Soleus Strain

Question
QUESTION: I have been running for 8 years, and for the past several years have focused on long distance trail running / races. The last race I completed was a trail 50K in Sept. 2011. I have had some chronic problems with both IT bands over the past two years, for which I抳e seen a sports med dr, a sports chiropractor and two PT抯. I抳e done the usual hip/glute strengthening stuff and continue to do these with other core exercises.  During this period, I changed to midfoot running and minimal shoes. My ITBS finally seemed to be resolving after ASTYM. The left IT band was still in the final recovery stages, when the calf problem arose.
I had noticed my calves being a bit tighter than usual on and off while running. On 11-4-11 while running trails, I rolled my left ankle pretty hard. After the initial pain passed in a few minutes, it seemed okay, so I finished my run (a bit over 14 miles). There was no pain or swelling of my ankle or foot post-run.  On 11-7-11, I was very sick with a stomach bug and on my first run after that both calves were very tight, but the left one had a sore spot on the medial calf a few inches below the knee. A couple of times over the next two weeks I noted in my log that spot on the calf was a bit sore or that my calves felt a bit tight. Then 11-21-11 I was three miles into my run (on a gravel road) when soreness in that spot on my left calf quickly escalated to a very sharp pain. I stopped running and could not even walk without limping. The next day I could walk normally, but still felt some soreness. I took three days off running, then tried an easy run/walk, but the calf was still sore, so I stopped. Took several more days off and then was able to ease back into running about 25-28 miles weekly. I had some low level tightness / soreness in my left calf, but it seemed okay to run.
Then unbelievably, on12-9-11, I rolled my left ankle again on the same trail. It didn抰 feel quite as bad, and once again, it felt fine and I finished my run (12.5 miles). I had some low level soreness in the medial spot on my left calf and some low level general calf soreness, but continued my running program (trying to train for a 50K trail race 1-11-12). On 12-16-11 while running on muddy, slippery trails, I had the sharp injury-type pain in that medial spot on my left calf again. I stopped running and walked out.
I found a sports chiropractor who does ART and Graston. He said I had a soleus strain probably related to rolling my ankle. I had 5 treatments including ART and Graston over the next 3 weeks, and also he prescribed stretches, and taped the calf with kinesio tape. He encouraged me to keep running (at somewhat reduced mileage) as long as the soreness was low level, saying this would actually improve circulation and speed healing.
Now, I抦 9 weeks out from the original calf injury and 4 weeks out from the secondary calf pain, and I抦 still having low level aching and soreness in this calf. I am still taping the calf. When I run, the calf feels pretty good for a while then I get some low level soreness which comes and goes and often seems to get better by the end of the run. I抦 talking about a 1 or 2 maximum on a scale of 1-10. But what concerns me is that I have low level soreness and some achiness after my run and sometimes the next day.
Here is my question: Do you agree with the active recovery ideas of the dr. I saw? Should recovery really take this long? Or am I just re-aggravating this injury by continued running? I抳e given up on running the 50K race 2-11-12, but I am hoping that maybe I can still do the 20 miler. I抦 tired of fighting this injury.

ANSWER: Wow Deb.  I'm sorry to hear all of what you've been through.  I'll answer your questions and give advice. 1) I agree with active recovery, but I don't think just somewhat reduced mileage is adequate. If you're not walking throughout the day then a light jog of about a mile is what I recommend. Listen to your body. Some days you may be able to do more, some days less.  Listen to your body. 2) Yes, unfortunately recovery can really take this long.  Giving it more time as opposed to rushing it is always what I recommend.  Rather be back a month later because of going slow as opposed to being back 8 months later because of rushing it.   

I think you should see a Total Motion Release therapist.  Given what your ankle and leg has been through there are surely imbalances/asymmetry present.  TMR therapists are best at fixing this.  Is either  Cincinnati, MI Salisbury, MI or New Berlin, MI feasible for you to go? If so I'll give you the address and contact info of a TMR therapist there.  All of these TMR therapists are physical therapists as well.  They will be able to get you fixed.

