The Relationship Between Age and Calf Injuries

In last week’s article, we saw that some particular injuries that are common among male runners—knee osteoarthritis, meniscus tears and calf strains—are also conspicuously more frequent as runners get older.

Calf strains (or tears) in particular are a very common problem among masters athletes, so today we’ll be looking into why this injury occurs more often as you get older.

Examining calf injuries and age

Calf injuries appear to be unique among muscular sports injuries in that they appear more frequently as you get older.

A study of professional soccer players by Jan Ekstrand, Martin Hägglund, and Markus Waldén at Linköping University in Sweden found that, while hamstring and adductor injuries were more common than calf injuries, the incidence of calf strain increased with age, while the risk of injury to the other muscles of the leg remained unchanged.

The calf actually consists of two muscles: the gastrocnemius and the soleus.  The gastrocnemius has two “heads” which make up the meatier upper part of the calf, while the soleus is the more slender lower part of the muscle.  Both the gastrocnemius and soleus can be strained, but the medial head of the gastrocnemius is the most common location for injuries.

Though calf injuries are a problem for runners, they also occur quite frequently in ball sports like tennis, soccer, basketball, and cricket, so many scientific studies, including the ones we’ll be looking at, involve competitors from these sports.

Research-backed theories

The first step in answering the question of why calf injuries become more common with age is understanding the mechanics at play when a calf strain occurs.

One creative study, published in 2002 by sports injury clinicians at the Australian Cricket Board, examined the exact moment of a calf strain, caught close-up by multiple TV broadcast cameras during an Australia vs. England cricket match.

  • The authors of the study noted that the calf strain—plainly clear to see in the video, when the athlete’s calf appears to slacken on the lateral side—occurred just as the player’s opposite foot left the ground, as the calf transitioned from an eccentric contraction to an isometric “stance phase.” 
  • The authors also cite other work which indicates that calf injury occurs not as you push off  the ground (a concentric contraction), but just as you transition from landing to supporting and beginning to drive off the ground (eccentric and isometric muscle contractions).  This is significant because it can help us predict strategies for prevention.
  • Eccentric loads are also known to be more damaging to muscles, though the body is capable of supporting significantly more weight in an eccentric contraction than a concentric one.  Knowing this, we can predict that aging would increase the risk of muscular injury, as muscular strength gradually decreases as you get older.
  • Not only that, but aging selectively weakens the “fast twitch” muscle fibers that are tailored to handle high-power contractions and rapid loading.
  • Less muscle strength overall will also lead to increased fatigue, which has been implicated in muscle strains—at least in one study at Duke University using rabbits.

Unfortunately, this still leaves open the question of why the calf in particular becomes more susceptible to injury with aging, and not the hamstrings, quads, or adductors.

I found no research that could directly explain this phenomenon.  It could simply be that the calf has less muscle mass overall when compared to the other prime movers of the lower leg, like the hamstrings and the quads.  A consistent rate of muscle fiber decline with age would therefore affect it to a greater extent than these other muscles.

On the other hand, there could be something biologically unique about the calf or its function during sport that makes it more susceptible to injury with age—either differences in the muscle itself, or differences in the relative amount of force that it must handle.

Final thoughts

Whatever the reason, older runners, especially men, need to be aware that their calves get more vulnerable to injury as they age. 

Our understanding of the injury process can also help predict some preventative measures; since we know that calf strains occur during the eccentric and isometric phases of the running gait, it is likely that calf strengthening routines that focus on these aspects will be more successful at preventing injury than simply doing traditional calf raises, a primarily concentric exercise. 

Eccentric heel drops,  often used to treat Achilles tendonitis, are a highly effective eccentric strengthening exercise, while “toe walks”—walking forwards or especially backwards keeping your heels off the ground—are a good isometric exercise that even strong runners will find challenging after a few sets of 15 or 20 meters.

Staying healthy is an integral part to success as a masters athlete, so being aware of the causes and possible ways to prevent calf strains will help your training and racing greatly.

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References

1. Ekstrand, J.; Hägglund, M.; Waldén, M., Epidemiology of muscle injuries in professional football (soccer). American Journal of Sports Medicine 2011, 39 (6), 1226-1232.
2. Dixon, J. B., Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Current Reviews in Musculoskeletal Medicine 2009, 2 (2), 74-77.
3. Orchard, J. W.; Alcott, E.; James, T.; Farhart, P.; Portus, M.; Waugh, S., Exact moment of a gastrocnemius muscle strain captured on video. British Journal of Sports Medicine 2002, 36, 222-223.
4. Lindle, R.; Metter, E.; Lynch, N.; Fleg, J.; Fozard, J.; Tobin, J.; Roy, T.; Hurley, B., Age and gender comparisons of muscle strength in 654 women and men aged 20–93 yr. Journal of Applied Physiology 1997, 83 (5), 1581-1587.
5. Larsson, L.; Grimby, G.; Karlsson, J., Muscle strength and speed of movement in relation to age and muscle morphology. Journal of Applied Physiology 1979, 46 (3), 451-456.
6. Mair, S. D.; Seaber, A. V.; Glisson, R. R.; Garrett, W. E., The Role of Fatigue in Susceptibility to Acute Muscle Strain Injury. American Journal of Sports Medicine 1996, 24 (2), 137-143.

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