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Breaking the injury cycle: Calf Tear in a Runner

Posted on 3rd November 2017 by

We were recently asked some advice from a regular recreational runner. It’s a story that we hear a lot of here at goPhysio (not always calf related, but the same principles apply), so we thought it warranted a little blog post!

The runner in question was concerned, as they’d picked up a calf injury when out for a run a few weeks previously. Nothing major, but felt a bit of a tug on the calf when they had to move suddenly during the run. The calf was painful, so they did what they thought they should and rested for a week from running. The calf then felt fine, so they went back to running. Since then, the calf pain comes and goes. They don’t only feel it when they try and run but can feel it driving, going up & down stairs and first thing in the morning.

The dilemma is……….what is the best thing to do? Carry on running (because they love it and it they were progressing so well!)? Stop running (because it’s making the injury potentially worse)? Exercise? Ice? Heat? Strapping? New trainers? Taping? See their GP? Have a sports massage? Ask a friend? Use a foam roller????????? So many questions?

This is a really common story that we hear a lot in physio. A simple calf tear should take 3-6 weeks to repair itself, however its easy to get stuck in a cycle of tear, rest, repair, tear again, making the recovery much longer and much more frustrating.

How do we break this cycle?

Whilst rest is important it is not enough to adequately repair our damaged muscle to take the strain of running again, which is why it keeps being re-irritated. If we continue to do this we cause a lot of scar tissue to form in the healing muscle. Scar tissue is neither as strong nor as flexible as normal muscle fibres which make it easy to re-tear when stressed by anything more than day to day activities.

In the early stages of recovery from an injury, relative rest is important to help with healing. What that means is avoiding any activity which aggravates the injury, but trying to do alternative activities or modified activities so that you aren’t resting totally.

However, the important thing is to rehabilitate the calf muscle during the ‘rest’ period – gently stressing it with progressive strengthening exercises and stretches to regain its normal strength and elasticity. Ready to run again!

Physiotherapists are experts at guiding you through this process, making sure you are exercising at the optimal level for your stage of healing. They will make sure you are doing the right exercises (technique, loading, reps etc. all carefully worked out) and that you progress them at the right stage – all tailored to you individually and your own goals.

A programme for a minor calf tear for an ultra marathon runner would look very different to a programme for a severe tear in a Saturday morning Park Runner. There isn’t a one size fits all approach and although ‘Dr Google’ or Joe Bloggs at running club who also had a calf injury can be useful resources, relying on such information won’t always give the best long term outcome!

In addition to a specific exercise programme, Physio’s can also carry out a range of other treatments such as hands-on therapy, ultrasound and taping which can help to speed up your recovery. They an also advise on treatments you can do at home, such as foam rolling. A crucial part of your recovery is obviously returning to running at the right time. We know taking time out of running can be very frustrating, so we limit this as much as possible, guiding you with your return programme so you don’t do too much too soon and risk re-injury. If you have a specific event or race coming up, this is factored in.

So, if you love running and are worried about a calf injury, don’t hang about, book in to see an expert to guide you out of the injury cycle and back to running!

Here are two great simple exercises for a calf tear

Calf raise exercise Heel raises – standing on both feet, slowly rise up onto your tip toes then lower back to the ground. If you can manage 20 or more of these try doing it just on the injured leg, holding onto a support for a little balance, remember slow and controlled is key!


Calf stretch – stand in a long stride position with the injured Calf stretch exercise leg behind. Bend the front knee and gently press the back heel down towards the ground until you feel a stretch in your calf. Take it to where you feel a mild to moderate stretch (but not pain!) then hold for 30secs.


More information

Treatment of calf pain in runners

Top Pilates exercises for runners

Top tips for injured runners

Get your running back on track

How to warm up for running 

 


Treatment of Calf Pain in Runners

Posted on 11th August 2017 by

Calf pain for runners is common complaint. Your calf muscles are used extensively and repeatedly during running, so it’s no surprise that sometimes they can become overloaded and develop pain. Here’s a great infographic from Tom Goom from the PhysioEdge series of podcasts, that highlights the recommendations for the treatment of calf pain.

So, what does it mean for you if you’re a runner with calf pain?

