• Dr. Rob Thiry

What exactly is a “calf heart attack”?


It’s a pretty common story my patients tell me: “I was out for a run and started to notice a faint tightness in my right calf. Then, within a few strides, it hit me—a sharp grab-and-tear sensation. I hobbled a few steps, but just couldn’t start running again.


Here is an article from a recent Runner’s World on what one expert calls a “calf heart attack.” Read what Daniel Frey, doctor of physical therapist and lifelong runner based in Portland, Maine, has to say.


"As a physical therapist, I see this injury often. One reason runners are so frustrated when they see me about is that there’s little information available. More than 20 years ago, Once a Runner author John Parker wrote about calf heart attacks in Running Times. That article remains one of the top results when you Google the injury.

Fortunately, there have been advancements in treating calf heart attacks over the past two decades. Here’s what you need to know to treat and prevent this injury.

What Exactly Is a Calf Heart Attack?

Although “calf heart attack” is common runner’s lingo, it doesn’t have a precise equivalent in medical terms. I think of the injury as being on a continuum; we can grade the levels of intensity from a mild calf spasm, to a more common strain, and on up to a tear of the muscle-tendon complex.

To better understand calf heart attacks, let’s look at where the injury occurs. The calf is a group of muscles comprising the gastrocnemius, which is more superficial, and the soleus, which is deeper. The calf is essential for controlling shock absorption when you land and propulsion when you toe off. Think of it as a large spring in your lower leg that needs to be flexible and compliant to remain efficient.

When the calf is overloaded, its muscle fibers are pulled to the extreme, causing micro-tearing of the soft tissue. This creates a break in the spring mechanism, leading to pain and deeper inflammation, ultimately stopping your run.

Although calf heart attacks strike a wide range of runners, I most often see them in middle-aged men who are tight all over and, often, have mechanical faults in their running form. A few key gait problems associated with calf heart attacks are:

  • Excessive toe-out: A tight calf complex limits the ankle from bending during toe-off. This can lead to a lateral toe-out pattern, causing the calf to be loaded unevenly.

  • Excessive forward tilt of the pelvis: The pelvis seems too distant from the calf to be related to a calf injury, yet the pelvis has a close connection to the calf. A tight iliopsoas, or hip flexor, can cause the pelvis to pull forward and limit a runner’s ability to activate their glutes, another key push-off muscle. If the glute is less active, the calf needs to take the brunt of the work, and it can be overstressed.

  • Over-reaching stride pattern: A longer stride means more time spent on the ground and more load on the calf. This limits the ability for the calf to be a responsive spring.

Men might also be more susceptible because they tend to have more Achilles injuries than women. One recent study found that men are about 75 percent more likely than women to sustain an Achilles injury. On average, men’s Achilles tendons are less elongated than women’s during dorsiflexion (i.e., when the toes move toward the shin), thereby placing more strain on the tendon. These findings might be relevant to calf heart attacks because the Achilles tendon is an integral component of the calf spring; dysfunction in the Achilles can restrict the calf, leading to injury.


First Steps: Make it Feel Better


What should you do in the immediate aftermath of a calf heart attack? Follow this routine for the next five to seven days before you resume running.

Rest: Don’t try to run. Doing so will require the calf to work hard and may lead to further injury. Walk, cycle, or swim daily to increase blood flow to the injured area. But do these activities only if they don’t cause calf pain. If they do, stop immediately and try again a few days later. You should be symptom-free during no-impact exercise and daily activities for a minimum of one week before trying to run.

Self-Massage: Lightly roll the injured area with a massage stick. Doing so will ease spasms, which are triggered by the discomfort, and decrease localized inflammation. Roll the calf two or three times a day for five minutes at a time. Keep the pressure at a comfortable level, while bearing in mind that you might have to press firmly, because the injured tissue is usually deep in the calf.

Ice: Use an ice cup to massage your calf two or three times a day, for 10 minutes at a time. Whether this helps in the first few days post-injury depends on the depth of the injury. If icing doesn’t seem to reduce your immediate pain level, don’t bother.

Compression: Although the research supporting compression stockings or calf sleeves isn’t overwhelming, many of my patients have found these to be helpful initially. I suspect the increased warmth and possible increased blood flow return helps the healing process.

Return to running slowly and cautiously. Your risk of another calf heart attack—and that much more missed training time—is high soon after your first one.

If you’d like to read the full detailed article, go to

https://www.runnersworld.com/health-injuries/a26944449/calf-heart-attacks-in-runners/

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