It’s often called the “over 30s injury”. It’s the soft tissue injury that makes veteran athletes worried the game may have passed them by. It’s that feeling like someone’s shot you in the back of the leg but hasn’t. That’s right, today we are talking the dreaded calf strain!

How?

A calf strain is a pull or tear of the muscle fibres of the muscles at the back of the lower leg, and can range from mild to very severe. It usually involves one of the two calf muscles: gastrocnemius or soleus.

Calf Strain - common injury location - Revive Physiotherapy and Pilates

Image credit: physioworks.com.au

The calf is commonly injured in sports which require quick acceleration or push off from a stationary position, e.g. hockey, tennis, squash, football and basketball. Another common cause of the injury is when walking or running and you step onto a kerb or uneven ground. If unexpected or unbalanced, the heel may drop backwards, causing a sudden forceful calf stretch and eccentric contraction of the muscle. The pain from this action may be felt immediately and indicate a calf strain.

Calf Strain - Squash players and sudden stretching - Revive Physiotherapy and Pilates

Image credit: squashmad.com

Signs and Symptoms

Symptoms of a calf strain can vary significantly but usually involve a sudden sharp pain at the back of the lower leg. The calf muscle will often be tender to touch at the point of injury and swelling, and bruising may appear within hours or days. Walking may be painful, especially walking or standing on your tip toes.

Depending on how bad the calf injury is, the athlete may be able to continue exercising albeit with some discomfort or tightness during or after the session. When injuries are more severe, the athlete should be able to recall the exact moment when the injury occurred. As mentioned above, people often feel like they have been shot in the leg or hit with a stick across the back of their leg. They may hear a “pop” and may not be unable to walk due to severe pain.

Calf Strain - Bruising following severe strain - Revive Physiotherapy and Pilates

Image credit: Muscle & Strength Forum

What can be done? Lots…

Like with most injuries RICE for the first 48-72 hours. The aim is to reduce the bleeding and damage in the muscle. The leg should be rested in an elevated position with an ice pack applied for 20 minutes every two hours (never apply ice directly to the skin). A correctly sized compression bandage should be applied to limit bleeding and swelling in the injured area.

The No HARM Protocol should also be applied – no heat, no alcohol, no running or activity, and no massage. This will ensure decreased bleeding and swelling in the injured area.

See your physiotherapist ASAP for an accurate diagnosis and commencement of your rehab plan. If you have trouble walking, your physiotherapist may prescribe a gait aid, heel lift or compression bandage until the pain subsides.

Common treatments for calf strains

Soft tissue massage

The benefits of massage are stimulating blood flow, micro-stretching the muscle and releasing areas of spasm (removing muscle knots) in the muscle. The other major benefit of massage in the latter stages of a calf strain recovery is to soften the newly formed scar tissue and help to align the newly laid fibres to encourage more effective muscle healing and prevent re-injury.

Ultrasound therapy

This transmits sound waves into the tissues, which in the early stages can help with pain relief and to reduce swelling. In the later stages of rehabilitation, the ultrasound can cause a micro massaging effect which can help stimulate blood flow into the muscle.

Taping

Rigid tape or “Rocktape” can be used to help support and take the strain of your injured muscle

Strengthening

A series of progressive strengthening exercises is imperative to assist with the scar tissue formation and muscle repair. Your physio will be able to guide you through a series of exercises, depending on your assessment, that will help you regain the strength required to return to sport successfully.

Stretching

Gentle stretching to assist the muscle to return to its original length is essential and goes a long way to preventing re-injury.

Dry Needling

Like the effects of soft tissue massage, dry needling helps to stimulate blood flow and releases tight spots in the muscle that may have contributed to the strain in the first place or may have developed post injury.

Passive joint mobilisation

This involves your physio applying manual pressure to stretch the ankle joints in a way that improves the ankle joint range of motion. Mobilisations will address any restrictions in ankle joint range of motion that may have developed post injury or may have been present prior to your injury (and hence a possible contributing factor).

How long will I be out?

Your time for a successful return to sport depends on numerous factors. Like all soft tissue injuries, the severity of your injury generally correlates with length of recovery time. Factors that may lengthen your recovery time:

  • Previous history of calf strains
  • A recent strain
  • Concurrent musculo-skeletal injuries
  • Age
  • Mismanagement of your injury in the acute phase, i.e. not enough RICE and too much HARM
  • Adherence to your rehab program
  • Type of sport activity you are returning to

Generally speaking, to return to full training or to be match fit, a mild (grade 1) strain will take 2-4 weeks, a moderate (grade 2) will take 4-6 weeks and a more severe (grade 3) strain may take 3-6 months (or more), depending on whether surgery is required.

Like everything, prevention is key!

  • Complete proper warm-ups and cool-downs in your training sessions or games
  • Don’t try and push through increasing tightness or pain
  • Have regular massages to loosen tight muscles
  • Stretch regularly to improve your muscle flexibility
  • Wear appropriate footwear for your sport
  • Avoid high heels – overtime they will shorten your calves
  • Avoid uneven surfaces when running outdoors
  • Keep your calf muscles strong so they can absorb the energy of sudden physical stress
  • Maintain the strength of your posterior chain muscles, especially glutes and hamstrings

Hopefully today’s blog has provided you with some helpful knowledge in the management of calf strains. Remember, the sooner you see your physiotherapist for an assessment and commence treatment, the quicker your recovery time can be!

The information in today’s blog is general in nature and should not be used as a substitute for an in person consultation from your health care practitioner.