Lots and lots of discussion on this . . . do a search.

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David
* Ironman for Life! (Blog) * IM Everyday Hero Video * Daggett Shuler Law *
Disclaimer: I have personal and professional relationships with many athletes, vendors, and organizations in the triathlon world.

I searched, felt like most were focused on short term and how to get back. Nothing focused on long term success.

Does it hurt when cycling or just running?

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https://www.strava.com/...tes/zachary_mckinney

Never hurt during bike, and never bothered me on the bike.
Same for elliptical, i can shortly after come back and go hard and long on elliptical.

I recommend a consistent run training plan that you do 52 weeks a year. This should include the exercises your PT recommends. You should run consistently whether or not you are racing. If you take time off know that you likely could have a set back and work back to optimum mileage gradually. Also running as soon as you get up in the morning will give you the best chance to remain injury free vs lunch time or running after work when your leg muscles are tighter. To recap, be consistent with your training, run first thing in the morning, and incorporate your PT exercises into your program. Good luck!

Interesting never thought about the morning part will try to focus on that.

My experience with it gave me a few thoughts.

1. I felt it was an over-use injury. Since I got it early in my running career where I went from 0 to 30 miles per week in 2 years. It was a time I started a heavy run program during the off season.

2. Since massage made it better I started to think it was a blood circulation problem. It could have been a collapse of capillaries or even a restriction from a small blood clot. I'm leaning away from the blood clot because my legs didn't swell up but it could have been from a lack of blood flow.

3. It may also have been a tightening of the sheath around the muscles. Again massage made it better.

4. It's also remotely possible it was from an antibiotic I took near that time - levofloxacin (Levaquin)

It was a deep pain I got in the center of my left calf. 16 years later I've never had it again. I've had problems in other parts of my legs but not my calves.

I got this problem seven years ago when returning to running in my late 40s. When the thing cramped it reduced me to walking and it was very painful. Tooks weeks of time to recover. First no running for a few weeks then slow return to activity. I found running after cycling and static stretch of achilles and soleus most helpful. Soleus stretch similar to achilles stretch but done with bent knee. I have learn to lay off at earliest sign of trouble. Which for me is aching pain in calf. In the first two years I bet I had five episodes. In the last 4 years I just have had episodes where I have had to back off for a bit. I think if I dropped ten pounds (I am 6'1" and 175) it would be less of a problem .

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They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

Google Eccentric Calf Loading Protocol, start on it, then hit it up every 2nd day from now until you plan to never run again.

Is it possible to describe your symptoms in a bit more detail?
The term "calf heart attack" has been used a few times on this forum in the past. As a medico....the terminology is confusing as a heart attack is just that, a heart attack and is caused by ischaemia to the cardiac muscle (which can have many causes)....so a calf "heart attack" presumably refers to some sort of calf related symptoms but would be nice to know what you are getting, where about in the calf, what brings it on, what makes it better and whether you have had any diagnostic tests done?

I had the same thought, calf heart attack sounds like a blood flow/ischemia problem (i.e. something akin to or even actually intermittent claudication) but what seems to be being discussed is a musculoskeletal problem?

It's just an exciting name to describe bad calf pain.

The name has nothing to do with any clinical diagnosis.

When I first started dealing with this issue I would feel it starting on a run, but try to just slow down and jog through it to get home. That’s not good enough, I’ve learned that at the first twinge to stop and walk it home or call for a ride even if that takes awhile. Once home I hit it with the massage stick, rest for at least a day or two with the eccentric calf raises worked in as long as there is no pain.

Thus far, I have avoided another full blown “attack” using that methodology. I’m not a doc and obviously YMMV.

People with peripheral arterial disease (i.e. narrowed arteries akin to what happens in the heart from atherosclerosis) can experience intermittent claudication, which is usually in the calves with walking. Usually the pain resolves when they stop walking and lower the oxygen demand of the muscles. Usually it's reproducible because the narrowing doesn't go away, unlike a blood clot that may resolve with time.

Those were just my thoughts at the time, I have zero qualifications to a provide anything more than my own speculation and what i did.

You and Amnesia appear to know so much more about this than I do.

I wouldn't worry about it being a blood flow problem, sounds musculoskeletal to me.

That was my first thought as well, thanks

Agree, pretty sure it is muscular, as I can go months at a time, with hard running with no issues at all. seems like if it was a constraint like compression syndrome etc, it would be more consistent, right?

How serious are you with PT exercices? Treat them as if they were as important as brushing your teeth.
+ I'd look at the shoes / drop / cushionning.

I had similar symptoms and my life has completely changed when I switched from Nike Pegasus to Hoka.

FWIW, I rarely have calf issues but a couple times a year I will suffer severe night time cramping that wakes me from sleep and feels like a knife stuck in the calf. When this happens I add in Calcium and Magnesium supplements and the problem resolves almost immediately.

It's unlikely to hurt and it might help.

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Jason
None of the secrets of success will work unless you do.

Does this happen more frequently when running off the bike? Does bike volume correlate to this happening at all? Do you have stretched where you don’t bike at all and this still happens?

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Trent Nix
Owned and operated Tri Shop
F.I.S.T. Advanced Certified Fitter | Retul Master Certified Fitter (back when those were things)

I am 47 and experienced intermittent calf heart attacks for many years now. As has been noted by others they are a bit random but in my specific case I think I have a few issues that may contribute to them. I have tight ankles from numerous sprains (basketball in my youth), I have numbness in the big toe of the leg I most often get them (circulation or nerve entrapment but not sure if one caused the other), I have always had a definite mid-forefoot strike and my calves are always crazy tight even when I take time off from running (like they almost always hurt until they loosen up). With all of these factors, as soon as I start increasing my mileage or doing more intensity my risk goes way up. Magnesium supplementation I think has helped as has making sure I stay hydrated (which is challenging in Fl).

When I do experience them I back off immediately and then begin rehab - which for me involves elliptical and oddly enough stair climbers for about 2-3 weeks and then I ease back into running starting with 1 mile and building. If I feel anything in my calf I back off and go back to rehab for another week and the repeat. During this time I usually also wear compressions socks when sleeping and a compression sleeve when rehabbing/jogging. I'll tend to wear a compression sleeve when racing also until I feel 100% healed.

One last thing is that for me, since I have had lots of these I now have a knot deep in the belly of my soleus. I can feel it when I massage or roll it. It is tender. It never seems to go away and I can't really get at it. I would expect that this means my risk of re-occurrence is pretty high. You probably don't want this.

Good luck!

Trent doesn’t seem to correlate to cycling at all. I have had stretches with just running, as I really wanted to be a runner more than a triathlete, now I’m closer to being a cyclist than a triathlete. :-(

Thanks for all the feedback. Very helpful.