Good luck and I look forward to your response.

---------- FOLLOW-UP ----------

QUESTION: Thank you for your response! I googled Total Motion Release and it looks very interesting. However, there does not appear to be anyone practicing it anywhere near my area, so that does not appear to be an option.  Also, I抳e already dumped quite a bit of money into this injury and don抰 have much more I can realistically spend on it. Any other suggestions about how to correct imbalances? I抳e done tons of reading online and do a fair amount of core/body weight strength work. I have a couple of kettlebells, but don抰 really know what to do with them.

I do feel that the ART/Graston has helped with the healing, and hopefully they are breaking up scar tissue and adhesions so this won抰 be a chronic injury.
I do walk and move around a lot during the day, and when I run, I always walk a half mile first, do some dynamic stretching drills, then I have been doing a run/walk easy pattern. No speedwork, no significant hills, etc. Then I do a half mile walk at the end and use the Stick and a foam roller with some AIS and /or static stretching.
I have learned a lot about listening to my body through my ITBS problems. I can read what's going on with my IT bands pretty well and know when I'm okay to keep running and when I need to stop, but this calf thing is harder for me to assess.
Seriously, a one mile jog? I抦 used to long distances and don抰 even feel warmed up until I hit 2-3 miles. After several soft tissue treatments I was running 5-6 miles on the road without feeling any soreness in my calf during the run or afterwards. But I tried running (technical) trails again (without wearing tape), because the sports chiropractor said to give it a try and I think I might have re-aggravated the injury some.
I抦 only running 3 times a week. Last week I ran 7.25 mi / 7.5mi / and 13.5mi (the first two runs on gravel/blacktop roads, the last on groomed chat bike trails) My calf actually didn't feel too bad. I can run about 2-3 miles without feeling anything from my calf and then I start feeling some intermittent low level soreness, which actually seems to feel better as I keep going until for the last few miles I抦 feeling nothing/ to a shadow level of soreness. But I do feel some achiness/very mild soreness intermittently the day after the run. If I抦 honest with myself, I think that the slight soreness/aching the day after a run is telling me I pushed too much.
Maybe I should run until I feel the low level soreness in my calf and then stop? I suppose you抮e saying I should ditch the race on 2-11 also. This is insanely difficult for me. I am a totally addicted runner and to think about reducing my mileage this much and missing this race is like telling me to cut off a few fingers. I抦 just being totally honest with you when I say that I don抰 know if I抣l really cut back that much. Knowing what you should do and actually doing it are separate realities.
What I抎 like to do is make it through this week at about the same mileage I did last week (about 28 miles) and then cut way back for the two weeks before the race, run the 20 miler, and then deal with the aftermath. (After all, I did convince myself that I should not run the 50K which is what I really, really want to do.)  If this sounds like I抦 setting myself up for real trouble, please help me talk myself out of it. I don抰 want to do something stupid that will keep me on the injury list all summer.

Answer
Don't do it Deb. I know that was blunt, but I'm serious.  Is it possible? Possibly.  The risk is way too high.  You'll be mad at yourself the rest of the summer and possibly into the fall if you damage yourself in the next couple of weeks.  Further, if you really are addicted to running then this will be therapeutic.  Running is a phenomenal thing to do, but I've seen the negative side of addiction with it.

If you don't feel any soreness until mile 2 or 3 then you're fine to go farther than the 1 mile.  The rule I'm giving you is to do less than you think you can, NOT MORE.  Being delayed a week or two in recovery is always preferred to being delayed several months.  

It's too bad that none of those cities are near you.  Try looking at some of the videos on their home page and trying a few and seeing if it helps.  It will be much more effective than foam rolling and stretching your IT band as well.  Please let me know if you have anymore questions:)