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Reoccurring Calf Injury

Hey T Nation,

I’ve been dealing with a nagging calf injury for about 6 months now.

I initially sustained the injury back in April while I running I felt a slight pulling sensation. I spent about 2 months rehabbing the injury through stretching, massage and calf strengthening exercises.

My calf was doing great for about a month. I was able to get back to running and playing sports, however one night I woke up in the middle of the night with an intense calf cramp. I tried running about a day later and felt another slight pulling sensation.

Ever since then I’ve been trying to rehab the calf and get it back to health (~1.5 months) but have had trouble getting over the initial inflammatory hump. Any advice on recovering from a chronic injury like this would be greatly appreciated.

Thanks,
Evan

how, exactly, are you rehabbing it?

After a flare up I’m spending 3-4 days resting the calf maybe doing a couple small walks.

For the next week or so after that I’ll stretch and massage the calf muscles daily and perform calf raises and a few other calf exercises every other day. I’ve also been swimming/biking during this period as it doesn’t seem to affect the calf muscle.

Once the calf starts feeling stronger from those exercises I’ve began getting back into light jogging. I’ll jog about a mile or less and continue the calf strengthening exercises after that. I’ll jog and strengthen the calf about every other day.

I’ve had instances where the running causes the calf to flare up again and other instances where the calf just flares up on a random day when I’m walking around. The flare ups however never seem to be too terrible as I’m still able to walk on the affected leg.

Loaded or unloaded?

Do you do strength training other than your calf rehab? What does that look like?

Do you ever get unexplained feelings of tingling, pins and needles, hot or cold or any kind of “electric pain” down your legs? Any low back pain?

The calf rehab is just body weight.

Yes, I’ve been doing lots of upper body work (e.g. pushups, pullups and dumbells). When my calf was feeling better I would do lower body to. I’d work in lunges, squats and some other variations.

I’ll get tingling heat sensations from time to time in my calf but other than that no shooting electric pain down my leg. No lower back pain either.

Rough rep ranges and RPE? Full ROM or partial? What’s your pain level during these exercises?

What lower body exercises exacerbate your symptoms? Which don’t?

10-12 reps full ROM with a hold at the top. No pain once I let the inflammation subside (~3-4 days) but their would be some tenderness if I did the exercises right after a flareup.

I can pretty much do all lower body exercises. Nothing really exacerbates my calf except running and sometimes it will randomly exacerbate when I’m just walking which just recently happened.

Also the area that hurts is the inside of the calf right along the shin bone.

RPE? How hard are these sets? You want to be challenging the muscle eccentrically. Shouldn’t be any easier than RPE 3-4

When coming back from a muscle strain, pain levels up to around 4/10 is acceptable, if not encouraged

This sounds more like tibialis posterior, which would explain why you get exacerbations when running. Try doing your heel raises with a tennis ball (or something of similar size) between your heel. How’s your foot arch? High or low? Stiff or floppy?

Keep training your lower body. I’d put a premium on hinge-based movements like RDLs or hip thrusts (although I’m not a massive fan of hip thrusts, personally)

Yeah, that’s a good call. I’ll focus on leg exercises for the next few weeks before getting into any running. Appreciate the insight!

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^^^^^

^^^^^^^

I have a pretty flat arch.

Go see someone who dry needles. I’d wager at most 2 sessions would clear this right up.

Sorry man, I cannot agree with that. Empirical support for dry needling sucks, especially for acute issues.

Definitely have a go at those modified heel raises. As whole, your approach is looking pretty good, just make sure you load enough to create a change.

Every other day I’d aim to do:

  • 2-3 sets of single-leg heel raises off a step (aiming for <12 reps and RPE >7)
  • 2-3 sets of modified (golf ball) heel raises. Add load if you can

You might also get some benefit from isometrics if you get a flare up and full concentric-eccentric ROM exercise is too uncomfortable

Really? Where have you read that? I’m not being hyperbolic when I say it has literally changed my life.

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It’s not that dry needling doesn’t temporarily create change in muscle tension, it’s the fact that the effects are very, very temporary and aren’t greater than massage in terms of effect size.

Needling works to change muscle tone in the short-term. There certainly are times when that’s very useful, but I don’t think this is one of them. Out of curiosity, what did you get dry needling for?

Wow, you are literally describing the exact opposite of my experience and everything I’ve heard about it. Massage work has always been temporary, but any work I’ve had done with needles has been just about permanent. I immediately feel the difference in my movement and it sticks. Actually, it continues to improve with each passing week. Once a trigger point is released the muscle tone never reverts back to what it was, and I feel this positive feedback loop where I’m moving better, recruiting more muscles efficiently, developing better stability/mobility, and that muscle begins to contract/relax more effectively.

I went to dry needling to help me with chronic pain and stiffness in my pelvis, hips, stomach, and lower back that resulted from a chronic infection that went systemic. Have you done it before?

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That’s actually the one good thing about needles. If you exercise, then benefits will last because you use the range of motion you’ve got access to. No doubt needling helped you, but it would (most likely) be the fact that you dry needled to improve ROM, and then moved through that ROM, that made the changes permanent.

What I forgot with my initial response to you and OP is that he is in fact active and training, and then the benefits he’d get from needling would be more permanent than gen pop. I’m sorry for doing that.

Yeah, I dislocated my kneecap about a year ago and struggled to regain knee flexion because of a very tight quad. I got needled a couple times but it only started to “stick” once I went and did 2-3 sets of goblet squats immediately after the needling. I also got my infraspinatus (rotator cuff muscle) and upper trap needled to improve my shoulder flexion/abduction. If anything, that needling immediately made me worse for about 2 weeks.

I don’t think needling is bad at all, just to be clear. I just see it as a very temporary intervention unless you make a conscious effort to train through new range (which you did). As to why it was less effective than massage for you, I honestly have no idea. My understanding of the literature around needling (mechanism, effects etc) say they’re the same, but I absolutely can’t say what you experienced is wrong. I suppose there is a high amount of between-clinician variability, which may explain the difference :man_shrugging:

Yeah, that all sounds like my experience. I’ve been blessed to find a great therapist who constantly belabors that exact same point. She’s always telling me to move around after sessions, drink tons of water and specifically work to “relearn” the triggering movement patterns that brought me in in the first place. I’ve also been diligent about doing targeted activation movements between work sets (i.e. side planks w/ clamshells between deadlifts, or glute airplanes between split squats), and I finish every workout with at least 2 EQI stretches on muscles I hit that day.

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Yeah that’s exceptional quality of care. Unfortunately, far too many (if not the majority of) clinicians will use dry needling without having that discussion