  1. Exercise Therapy is a crucial part of the treatment of calf pain. Exercises should be specifically targeted to increase your calf’s capacity for the demands of running. There are some great examples below. Your Physio would be able to identify exactly where any weakness may lie and subsequently advise on the most effective exercises for you. It may not only be your calf muscles that are weak, muscles around your hip and knee support the work of the calves during running, so strengthening these muscles is crucial too. Pilates is great for this! And don’t forget your feet. Working on the static strength of the muscles in your feet that bend your toes can help your running technique.
  2. Neural Mobility is how well your nerves ‘slide’ or move in your body. We all know that our joints and muscles move and stretch but our nerves also have to be able to move freely. When they don’t, this itself can cause pain and restricted flexibility. Reduced neural mobility may not be local to your calf, it could be originating from a more central source (your back/spine). Your Physio would be able to identify whether you have reduced neural mobility and advise on the best exercises to improve neural mobility. It may be that some manual therapy would help too.
  3. Training Loads, so distance, time, speed, terrain, will all have an impact on calf pain. Our aim is to always try and keep you running wherever we can (always keeps runners happy!). So, we offer customised advice in modifying your load to keep you running whilst your calf pain is addressed. This is not always possible though and there are cases where resting from running and doing some specific rehabilitation is essential to your recovery.
  4. Gait Retraining can have a massive impact on recovery and prevention of calf pain. Your running technique and style can improve your efficiency of your running and reduce demands on the structures involved in running. Here at goPhysio we offer a specialist Running Rehab service, where a biomechanical and video running analysis is carried out to guide any beneficial changes to your running technique. Small adjustments to technique can often have a massive impact on your running.

Treatment of calf pain in runners

The trap many runners fall into when they get calf pain is to stop running, rest completely until their pain is gone and then go straight back to their normal running routine. Then they’re frustrated when the pain comes back again and they repeat the cycle. When you pick up an injury, particularly an overuse injury like calf pain, it is crucial to identify and address the cause to prevent the potential long term cycle of injury.

Read More

What’s physiotherapy got do with a dripping tap? Overuse injuries explained.

Top 6 Pilates Exercises for Runners

Top Tips for Injured Runners

Running Rehab Service


Top tips for injured runners

Posted on 28th June 2017 by

Having an injury can be a frustrating time for a runner, particularly when you have an event looming. How do you maintain your fitness when you can’t run?

Here’s our top tips to keep your physical and mental health in tip top condition whilst you’re recovering.

  1. Can you still run at all without increasing your pain? For most people maintaining some level of running is going to be better for them than complete rest as it helps prevent deconditioning both of the muscles and of the cardiovascular system. This one will depend on your injury so its always best to seek professional advice from a physiotherapist. Try taking out hills and speed work, go back to short, gentle runs on flatter terrain – its going to be much better to keep up short frequent runs of 1-2 miles rather than nothing at all even if you’re used to doing 10miles+ as this will give you a starting point from which you can progress. The main exception to this is running on a suspected stress fracture – you will not be able to run through this pain and you WILL make it worse by continuing to run. As a guide consider your pain levels during the run, but also over the next 24 hours – if your pain eases quickly when you start running and doesn’t leave lingering pain or stiffness into the evening or next day you are generally fine to keep going at this level.

  2. Cross training such as cycling, swimming and deep water running are great ways to keep up your cardio fitness whilst not running at your usual intensity. Try to match this to your normal training schedule – for example if you would normally do 3 runs a week – perhaps a 1 hour slow run, a 30 minute tempo run and a 20 minute speed/interval session try to replicate both the time and the intensity of these sessions on a bike or in the water.

  3. Work on technique – video analysis can help to find the route cause of why you are injured and specific tailored running drills and strengthening exercises can help prevent this problem reoccurring in the future. This is also going to help improve your efficiency as a runner so when your injury is healed you’re likely to be better than ever! Think about investing in our Running Rehab service – where we will analyse your running and combine this with an in depth physical assessment to identify and target any potential troublesome areas that need some work or adjusting.

  4. Don’t neglect strength and conditioning – use the time off running to work on areas of weakness. For example if you always get achy calves at the end of a run try building strength with single leg heel raises. Or if you are getting knee pain you can often work the hip and core muscles really hard without irritating the knee. A physiotherapist will be able to assess which areas of weakness might have contributed to your injury and guide you through a specific individualised strength training programme that isn’t going to aggravate it.

  5. Beat stress! A lot of us use running as a tool to keep our mental health in check so not being able to run can lead to feeling of guilt, anxiety and depression. It’s important to find another outlet for stress – cycling, swimming, yoga and Pilates can be great alternatives. Remember not to be too hard on yourself, recovery is an important part of the training process. Take this time to restore your general wellbeing – eat healthily, drink plenty of water and make sure you are getting enough sleep – this is going to speed up your recovery.

Read More 

Running Rehab

Warming up for running

How to maximise your training time

 


How to warm up for running

Posted on 27th June 2017 by

Many runners will head straight home from the office, pulling on their running gear and hit the tarmac, going from a sedentary 8 hours or more sitting at the desk straight into their evening run without so much as a brisk walk to wake up the muscles first.

