Calf Muscle Strain
Calf Muscle Strain
In our practice it is common to see a patient attend for treatment complaining of sudden calf pain during a game of squash or midway through a run.
Causes of calf pain can include muscle cramp, delayed onset muscle soreness (DOMS) and referred pain from the lumbar spine, however, by far the most common cause of pain in the lower leg is a strain to the musculo-tendinous complex of the Gastrocneimus and/or Soleus (the two main calf muscles).
Within the fitness industry calf tears often occur in typical personal training activities such as shuttle runs (requiring rapid acceleration and change of direction), split jumping (where one leg is thrust backwards on landing), incline running and sprinting. This injury is common in boxing sessions where participants are jumping and hopping on their toes and also in hill work on sand in the popular “Boot Camp” activities due to the unstable surface the sand provides and the intense muscle work involved in these sessions.
Examination reveals tenderness localised to the site of the tear and if severe, a palpable defect or gap may be felt. Stretching of the Gastrocneimus will also reproduce pain, which is why the patient will usually walk with the foot turned outwards as this limits ankle dorsi-flexion (ankle bend) and reduces the need to dorsi-flex (bend) the ankle whilst walking. Muscle tears are classified by the amount of tissue torn. Grade I is a mild tear of only a few muscle fibres, generally speaking this will take 2-4 weeks to recover from. Grade II is a partial tear of the muscle which varies in thickness; this will take up to 8-12 weeks to heal. A full rupture of the muscle is referred to as a grade III. This can require surgery and can take many months to recover from.
There are a significant number of people who do not have the sharp, stabbing pain associated with the typical calf strain – but report more of an intermittent cramping sensation during exercise. This “cramping” sensation is often due to recurrent minor calf tears which can be linked back to old scar tissue from a previous (and more severe) calf tear – this scar tissue is common in patients that did not undergo adequate rehabilitation following their initial calf injury.
As with all episodes of pain it is essential the client is examined by a Physiotherapist or sports physician as soon as possible. The medical professional will evaluate the extent of the injury; outline an approximate time line for rehabilitation, as well as excluding any more serious problems such as Achilles tendon rupture, lumbar spine referral and deep venous thrombosis (DVT).
Once the calf strain is diagnosed and other problems excluded, initial management will aim to reduce pain and swelling. This is best achieved with ice, elevation and compressive bandaging. The patient may also benefit from a small heel raise in the shoe to prevent excessive stretching of the calf when walking, females will typically be more comfortable in shoes with a moderate heel raise.
Gentle stretching to the point of a “tightness sensation” and muscle strengthening can begin after the first 72 hours. The exercise progressions commence with bilateral (both legs) concentric (muscle shortening) calf raises and gradually progress to unilateral concentric, adding of weight and finally bilateral and unilateral eccentric lowering over the edge of a step. It is important to do the correct amount of reps with a graduated increase in number over a specified time. Final stage rehabilitation will involve plyometric (hopping and jumping drills) and sports specific drills to ensure complete recovery prior to returning to sport. Soft tissue therapy is an important component of the management plan as residual scar tissue can lead to long term problems and injury recurrence.