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Hi, I have started to run again and have been doing so consistently for the last 8 weeks slowly building up in time and speed, i warm up and cool down and stretch however on my right calf i am geeting pain on the medial aspect at the lower point of the gastrocnemuis and TA i where orthoses with a 4mm medial skive and a 6 mm heel raise ( have approx 10mm LLD without the heel raise my back kills me )
when i stretch the calf muscle it only hurts in the first few degrees of motion and i am able to stretch the muscle well past 20 degrees


what am i doing wrong ???

Thanks


Yehuda

Tigger point (myofascial pain)? or get someone to do slump test on you?

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Musculoskeletal Pain ( Myofascial Pain Syndrome).
Clinical features: Myofascial pain is a regional muscle pain disorder accompanied by tigger points. A tigger point is a discrete focal tenderness located in a palpable taut band of skeletal muscle which produces a local twitch in response to snapping or palpation of the band. Myofascial trigger points are associated with many chronic pain syndromes

negative to this and the slump test try again

If not a Tigger point, then maybe a Pooh point or a Christopher Robin syndrome?

I will blame it on the heat here in Cleveland....

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Not giving enough info.

First, when are the symptoms worse, and what happens during your run. A tendinopathy-presention should actually improve as it warms up; whereas a compartment syndrome will continue to exacerbate with activity, to the point where the 'patient' is forced to stop.

Second, get deeper with your clinical testing. Resistance testing and length testing of TP, gastroc, soleus, FHL etc. may localise the 'medial aspect pain'.

Third, review your orthoses.

First, when are the symptoms worse, and what happens during your run. A tendinopathy-presention should actually improve as it warms up; whereas a compartment syndrome will continue to exacerbate with activity, to the point where the 'patient' is forced to stop.

starts to hurt 8- 10 mins in run dissapears for the remaining 30 mins comes back within minutes after stopping


Resistance testing and length testing of TP, gastroc, soleus, FHL

please elaborate

thanks yehuda

Sounds like a tendinopathy.... You should be able to palpate a thickened/tender region. As Craig suggested, a bit of manual therapy (friction) followed by ice is a start.

Do a calf raise. Is it symptomatic. Now while relaxing your calf, press your big toe into the floor (FHL test), attempting to plantar-flex the hallux through the floor. Is that symptomatic etc...

What you are trying to do is contract specific musculoskeletal tissue. Your description sounds like medial gastroc, but it could also be tib post (dorsi-flexor, inverter).




The orthotic review may be just as important a step.

Yehuda:

It sounds like a gastrocnemius myo-tendinous junction tear or strain, from the information you have provided. This is a fairly common running injury and seems to be more frequent in the 30+ year old or older men that I see in my clinic. With a myo-tendinous junction tear of the gastrocnemius the tenderness will be located at the medial border between the inferior gastrocnemius muscle belly and the Achilles tendon aponeurosis. Sometimes a palpable defect can be detected, if it is a actual tear, other times nothing is palpable and I consider that a strain.

Stretching, heel lifts, running slower, and avoiding hills will help. I would ice the area for 20 minutes after running and one more time during the day (2 times per day). I have also found that deep tissue massage and ultrasound has been helpful in some cases.

You will probably find that running on grass or a softer surface is less painful than running on concrete or asphalt. Since your orthotics have a large medial heel skive and heel lift, you may experiment at adding or removing a few mm of heel lift. Even better yet, try having the lift added to the whole shoe sole, rather than just the heel since you may be affecting the length-tension relationship of the gastrocnemius muscle for that leg by running with such a large heel lift.

Hope this helps.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
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