One of the most common complaints I see in my clinic, are clients hobbling in with calf strain. Sometimes they really felt it go, and other times they were just waiting for a tennis ball at the net and felt sudden weakness or cramp hence the name – ‘Tennis Leg’. I had one client in particular who
thought he was cramping, kept playing and the next day and for a number of weeks afterwards he had quite a spectacular bruise…. cramps don’t bruise!
First things first, what exactly is your calf? The calf muscle is a generic name used to describe the muscles at the back of the leg. In fact there are several muscles living in this neighbourhood and identifying which one has been damaged is key to fixing the problem and getting you back on form.
The most common muscles that are injured at the two most superficial muscles: The Gastrocnemius and the Soleus. They both help us to plantar flex or point our toes, the differentiator is that the Gastrocnemius crosses the knee so is also active in Knee Flexion. This piece of anatomy will also help us in our testing to identify which muscle has been damaged. The Achilles Tendon is also part of the picture and a whole other ball game! Lets leave that injury for another time.
How bad is it and how long to heal?
As with all muscles tears we need to establish whether we are talking a mild strain – Grade 1 (<10% of fibres damaged) which can take days to heal, or if there is a complete tear or Grade 3 strain. Most of what I see falls into the Grade 2 range but again this can be anywhere from 10% to 90% of fibres torn so healing times can vary enormously… typically anywhere from 4 to 8 weeks.
In terms of assessment I am looking to identify the muscle or even tendon that may be the problem. This involves Active, Passive and Resisted testing as well as Range of Motion testing with both a straight and bent leg. Muscle strength is also important so looking for equality of strength from side to side. Along with testing, a visual assessment and palpation of the area provide critical input in to deciding on the next steps.
Assessment & Treatment
In the first 24 – 48 hours I advise my clients to engage in the Acute Injury protocol PRICE/RICE. No treatment over the direst site of injury but some light flushing techniques away from the injury site can help to manage inflammation.
After a couple of days when the acute stage has relented and we now in sub acute phase our goal becomes about ensuring mobile scar tissue develops, that range of motion can return and that we restore proprioception and strength to the calves. This phase can last anywhere from 3 days up to 3 months after an injury depending on the grade of tear. With this in mind, treatment starts conservatively, slowly building up in pressure and depth as the tissue heal. Passive mobilisation, light massage, medical acupuncture and kinesio taping are all techniques I would use during this time but being very conscious of not removing muscle guarding too early and ensuring that we do not separate the healing tissues. To this end I avoid friction and deep compression over the injury site until the scar tissue is fully formed.
The final phase – the remodelling phase is to me the most important but often the one most ignored as the client typically feels ‘better’ and keen to get back to their usual routine. This is where we need to break down the adhesions, help realign the scar tissue and gradually increase stretch levels to ensure an elastic, mobile, pliable but strong tissue remains preventing re-injury in the future.
As with any injury, what you do at home has a massive impact on healing time, strength of healed tissue and also in reducing the risk of re-injury. This can involve hot and cold therapy, stretching, balance work building up to strengthening exercises. The stretches and strengthening required depend on what muscle has been damaged – that old question of do I stretch my calf with a bent leg or straight one!
A gradual strength programme is key. Too much too soon and you may be back at square one. I generally start my clients on isometric contractions, building up to adding light resistance before moving onto heel lifts. In the final stages I introduce eccentric heel drops – getting the damaged muscles to contract while lengthening. This has been proven to create greater levels of strength and to decrease the risk of re-injury significantly. Finally and most importantly we move on to functional movements to ensure that the newly rehabilitated muscles can function in movement – which let’s be honest is where we all want to be… back doing what we love best!