As a professional physical therapist and ultrarunner, I’m excited to begin a monthly column to offer solutions for those who run long distances and experience physical ailments or have pain that prevents them from running long. It’s my goal to not just help you run more efficiently with less pain, but also help you gain a better understanding of how bodies work. The unique demands ultras put on our tissues can lead to injury if not dealt with properly.
With that in mind, I have to put in my medical disclaimer. As with many body issues, there can be multiple ailments contributing to your aches and pains, and in some cases, more serious underlying conditions that can be manifesting as physical symptoms. It’s always best to have a PT that you can see when you have concerns so you can make sure your personal situation is being addressed appropriately and safely. This column should in no way serve as a substitute for seeing a licensed medical practitioner.
Ok, now that we’ve addressed the logistical stuff, let’s dive into this month’s topic. Many of you sent messages concerning calf tightness and Achilles issues, so I’d like to address both of those areas, as they are definitely related to each other and the treatments that I employ are similar for both. They are a linked system in your body, especially when it comes to ultras.
When we talk about calf muscles and the Achilles, it is important to understand the forces that are involved which can put those structures under excessive load, causing problems with running. There are basically three things that I look at:
- Active load
- Passive load
- Compressive load
When one or more than one of these loads is in excess, we can end up with calf and Achilles problems. Let’s briefly look at how each of these loads are achieved.
- Active Load
This is the easiest one, as active load is when you are on your toes. Think about running uphill. Your calves and Achilles are activated and under load, storing energy every time your foot hits the ground and your heel doesn’t touch. The longer the hill and the longer you stay on your toes, the higher the load.
- Passive Load
This load is achieved through the stretching of tissue during activity. Think about pulling your toes toward your nose. You achieve this by activating the muscles on the front of your shin, but at the same time, the Achilles and calves are being stretched. So, essentially, when you lock your ankles by pulling your toes up, your Achilles and calves are on stretch, which is stressful on those tissues.
- Compressive Load
This one has to do with ground reactive forces, pure and simple. The more we bang our feet into the ground, the higher the compressive force.
If we have Achilles and calf problems, it is essential to decrease all of these forces to allow those tissues to recover and not start to break down. This is super important for ultrarunners, as we tend to excessively abuse the Achilles and calves actively, passively and compressively as part of our racing and training.
So how do we decrease those loads? Here are some of my ideas and things that I work on with my patients (and on myself) to ensure more pain free and enjoyable miles.
Active Load: Vary foot position when climbing uphill. If the opportunity arises, even for a moment, to plant a foot flat and get off your toes, do it. It is also important to periodize vert training. If you have a week where you are doing a lot of vert, you probably need a flat week to allow those tissues to recover and absorb the training. Shoe choice is also important. If you always run in a low drop or zero drop shoe, this will keep the loads on your Achilles and calves high, as your heel is lower, putting more stretch on the Achilles and calf. Think about running in a higher drop shoe, especially with high vert weeks. This will put your Achilles and calves on slack when climbing, keeping those loads lower as you run. I have a lot of thoughts on the shoe industry and the low-drop phenomenon, but that is a topic for another day.
Passive Load: Decrease these loads by allowing your ankle to relax and your foot to “flop” when you’re in the air during the swing phase of your gait. I tell my patients to view their foot as a dead fish when it’s in the air. Many of us pull our toes up as we pick our foot up, and if you are driving the running motion with the bigger muscle groups of the hip (like we should be) in an almost marching motion, we should be able to release tension through the ankle when it is off the ground. Proper running form is super important for this, and that may be another topic for discussion down the line.
Compressive Load: This can be decreased in much the same way as active load. What goes up, must come down, and periodizing vert training where hard, downhill running is taken in smaller doses can help to decrease compressive load. Also, decreasing vertical displacement or “bouncing” when running on flat ground through proper gait kinematics can also decrease compressive load.
If we can decrease all three of these loads with technique, periodization of vert training and shoe choices, ideally, we should see decreased stress across the calves and Achilles and more pain-free miles in the mountains. Of course, making sure that your tissues are nice and pliable with regular (think daily) foam rolling and periodic deep tissue work is also super helpful in keeping symptoms at bay. I hope this helps you understand the unique variables at play when it comes to Achilles and calf issues.
See you out on the trails!
Medical disclaimer. What I write here in no way substitutes for an in-person, thorough evaluation by a licensed Physical Therapist. As with many body issues, there can be multiple factors involved with your aches and pains, and, in some cases, more serious underlying conditions that can be manifesting as physical symptoms. It is always best to have a PT that you can see when you have concerns, so that you can make sure your personal situation is being addressed appropriately and safely. This column should, in no way, serve as a substitute for seeing a licensed medical practitioner.