Calf Muscle Strains and Achilles Tendinitis: Prevention and Treatment

David Holt specialized in orthopedics 20 years ago, and has been a regular runner for longer than that. Here is his advice on two key exercise injuries. The Achilles tendon attaches to the Calf Muscle. Strain the gastrocnemious muscle and you'll have placed great pressure on the Achilles tendon. Strained the Achilles or have chronic Achilles tendinitis...look to the calf muscle for associated injury or muscle shortness.

Calf muscle strains

	CALF MUSCLES
Causes--see below for Achilles tendon. Include overload; running too much
track speedwork; or a series of very minor twists on rough
trails. 
Many calf muscle problems are resolved by use of a heel lift in all shoes
and regular stretching. Some people say avoid walking bare¨
foot; others say walking barefoot will stretch the calf muscle to its
ideal length. 
	The gastrocnemious muscle responds well to ice, strains more
when running up hills; and you may recall from the stretching page, it requires a nearly 
straight knee to stretch it.
	Because the soleus is under the gastroc, itís less amena¨
ble to ice therapy. The soleus muscle is best stretched with knees bent. 
	Both calf muscles are receptive to massage. Use fingers or finger
shaped gismos or a roller to break up tiny muscle adhesions. Massage
toward the heart.
	Both calf muscles heal well with active rest--run on soft even surfaces. 
	Use mental preparation when on trails. Expect and look forward to
adjusting your stride. Be ready to take several short strides or relax
at the knee to make those adjustments. See sprained ankle.

Achilles tendonitis--inflammation of the achilles tendon.

The achilles tendon connects the gastrocnemius and soleus muscles
to the heel bone.
Symptoms - Dull or sharp pain and inflammation of the achilles
tendon cord or its sheath--from the back of the heel and
ankle, up through the cord and could extend into the calf
muscle. Pain may be gradual or come on suddenly; itís espe¨
cially stiff in the morning. The achilles tendon often thickens; a nodule
may be felt; a cracking sound may be present.
Causes: The Achilles tendon tries to compensate for tight calf muscles.
Stress at footstrike  and push-off must be absorbed by the achilles
cord. Damage can be the result of a gradual increase in mile¨
age that catches up with the tendon, or 
	a sudden introduction of hill work; 
	short, inflexible calf muscles...perhaps secondary to
	increased, slow mileage!
	A lower heel on shoes (running or non-running); 
	increased running intensity;
 	sprinting--all can stretch the achilles tendon too much. 
	Not warming up properly--calf stretches are vital.
	Running with the weight too far back;
	striking the heel; 
	worn-out shoes.
	A history of weak feet or Mortonís toe (long second toe)
predisposes you to this problem.
The back of running shoes digging into the achilles tendon on every
stride is a major culprit. For some reason, running shoe manufacturers in¨
sist the achilles tendon needs protecting, whereas all we need is suf¨
ficient support for the shoe to stay on. Shoes with an Achilles
dip are not much better--the top of the ďdipĒ is often higher than the
level at which runners feel pain. Overpronators are prone to
achilles tendinitis injury, perhaps because after the achilles tab has slammed into
the tendon, it rubs the tendon as the foot rolls inwards; in ad¨
dition, the achilles tendon is given an extra twist on every stride.

Prevention - Well fitting shoes with heels in good condi¨
tion: cut the tabs off if necessary; or, make two vertical slits
where the achilles tendon will go; this allows the now floppy tab to roll
gently and almost innocently up and down the achilles tendon. 
Prepare your Achilles for speed and hill sessions with copi¨
ous stretching of calves; stretch before and after running.
Avoid sudden changes in training.
Loose, full length, warm calf muscles will ease the strain on
the tendon during all running--not just your quality running.
There are many Achilles stretch gismos on the market--visit
your lumber store, a triangle of wood works just as well.

Treatment - Rest the achilles if it's painful to allow swelling to decrease.
Apply ice for ten minutes several times a day and take two
aspirin or other anti-inflammatory at the same time--both will
help reduce the swelling. A strip of tape applied along the
length of the tendon when in the relaxed position will act as a
splint, discouraging you from using and stretching the achilles tendon
further. 
Massage nodules away. Do toe raises. 

If the pain stops on warming up and it does not put extra
stress on the muscles, you may continue to run. Look for the
cause in your case, if it was due to other factors, you may not
need to mutilate all your footwear. 
In the acute phase, use heel pads such as sorbothane or or¨
thotics to raise the heel--high enough for walking to be pain
free. Check your non running shoes--these can also rub the achilles
tendon. Run on flat grass areas for the first few days
back in training.
Avoid hills and track until youíve stretched the calves for
10-20 sessions. Run some of your track miles clock¨
wise.
Cortisone will not help--its use is likely to lead to rupture due
to continued use of a damaged achilles tendon. A few runners may
resort to surgery--scare tissue removal--easing the tendonís 
movement within its sheath--but it often stimulates more scar
tissue. If you donít address the short calves, foot control, low
heels or inappropriate training, treatments will be pointless.

Shortening of the Achilles tendon and calf muscle is a big part of the problem. Avoid high heels...you don't have to follow the fashions.
Heel inserts are a great aid to reducing strain on the Achilles tendon, but are not effective unless you also work on the flexibility aspect with whichever two or three stretches you prefer from:

Calf muscle stretches...5 stretches to decrease injury risk

Overpronation and other factors damage the Achilles tendon, but a FULLY stretched pair of calf muscles, gastrocnemius and soleus, is your first line of defense against damage to the Achilles tendon, the muscles, or that all important muscle tendon unit.



Slow stretching...no bouncing
Charley horse: Severe muscle cramp
Running and Sports injury treatment page
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