I remember reading about calf tears in one of my Sport and Exercise Medicine textbooks by Brukner and Kahn and they stated that they were more common in men, especially those over 30. I didn't think much about it at the time. Then over the next few months I suddenly recall thinking about how many men that I knew who had had calf tears - all of whom were over 30. Of my close network of friends, I can think of 4 off the top of my head.
I previously asked for some ideas on what to blog about and I had a request for this topic. I don't profess to know the complete and evidence based answer, but I have a few good ideas that might be interesting.
The first thing to consider is why it is that age is so important. And the simple answer to this is 'stiffness'. As we age we get stiffer. This is both at the connective tissue level as well as at the muscle level. Our joints have a smaller range of movement and therefore overstretch of tissue, whilst
being loaded, becomes an issue at an earlier range of movement in the running cycle i.e. imagine that you are running and you put the front of your foot on a stone as you are trying to push off. The calf muscle is contracting whilst at the same time it is being stretched more than normal. If the muscle is sufficiently strong you may get away with it, but with less 'give' in the muscle and connective tissue associated with age, the strain within the muscle at a cellular level may exceed the 'elastic limit' of the tissue and the muscle fibres will tear.
Another component that I think is important is stiffness at the spine. If all our soft tissues are stiffening, with associated 'stiffening' or loss of range of movements at our joints, then consider all the joints that are found in the spine. There are 7 cervical vertebrae, 12 thoracic vertebrae and 5 lumbar vertebrae (and these then attach to the sacrum which is essentially fused vertebrae and is part of the pelvis). Each of these levels may become stiffer, but in particular the lumbar spine and its connection to the pelvis. With a stiffer spine, this may result in changes in how we hold the pelvis and hence how the muscles of the body operate. In particular, how the glutes operate. And if the glutes, the largest muscles in the body are not able to function as well, then where do we get the same drive from in order to run? We may have to load through the calves more...
Finally, with increasing stiffness of all connective tissues (fascias) there is also the likelihood that nerve tissue moves less well - something that we call 'adverse neural tension' or 'neural tethering'. Essentially nerve tissue, which has a considerable degree of 'play' in order that it isn't stretched as it passes through the body across our joints in order to supply the muscles (and other structures), can become 'caught' in tighter connective tissue and can cause 'neural tightness'. This will also reduce our range of movement at our joints and may result in higher 'tension' in the muscles that they supply - thus potentially putting them at greater risk of tearing due to the higher innate muscle tension prior to load.
So those are some of the reasons why I believe the risk of calf tears increase as men age. Why men in particular....I haven't cracked that yet but potentially hormones have a part to play in this....
So then how do you either avoid or overcome the calf tear? (I will let you google calf tears to revisit the different grades of tear and what they mean).
To my thinking, the key to overcoming them is to address the above issues.
1) Stretch - I have never stretched as much as I do now. It is critical to my performance. And I don't just mean the calves. I mean the whole body. The arms are just as much connected to the legs as the feet are - I have discussed the fascial slings in a previous blog - and stiffness from top to bottom needs addressing. When I stretch I make sure I stretch the following:
a) neck - flexion, extension (clench your jaw doing this to stretch out your platysmus muscle under your jaw), side flexion, rotation.
b) arms - especially the pecs (stretch them in a doorway), triceps - and when you are stretching these, stretch the whole of the back and side by leaning to the opposite side with the same side leg held straight but crossed behind the other leg)
c) back - flexion, extension, side flexion, rotation.
d) glutes - I get down into a crouch whilst holding onto something e.g. my bed! Try to do a full squat with your feet flat on the ground - concentrate on NOT tucking your pelvis under - your lower spine should be extended not flexed.
e) hamstrings - especially upper hamstrings - lunge position - think about stretching out your bum muscles as you do it - again, don't tuck your pelvis under - stick your bum out!
f) hip flexors - both deep hip flexors and the quads
g) calves - straight and bent knee
h) ITB
The whole stretch takes no longer than 10 mins. I manage it most mornings before work (after breakfast, reading to my son, before getting dressed, making my pack lunch, packing my running kit and getting out the door without forgetting anything...)
2) Stretch out the lumbar spine, work on your lumbo-pelvic control and ensure a strong posterior chain (see above and previous blogs).
3) Perform nerve 'flossing' exercises to relieve neural tension.
Nerves don't like to be on stretch. Nerves that are on stretch give you pain. So if you stretch a nerve and keep it on hold it will become more irritated. So the way to stretch nerves is to put them under a degree of stretch (but not full) and then take the stretch off again. A good way to do this is to get in the 'slump' position (sitting on a table with your legs hanging off the side and with your back in a full slump with your head hanging over - so your head, neck and back make a 'C' shape) - then with one leg dorsiflex your foot at the ankle ('naughty toes') and then straighten the leg at the knee in a swinging motion until you feel the stretch on the back of your leg (or in your back or wherever the 'tightness' is) and then release it. Then bring it on again, then release it etc etc until you have done this about 20 times. Then do it on the other side. This is called neural 'flossing'. Do this 2-3 times per day for a few days and you should start to notice the difference.
So, yet again it would seem that the calf tear may well just be a symptom again of a problem elsewhere. Calf tears, like many other muscle tears, recover over a period of weeks to months depending on their severity. It is important to be aware however that even though you are pain free, your tear may not have fully healed and it is at risk of re-tear at a lower threshold than before. It is possible that even smaller tears (not the smallest) may take up to 3 months before MRI evidence of the tear has resolved. That doesn't mean that you can't return to running before 3 months are up - but it means that the running should be careful and not high impact or intense.
Summary - stretch - not just the calves but the whole body. Stretch the nerves. Have good lumbo-pelvic control with good, strong glutes, hamstrings and upper body strength - take the load off the calves. And did I mention before...STRETCH.
No comments:
Post a Comment