The calf muscle is one of the most commonly ‘torn’ or ‘strained’ muscles in the body. This occurs when the muscle is forcibly stretched beyond its limits resulting in tearing of some of the muscle fibres.
The calf is comprised of two muscles. The Soleus which is deep and the Gastrocnemius which is superficial. They both come together and form the Achilles tendon which inserts onto the heel bone at the bottom of the leg.
- Most common in tennis and football players.
- Very common overuse injury in runners (more common in people who have not been physically active for an extended period of time).
- The most common place to incur this injury is at the muscular tendinous junction of the Gastrocnemius, roughly halfway between the knee and the heel.
Calf strains are graded according to their severity and based of that, a return to activity guide can be used. However, return to activity varies between individuals and is best assessed by your health professional.
Increased age and previous calf injury are the strongest risk factors.
Other less common factors: inadequate rehab from previous injury, loss of strength as we age, load intolerance (too much too soon).
How it happens and how it’s different to fatigue like pain?
Suspecting a tear: Sudden onset, like a kick in the back of the leg. Pain tends to hang around for time after exercise, swelling or bruising in the calf, pain when doing a heel raise.
On a longer run where there is pain in the calf and it stops when you stop. Symptoms aren’t present post-exercise or the days following. That tends to be more fatigue related.
A good example of how the injury can occur is when you try to change direction. When the knee is extended (straight) and the foot is dorsiflexed (toes pulled towards the body), the calf is on stretch and then tries to contract and generate force. It’s like trying to pull tighter a piece of string that is already tight, its either going to withstand the extra force.. or tear.
How are they managed?
- Activity and load modification. Low-impact activity to keep cardiovascular fitness. E-g, cycling, swimming or upper body strength training.
Fun fact for strength training: A meta-analysis (reviews strong evidence papers and combines them into one paper) in 2006 found that training the non-injured side of a body part showed an increase in strength on the injured side on average of 8%.
- Maintaining range of motion and strength over the rehab period. Each individual is difference and no two injuries are the same. We now know it’s not just muscle damage that affects rehab but external factors such as sleep, nutrition and previous activity levels. It will most commonly follow a timeline of exercises with progression each time an activity is able to be completed. Such as starting with basic range of movement at the ankle, then to heel raises, then to a single leg powerful hop.
Your health professional will determine the most beneficial and timely regime to follow as you work together to reach your goals.
- Education – this is a pivotal part of your rehab. Your health professional will always explain and reexplained analogies, protocols and more as you progress through your rehab. An example of this and why it’s important: if we think of rehab very simply (acute stage, mid stage and the final stage), you may be pain free in midstage in which its quite easy to think you’ll be okay to return to previous activity. However, this is one of the most common reasons as to why re-injury to occurs. This is where education is important to gain an understanding of what activity may increase the risk of injury and when it’s okay to get back to loading the calf again.
- Footwear assessment: Previous footwear and current footwear can have an impact on your rehab and returning to activity. Your Podiatrist will assess your footwear and make a recommendation based on many things including foot type, previous history and current goals.
- Gradual return is the most beneficial while keeping risk of re-injury low. For example, a runner or individual participating in sport return may look something like the following: Brisk walking > running of the spot for a minute > flat running for a limited time > return to activity. Again, your health professional will determine your return to activity and is well-equip to judge when return is warranted.
Great video below of a tear happening in real time.
This presentation was presented by Blake Withers from Newcastle Podiatry. It is talking about Blister Prevention and Footwear Management.
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