidance about when and how to return to running. No running–zero–for at least three weeks. I need to be able to hop on my bad leg repeatedly (which I can’t do now) before I can even think of high load-bearing exercise like running. Then, when I start running, she recommends intervals of one minute running, one walking, gradually building up. She says I likely re-tore it on my test runs and I face the risk of this injury becoming chronic. Lesson learned.