Monday, June 29, 2015

Calf Heart Attack

OK! So, an update to the famous injury... Some folks call it calf heart attack. See more below, but will just jump onto what I think may be the reason, even if it looks really lame! Basically, don't cross your legs! I used to spend all the day sitting and crossing the legs is a natural way. Funny enough, I cross my left over my right, and sure enough, the right knee sharp pressure was in the spot of the left leg that eventually was "breaking" when running. Also, funny enough, I never cross the right over the left which would explain why I never had that issue with my right leg (except for once that I really strained putting a lot of force into it, so it may have been totally unrelated).

I stopped crossing my legs 2 years and I have been free of that injury the same time. Nothing of the other stuff correlated with or fixed this (stretch, hydration, warming up, compression socks, deep tissue massage, the stick, rest, no rest, change shoes, physio...). I used to have them every 3 to 6 months for almost 5 years. Boy that was frustrating. This so far seems to be the only correlation and certainly I am not planning to cross my legs just to check it is not! :)

PS.: The only other thing may had been a butt stretch (the kind that you bring your bent leg to your chest). But I think that wasn't working either in the past. The crossing the legs really seems to be the one.

PS2.: UPDATE (2/2/2019): Kept running since I wrote this article and never ever got injured again. But sure, never crossed my legs (except for very short periods) since then. It is actually not so easy to avoid crossing them :). Anyhow, if you are reading this and have a similar issue can you please comment 1/ If you cross your legs or apply any other kind of continuous pressure over the day on the calf that eventually gets injured. 2/ Did stop doing that solved the issue? Thank you! It'll help get some statistics...

OLD POST ===

Thought I would quickly list the symptoms/clues about my recurring injury in what seems to be the soleus... Maybe somebody got a clue? Please comment :)
  1. Sudden pain deep in the left calf, half height, a bit to the left.
  2. Always same leg and same point in the leg. Only once I hurt my other leg after pushing an SUV, but never "broke" again... Funny though that the pain really felt the same, so, it could be a good clue.
  3. Injury feels like a very localized pain, a bit like if you were sticking your finger deep in the muscle. The pain  is strong enough that you really got to stop running. Walking is fine but still hurts. Hurts mostly going tip toe or downstairs (typical indication of soleus damage).
  4. Once injury happens, will take 3 days for the pain to go away. One can then run no problem without pain.
  5. Nevertheless, running longer will likely bring the injury back. 
  6. So, solution is to ramp training slowly. The longer it takes to ramp, the less likely getting hurt at any of those runs.
  7. Running on your tip toes will likely bring the injury back quick.
  8. The time when it happens must be important. It never happened after a good while of running or just at the beginning (unless you were injured already), but more around the 10-15 min mark (2-3Km). Trying to see what happens around that time, I found this link about the phases of a 30 min run and a more detailed one here. It is basically the time that the aerobic systems takes to take over.
  9. It has happened many times in really easy runs. Couple of times even texting, which makes me think is a posture issue. Or in other words, very sensitive to the posture.
  10. Eating bananas has not helped (see below).
  11. Not sure hydration has anything to do.
  12. Warm weather seems to be worst.
  13. Massaging after the injury doesn't seem to help or make worst the recovery. Icing may help but not sure.
  14. Stretching before didn't seem to help but warming a bit and stretching afterwards may be helping.
  15. Working out (besides running) the soleus didn't seem to help.
  16. Deep tissue massage didn't seem to help.
  17. The rate of injury has not changed over the years (for the same kind of training). I.e., the more I train, the more times I can run without getting injured. But that likelihood is the same now, than it was few years back. I.e., getting injured doesn't seem to make things worst with time. The right leg didn't get injure ever again (touch wood).
  18. Biking is fine even when injured.
These ones look very similar to mine and the solution, may actually work...:
http://www.runnersworld.com/injury-treatment/calf-heart-attacks
http://www.endurancemag.com/2013/06/sustainability-of-you-the-anatomy-of-a-soleus-strain/

This one not so much, probably not, although the exercises may work out (?)
http://www.legacieshealthcentre.ca/resources/articles/soleus-syndrome-and-running/

I started suspecting that this may be some kind of cramp?  I mean, it does feel like a cramp but with some differences:
  1. It is a very concentrated pain in the leg, not just the whole calf, for instance. Are there micro cramps?
  2. It does feel like stretching it in order to remove it, but if you do, it can really break. What happens to a cramp if you force it? Funny enough, this link seems to nail it on what happens to me and what works... #1 still a doubt.
  3. Cramps do not seem to leave injuries. I.e., you are not more prone to a cramp just because you had one last week. Here it seems the case. It is correlated to how long ago you had the previous one, not to how trained you are...
Interestingly, this link explains that contrary to the popular believe, water or electrolytes do not seem to affect cramping rate.

I do feel that it is some lack of something, though. Like oxygen (for some time, it felt that breathing was able to control the onset). Maybe there is a lack of blood vessels to that part of the leg? That would match overall clues:

  1. The lack of nutrients/oxygen (hypoxia) eventually triggers a cramp on the region not getting them.
  2. It is not as massive as a normal cramp as it is not that your blood doesn't have the nutrients, but that small portion of the body doesn't have enough blood vessels.
  3. Training increases the build up of muscle and blood vessels, which lowers the risk.
Let's focus on hypoxia. On the Wikipedia link they say there can be couple of reasons. One of the would be ischemia, which is the lack of blood supply.

Pardon the rest: still under construction :)

https://runnersconnect.net/running-training-articles/aerobic-vs-anaerobic-training/

When running anaerobically, the muscles begin to break down sugar, but instead of producing just CO2 and water, they also produce excessive amounts of lactate. In the absence of oxygen, your body can’t clean up the extra hydrogen ion created by lactate and this is what causes that burning feeling in your muscles.

During exercise, things change. Your ATP stores are used quickly while your Anaerobic stores kick into high gear.  While that happens, your aerobic system starts producing more energy as well, though it takes about 15 minutes to really get it ramped up.

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For my old tracking, places I left a comment on this:




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