Warming up before running is essential not only to reduce risk of injury but also to help maximise our training session so that we can work harder, for longer.

A good warm up should aim to prepare the body for exercise; it needs to be dynamic, cardiovascular and involve some balance or control work.

Dynamic

This means loosening up the joints and waking up the muscles that we are going to be using in sport.

Aim to do 30 secs – 1 min of each exercise.

Examples

Heel raise exercise

Heel raises

Knee lift exercise

Knee Raises

Heel flick exercise

Heel Flicks

Hacky Sacks Exercise

Hacky Sacks

Standing active trunk rotation exercise

Trunk rotations

Cardiovascular

By gradually increasing our heart rate and breathing rate we are pumping more blood and therefore more oxygen to our muscles to fuel them for the aerobic demands of our sport.

Examples

  • Brisk walk 1-2mins
  • Jog 1-2 mins
  • 5 x 100m ‘pick-ups’ – short bursts of increasing pace with 60secs rest in between

Motor-control

Exercises that stimulate our balance receptors to help prevent ligament sprains. Aim to do 20 of each exercise on both legs.

Walking Lunge Exercise

Walking lunges

Side shuffles Exercise

Side shuffles

Note: Static stretching is not recommended prior to exercise as it reduces the force output of our muscles and delays the activity of our balance receptors – actually making injury risk higher and performance lower. However it’s great to do these static stretches after running to cool down and prevent muscle soreness the next day.

Read More

Running Rehab Service

Warming Up For Sport

Running Injuries – The basic Principles

How to maximise your training time

Top tips for injured runners

 

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Runner’s Knee (Patellofemoral Pain Syndrome)

Posted on 19th August 2016 by

Knee pain is one of the most common running injuries we see here at goPhysio. A regular injury is ‘runner’s knee’ or more technically Patellofemoral Pain Syndrome (PFPS).

What is ‘Runner’s Knee’?

As you bend and straighten your knee, the knee cap (or patella) naturally moves up and down in a Runners knee groove in your thigh bone (or femur) . The knee cap is held in place by various muscles and tendons, helping it to move well. If any part of this isn’t quite working right it can affect the knee cap, particularly if you’re doing a repetitive movement such as running. Such problems around the knee cap can cause damage to cartilage, ligaments or fatty tissues near the knee cap and as a result cause pain and inflammation.

Pain often originates from the contact between the back of the knee cap and the thigh bone.

What does it feel like?

Pain is often felt during a run behind the knee cap or infant of the knee. It can be a dull achey pain or may be quite sharp and severe. Other symptoms include:

  • Pain during other activities, sports or even walking
  • Pain when squatting or going up or down stairs, down especially
  • Stiffness and swelling around the knee cap (‘puffy’ knees)
  • Loss of muscle bulk in your quadriceps (front thigh muscles)

What causes it?

A number of issues can cause runner’s knee. It’s often something that comes on gradually and people endure for some time before seeking help, so often, by the time a runner comes to see us there are a few things going on and compensations have developed. Problems that can contribute to runners knee include:

  • Overworking the patellofemoral joint (joint between knee cap and thigh bone)
  • Stiff hip joints
  • Over pronation at the foot (flattened arches
  • Tight hamstrings, calf and quadriceps muscles
  • Lack of strength in quadriceps  muscles
  • Issues around the glutes and pelvis

What can Physio do to help? 

To settle the pain and discomfort of your knee pain, you can rest and use ice and painkillers. Rest is crucial, as the problems is often a result of  overuse, so reducing activity will help this. However, if you’re like most runners, you aren’t going to be keen on resting for long.

As with any overuse injury (read a previous blog about overuse injuries here), it is crucial to identify the cause of the problem. This is where physio comes in, as we’ll be able to identify exactly where the cause of the problem lies and address it. This may be through a tailored exercise programme to strengthen, stabilise and stretch particular areas around your knee, hips or pelvis. It could be that you’d benefit from orthotics and if so we can assess your need and advise accordingly. Or it may be an issue with your running technique, training programme, running shoes or other activity you’re doing.

In combination with addressing the underlying issue, we provide relief of your symptoms to make you feel more comfortable. This could be through hands on physio techniques to release soft tissues, acupuncture, electrotherapy or taping. We have a huge range of techniques and tools that can help you.

Most importantly, we’ll guide you back to doing what you love to do and that’s run! We make sure you know when to start running again without re-injuring yourself, it’s a difficult balance. We advise on distance, timing, rest, speed and making sure you are progressing your specific exercises to support your recovery.