Brian Schiff’s Blog

Hi Brian,

It was great to stumble across this blog!

I’m a 33yo runner who is travelling from Australia to do New York Marathon in 1 month. I qualified and entered last year, but had to forfeit my entry due to recurring problems with my left calf (near base of gastroc), which meant I was unable to train for most of last year. I decided to focus on this year instead.

I have built up my training slowly over the year and was running very well with no calf problems (I still tape them every run).

Unfortunately, I got a little eager and ran a very hilly trail marathon 12 days ago. I was running very well during the race with no calf problems until about 36km, when I started to get pain in my left calf (below gastroc) whist running downhill. The pain was not debilitating, so I back off the pace, shortened my stride and finished the race. I iced immediately afterwards, saw my physio and the pain went away for a few days.

5 days later I went for a short jog and the pain returned after 1km – a dull ache in my lower calf. I have since seen a podiatrist and a physio who diagnosed a soleus strain. I’ve had dry needling, massage, electrical therapy, anti inflammatories, stretching and icing. I’ve recently started eccentric exercises and low resistance cycling and elliptical but the pain is still there – a dull ache in my lower left calf and I cannot run at all or it gets worse.

I absolutely must be able to complete NY marathon on 6 November (I have now paid for the trip twice and there is no option to withdraw and re-enter next year). I know I probably won’t be able to run the whole race, but I at least need to be able to finish. What do you recommend? Should I rest completely for a few days or continue with my stretching and strength regime. When is it safe to try running again?

Thanks 🙂

Toni,

Sorry for the delayed response. I think relative rest is good (cross train and trial some light running). You may try a heel lift and see how that does. I once used one to get through a half marathon with a soleus issue. This is not a great ongoing fix, but could help in a pinch for a situation like this. I would keep doing soft tissue work, eccentric single leg heel raises with a bent knee and let pain guide you. As far as complete rest, again, gradually ramp load and activity based on the leg. Good luck!

Hi Brian, Thanks for your response! I have continued with the recommended rehab over the past week (stretching, eccentric exercises, massage and some easy cross training). I am also supplementing protein, magnesium and potassium. The pain in my lower leg has now gone, I can walk downstairs and it is stronger, but it’s still feels very fragile (like I will pull it with one wrong move). I have heel lifts in my shoes and have introduced walking up to 3km. I’m a little scared to try running, but might give it a go with short intervals and tape. Thanks for your suggestions and great blog, it has really helped point me in the right direction!

Googled my issue and stumbled upon this blog.
Have been having soleus problems for over a year now, and getting desperate. Thought I was getting better, but back to cramps/burning/lightning in my soleus 10 minutes into a slow run.

Seeing a physio on Monday, hope he can help but not sure.
Will let you know if I find a miracle cure, as I see so many others struggling with the same issues.

Good luck – this can be a tricky one. I do feel it takes a combination of STM, stretching and appropriate movement prep prior to running to resolve pain long term.

I was diagnosed with DVT in my R leg on September 8th. With some blood thinning medication it was improving quickly. On October 18th I missed two steps going downstairs and jammed my bad leg hard against the landing. An x-ray showed no fracture. A MRI indicated a Soleus tear. The combination of DVT and the calf muscle injury in the same leg landed me in the hospital for 2 days. I am continuing on the blood thinner medications and wearing a boot plus using crutches, with a lot of elevation of the lake and icing the calf. I am 63 years old and self-employed. Can’t afford to stay away from work too long. What are your thoughts on healing time? Thank you for this blog.

Soft tissue injuries typically heal in 4-6 weeks. Depending on the tear, it may progress little faster or slower. In severe tears, it may take 8-12 weeks. Collagen becomes much stronger and mature between weeks 8 and 11 so by three months it should be fully healed. With that said, after you get past three weeks post-injury, you can begin to put more controlled stress on the tissue and I would think be feeling much better in the 4-6 week mark.

Hi Brian,
I am a collegiate runner and stumbled upon your blog because I am currently struggling with soleus pain. It is by far the worst when I go down stairs. When I run it typically hurts in the beginning but is fine once the muscle heats up(I have been heating and rolling out often). I really can not take more than a few days off with track season upon me, but do you think that is necessary? Or some cross training days? It definitely is not getting better and I am frustrated.

Thanks so much,
Dee

Dee,

I would advocate the rolling followed by a dynamic warm-up and even some light skips to prime the muscle before the run to see of this helps a bit. You can cross train too and see if that helps, but it may be more of a fascial tightness issue.

