Written by Tom Goom, senior Physio at The Physio Rooms Brighton. Follow Tom on Twitter.

The words 'calf pain when running' are the most searched for term that leads people to RunningPhysio. The calf is a common problem area for runners and can persist despite calf conditioning work. Our previous articles on this cover calf tears, causes of pain and basic strength work. This piece looks at some more advanced strengthening strategies to build calves of steel!

Before starting advanced strength work I recommend reading our previous articles to determine why you have pain and tackle basic calf strength. You should be able to do 20-30 repeated single leg calf raises, ideally managing an equal amount on both sides.

The next step is to work pure calf strength and power. Some of you might be thinking, 'hang on, haven't I done that already?' The answer is sort of yes, but technically probably not!…when we think of pure strength we're looking at a muscle's ability to produce maximal force. There are specific reps, sets and loads recommended to do this. Research from the ACSM suggests that the optimal way to build strength is by lifting a load of sufficient weight that you can only manage 8-12 reps. Your body weight alone is often not enough weight to achieve this for the calf muscles. While doing repeat calf raises of body weight will result in some improvement in strength it won't be as effective as increasing the weight and working with lower reps.

When working with heavy loads and progressing to strength and power work I recommend doing so under the guidance of a physio/ health professional.

Recommendations for reps and sets below are not set in stone! They are a general guide based on work by the American College of Sports Medicine (ACSM).

To work on strength and power it's helpful to briefly touch on some terminology. We use the term '10 rep max' (10RM) to mean the maximal amount of weight you can lift 10 times with good technique. The 9th and 10th reps will be tough and you wouldn't manage an 11th or 12th rep. Obviously it doesn't have to be 10RM it can in theory be any number. Often the term 1RM is used in strength and conditioning. Obviously this means the maximal amount of weight you can lift just once with good technique. Many recommendations are then made based on this – such as a percentage of 1RM. The downside of this is that it is actually pretty hard to determine your 1RM if you have no access to gym equipment or are inexperienced in the gym. What we'll do instead is approximate, below is a table approximating percentage of 1RM (I forget the initial source so I don't have a reference I'm afraid);

Confused?! Don't be!…What this all means to you in a practical sense is if we say 10RM increase the weight you're using to a point where you can only do 10 reps. Job done!

The first step then is to determine your 10RM for each side for your gastrocnemius muscle (the one that works during a calf raise with the knee straight). There are a few ways you can do this. I use 2 main ones – smith machine or back pack!

The smith machine (see below) allows you to add weights to a bar across your shoulders, you can then calf raise against this bar. I recommend sticking an easy low weight on it and trying it out for a few reps just to get the feel for it. Then you can repeat it, again on 2 legs, on a step so your heels can drop off the edge of the step. Always think safety first if you're not comfortable or are unsure with the equipment ask a health professional to help you! When you've got to grips with it try on one leg with a low weight making sure you can go fully through range. Gradually increase the weight to find how much you can lift 10 times with good technique and no pain – this is your 10RM – compare left and right.

Here's a Erin Stern demonstrating a 2 leg technique (we're hoping to add our own video soon);


The back pack technique is much simpler! Get a sturdy back pack with padded straps, it needs to be strong enough to hold at least 20-30kg. It's best to use some support, such as the bannister rail, for balance. Do a single leg calf raise on the edge of a step and gradually add weight to the bag to determine your 10RM.

In many cases runners will score the same for both legs for single leg calf raises but once additional load is added there will be a weakness in the painful side. I'm not aware of a target weight that people should aim at for calf strength. If you have a one sided issue just aim to restore equal strength between left and right. If both calves are problematic them aim to increase strength until symptoms subside when running.

There is another important muscle in the calf complex to consider – the soleus – it works when doing a bent knee calf raise. The same technique as above can be followed but perform the calf raise with the knee flexed around 30°. Most people find this harder so start with a lower weight.

If there are any problems with these exercises ask for help from your health professional. They should be pain free, the usual sensation of a muscle working is to be expected but they shouldn't cause your symptoms.

Using your 10 rep max for strengthening

Once you've determined 10RM use that weight for your rehab (on the smith machine or with weighted back pack). Do 3 sets of 10 reps with a rest period of 2-3 minutes between sets. You can work both gastrocnemius and soleus in 1 session but it's often best to work different muscle groups in between to allow adequate rest. If you're new to weight work start below your 10RM and build up as comfortable. The ACSM recommends working 8-12RM so you could start with a slightly lower weight at 12RM and build up to 10RM. You can increase the load by 2-10% when you are able to increase your reps by 1-2 over your target number. Carry out strength training 2-3 times per week, on days when you don't run. Ideally allow a rest day between each strength session and between run and strength work. This can be hard to juggle – you may need to prioritise – if calf pain is making running difficult it might be best to focus on a period of strength work before returning to running. Small strength changes can take place in as little as 2-3 weeks, this is often due to an increase in 'neural drive' to the muscle. Significant strength changes take around 6-8 weeks while changes in muscle bulk may take around 12 weeks.

I consider strength to be the basis of much of muscle function and it is necessary to achieve adequate strength before progressing to power. When you have achieved the same weight for 10RM on both sides move up to 9RM and then 8RM (providing you can do so with good technique and are not getting pain during the exercise).

Note: if you're moving up to 9RM or 8RM adjust reps accordingly i.e. 3 sets of 9 for 9RM and 3 sets of 8 for 8RM.

For many people this level of strength will be perfectly adequate for their running and above what many people will do when rehabbing a calf problem. If pain persists when running despite achieving equal strength then make sure you have determined why and consult your Physio/ health professional.

Building Power

There are other aspects of calf muscle function that can be linked to pain and performance. If you have equal strength you can progress onto power work. Muscle power is essentially strength over time. Power work is usually less reps and higher speed. As a result there is risk of injury doing power work – go carefully and ask for help!

Start with the load you've used for 10RM. Do the calf raise as before but increase the speed, aiming for an 'explosive tempo'. Do 3 sets of 6 reps with a 3-5 minute rest in between. This longer rest period allows the muscle to recover enough to maintain good technique with rapid movement. Gradually build up to 8RM if comfortable, as mentioned above proceed with caution – ideally progression through strength work into power should be guided by a Physio/ health professional.

To include soleus in your power work progress by starting with the knee flexed to around 30°, this time though push up on your toes and straighten the knee as you do it. This makes it a 'multi-joint' exercise as it will involve knee and hip extension as well as ankle plantarflexion. Multi-joint exercises are often recommended for power work as we seldom produce power from one joint movement alone.

Once strength and power are equal left and right then you may choose to add plyometrics into your training, this is an area in its own right and will be discussed separately.

 

Closing thoughts: improving calf muscle strength and power can help prevent calf pain when running. It could also potentially improve performance – stronger muscles are more efficient when running and resistance training has been found to improve running economy. This type of resistance training is potentially very rewarding but also not easy to do on your own – work with a Physio or strength and conditioning coach for support and guidance. When rehabbing an injury always follow our moto – if in doubt, get checked out!

 

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