Brian,

Stumbled across your article on Compression Garments and embedded was this piece on the Anatomy of a Soleus Injury. I started having calf pains while training for a half marathon like yourself and I guess I over did my training, but chalked the injury up as just running pains since it was not debilitating. I no newbie to muscle injuries, so I treated it like every other, but I would get pains from just walking around, so I never dared running again. I’ve seen an ortho, stretched and done strengthening exercises and upon return to sports (non-distance running) I feel slight pains while playing but nothing that’ll stop me. The next day, my entire ankle is sore and locked up to the point my Achilles feels like it is going to explode. Would a compression sleeve help?

Franklin,

It is certainly worth a try. Some people really swear by them. Obviously, try foam rolling/compression therapy as well. Dry needling is another option to consider that can be helpful for chronic muscular pain.

I don’t know if you are still responding to this thread but I have found it very enlightening. I should start out by saying I don’t fit the profile of most of the commentators – I have never been a runner. In fact I am a 63 year old woman with quite severe osteoporosis. Last year I suffered a crush fracture of my T12 and was in a back brace for three months. I initially healed very well and was about 90% better within two months. But the remaining 10% took a very long time as I had a lot of trouble with a trapped sensory nerve which radiated pain out to my side. Eventually the bone remodelling process eased that.
A bout a month ago I realised that my back felt as good as ever. I ran for a train one day – the first time I had moved at faster than a brisk walk in over a year. I remember feeling elated that I wasn’t condemned to move like an old woman for ever. Next day I was walking briskly down the street when I felt a sudden cramping pain in my lower left calf. It got worse to the point where I had to stop. It went away with rest but started up again as soon as I moved around. Then the right leg decided to join in but that pain was a bit lower radiating down my Achilles’ tendon to the heel. It was so bad I couldn’t walk at more than a slow shuffle with a strong limp and had to go downstairs one step at a time

It has been a month now and it still hurts quite a lot to walk although I am no longer limping. I’d say the pain is a bit less but I’m resting so much that I’m hardly putting a lot of stress on my muscles. All the other comments on here are from people who can walk ok but who get pain when they try to run.

Have you come across a situation like mine before? I’m prepared to give it time though I miss my walking. But it would really help to have an idea of how long an injury like this could take to heal

Oh, and next time I’ll just let the train go – there’s always another one

Thank you so much for sharing all the information you do. It has really helped me to get an understanding that it’s probably my soleus muscles

Hi Mary,

So glad to hear you recovered from your crush fracture. It is possible you strained the soleus or even injured the Achilles as well. Where is your pain localize to now? Still on both sides? Still pain with stairs? Are you able to rise up on your toes pain free?

Hi Brian thank you for responding so quickly. I have sort of self diagnosed a soleus strain from reading all the great information on this site. It still hurts on both sides but it seems to originate from a point in my lower calf just below the bulge. It hurts most if I bend my legs and point my toes up, that’s when I can pin point it. I don’t think I have injured my tendon as such, the pain seems to run down the side of the tendon from a point in the calf. It does seem to me to be very similar to the issues that people on this thread have been reporting but, as I say, they only seem to have trouble when they try to run, whereas I have difficulty walking.

Since reading your advice I have been trying to do single keg calf stretches and that does seem to have helped the leg where the pain was a cramp in the muscle though the other leg still hurts along the tendon when I walk. I’ve also ordered a foam roller and will give that a try

Do you think another month will see some progress? I do miss being able to stride out.

Mary,

Okay – sounds as if you are on the right track. I think with some persistent rolling, stretching and strengthening it should continue to get better.

Hello Brian
I seem to have this injury! I have this after getting cramp while jogging. I am ok while wearing heels but coming down stairs is painful and putting pressure such as standing on tip toes is v painful. The pain can go down to my foot and up to my hip, Have you any advice please? This happens occasionally after cramp, I take magnesium and a little extra salt on doctors advice.

Thanks

I would see a good PT or sports doc who can further evaluate you to see what the source is. Soles pain does not travel up to the hip. You may have more than one thing going on.

Hi Brian,
Thanks for your informative article. I am almost 62 and hobbling with an injury that keeps flaring up over 4 years. I am not a runner but would love to be able to walk or sit without pain for more than ten minutes and to start exercising again for my health. I went to a physiatrist and xrays show SI joint strain and inflammation. I previously had a bulging disc and PT took care of that. Now in PT they have gotten the SI joint pain free but there is serious sciatica pain off and on but only in the lower leg and under the SI area. I also think the soleus is aggravated because when the sciatic pain is not there the calf still aches the worst. It is dibilitating and I need to sit even after five minutes of walking. No muscle relaxers or pain meds work. I also had plantar fasciitis years ago and simply wore heels to make it go away but continue to do calf stretches. I have had problems with that tendon for years off and on since a teenager. Now I am wearing flat shoes again and wonder if wearing heels (since nothing else is working) might help the soleus heal faster? I also wonder if a back brace/belt might help. So far it feels like sciatica but I have never heard of just the lower calf area in pain and the rest of the nerve quiet. I would appreciate any of your informed input here. Thank you!

Kat,

Sorry you are not feeling well. Sciatic nerve pain can localize in the calf itself. If walking bothers it, it is likely you have some stenosis or narrowing in the spine that is aggravated with extension (this happens with walking). Do you find that walking with a slight forward lean or bend helps ease the pain?

Hi Brian
Just found this and it’s a great article.
I’ve got Soleus issue in my right leg which is seriously interfering with my half marathon training. I first strained it 6 weeks ago, but it seemed to get better through rest. Yesterday I felt the tightness again, following by full ache, followed by soreness after.
I’m seeing a physio on Monday but just wondered if there’s any hope that a deep massage could resolve it? Seems like there must be some kind of chronic micro tear with scar tissue so, probably rest alone won’t fix it anyway.
Thanks
Matt

Matt,

I usually try ultrasound, dry needling, heat and soft tissue work to try and resolve any trigger points and inflammation from micro tears. In some cases, it requires a little longer layoff as well.

Brian,

I know this is an older post but I’m hoping you are still reading and responding to comments. I am at a loss on how to help my 16 year old daughter. She is highly active in high school sports – volleyball and track. She participates in intense off season training including daily workouts at school during the summer break. She is very active all year round.

Last April she started having calf pain during a run. At the start of the run, she is pain free. After a few minutes into the run the pain starts slow and builds to a point that she has to stop. Once she does stop, she gets a sudden increase in even more severe pain that lasts about 10 minutes, then she is sore and achy for days after. Then it starts all over when she tries to run again for longer than a few minutes. (As a side note, she is a sprinter so her events are normally shorter runs but her coach requires everyone to run longer distances in warm ups and condition training. )

Starting in May (after track season) my daughter moved away from the longer runs and began doing much shorter runs and general conditioning workouts throughout the summer.

She sprained her ankle in late July during summer workouts and again in early September during volleyball practice (same ankle and same leg with calf pain). She was placed in a boot in September for 4 days and then resumed volleyball activities after that. During volleyball season, she did not experience any pains (other than normal sore muscles) but they do not normally do much running. Immediately following volleyball season, she started in pre-season track conditioning. The pain in her calf has now returned. No pain at the onset of a run but starts a few minutes in, then builds to a point of being forced to stop.

She discussed this with the school trainer, with no real guidance or solution. We have been to a sports medicine doctor who ordered an MRI looking for stress fractures. We were told the MRI didn’t show any fractures but nothing was said about any muscle issues. I’m going to call tomorrow to see if the report mentioned anything about her muscles. For now, the doctor has told us to increase activities as tolerated but I don’t feel like we have any answers or treatment plans.

My daughter is now scared to run and is considering giving up track all together. She is accustomed to normal sore muscle pain and is adamant that this is not normal pain. I hate to see her like this and thinking of giving up something that she has enjoyed for so long and has always been a big part of her life.

Is there anything you can suggest we do or another route for us to pursue? By the way, she does daily stretches and has started wearing night splints as recommended by the school trainer. She’s been doing that since September.

Thank you,
Becky

Hi Becky,

Has anyone assessed her ankle mobility in standing? I always look at a weight bearing lunge test to see if my athletes have symmetrical dorsiflexion. If there is asymmetry (and often there is after ankle sprains), this can cause increased pronation and medial soleus/calf pain with running. Looking at her hips is also important as she can have proximal muscle imbalances or gluteus medius weakness that may impact her on that side as well. If your school trainer is not be familiar with these assessments, you may need to seek out a sports medicine PT who is well versed in treating runners. My hunch is there is an asymmetry contributing to this issue. If she has intense pain in the inner part of the calf and stress fractures have been ruled out, aside from some soft tissue or biomechanical reasons, the other differential diagnosis to rule out is chronic exertional compartment syndrome. This can be loved at once the other issues have been cleared in my opinion. I am happy to help guide you as much as possible but without being able to assess her myself, it is hard to say for sure.