Managing a Calf Strain like a Pro

Oh the Pain of a Calf strain 

We’ve seen a number of patients who have injured their calf muscles recently.  Hence why we’ve decided to put this little video together (scroll down for video). (Also watch to the end for a special treat:))

It is not only runners who sustain calf strains, but it is one of the most common running injuries we see in clinic.  Those who spend long periods of time in high heel shoes are also more susceptible because the calf muscles can shorten and then struggle to meet demands when doing activities in flat shoes.

If you play a sport that demands quick acceleration, deceleration and direction changes, your muscles, including calf muscles, are at risk, especially if you do not warm up properly.

Muscle strains are graded to communicate severity in the diagnosis as follows. 

Grade 1 – minimal amount of fibres torn in the muscle with focal tenderness and almost no swelling. Strength is not affected.

Grade 2 – a significant amount of fibres are torn.  There is pain and swelling and some loss of strength.

Grade 3 is a complete tear in the muscle.  In some cases surgery might be indicated, for the most part conservative treatment is sufficient though.  Definitely get to your physiotherapist if this happens to you.

The first 72 hours after injury is the acute phase.  During this phase treat your injury with the RICE regime.

Rest – reduce walking or use a crutch

Ice – always protect the skin with a layer of cloth or oil and only ice for 10 minutes at a time.

Compression – a tight flight sock or tubigrip will reduce the swelling.

Elevation – raise the leg to further reduce swelling and aid lymphatic drainage to the body.

‘Do I need a scan?’ I hear you ask me.  No is the short answer.  It will be helpful to have a scan in the case of a grade 3 tear so that the surgeon can assess the task at hand, but for grades 1 and 2 the last thing you want to do is spend hours in an A&E waiting room in pain.

Does anti inflammatories help?’ I’m so glad you ask this question.  

Remember that our body’s response to acute injury is inflammation.  We need this inflammation to heal.  It is only when there is a persistent, low level inflammation when this becomes a problem and Non-Steroidal Anti-inflammatories (NSAIDS) such as ibuprofen or Nurofen are helpful.  If you need something to curb the pain, rather take some paracetamol if this agrees with you.

After 72 hours, in the subacute phase you can start gentle self release through massage with fingers/ spike balls or a foam roller and also gentle stretching.

There are 2 stretches for the calf.  The first is to lean forward with one leg back.  Your hands are on a wall.  The leg to the back has the toes pointing straight forward, the heel down and the hips leaning toward the wall.  The back knee is straight!!  This will stretch your Gastrocnemius muscles.

The second stretch is exactly the same, except the back knee is bent!! This will stretch the Soleus muscle.

Hold the stretch for about 15 seconds to allow lengthening and repeat 3 times a day.

We can help further in clinic by doing soft tissue work, acupuncture, taping and fully assess your biomechanics to sort out other contributory factors.  We can look at the role your footwear played and adjust as needed with some felt and heel raises or refer to a podiatrist where needed.

After gentle release you can now start strengthening appropriately.  Rehab always happens in this order.  Always release what is tight first and then strengthen what is weak.  We always work on this principle.  We also aim for 3 sets of 15 repetitions during rehab, as long as this is within a pain free tolerance.  Some discomfort is allowed but not pain – remember you are still healing.  Soft tissue takes 3 – 6 weeks to heal and you do not want to tear those fragile newly formed muscle fibres again.

We will only address the first phase of your rehab here to get you started.  Please get in touch with your physio for further guidance and management.

Calf raises are easy to start with because you can help with your uninjured leg as much as is needed.

First give a lot of support to the injured leg on the way up as well as down. 

Towards the end of the first week roughly, you can support fully on the way up and less on the way down.  This eccentric strengthening is very important in promoting the laying down of muscle fibres and tendons. Together with gentle massage and stretching it also guides the directional growth of new fibres.

Repeat the calf raises while in a wall sit to target the soleus muscles more – alternate rather than both together if it feels a bit unstable.

Balancing exercises are easy, can be done anywhere and everywhere and are a great way to strengthen and improve control and stability of your joints too.

Stand on one leg whenever you get the opportunity – when you’re brushing your teeth, on the phone, on the tube, making tea – you get the idea.

Challenge your balance by swinging the other leg in a figure 8, or turn your head, or close your eyes.  You can also catch and through a ball.  Get creative.

Foot schrunchies strengthens those foot muscles that provide invaluable support to the calves because when the foot and ankle deals with impact and load, the calves do not have to deal with that load.  Never underestimate the value of foot exercises.  Pick up marbles or pencils with your toes, wrinkle a towel underneath your foot with your toes and widen and move toes in opposite directions.

You can also do an ankle point and flex while holding a pencil under your toes.  This is great for smooth ankle control. 

In clinic we will get you started with more exercises using therabands, wobble boards, Swiss balls and TRX suspension slings.  We will also address any other biomechanical deficits you might have that will predispose you to injury, so it is important that you visit your physio to ensure returning to your sport in good time with less risk of re-injury.

Patient S strained her calf training for a triathlon.  She felt a twinge early on in one of her training runs and then felt it go when she sidestepped tourists off the pavement.  She was in pain but managed to hobble on her toe and get the bus home.  She had some bruising and walked with a limp so we diagnosed her with a grade 2 strain of her medial gastrocnemius.  She had 5 sessions of physiotherapy over the following 3 weeks.  She was diligent with her rehab programme and self treatment the rest of the time.  We also addressed some weakness in other parts of her body that most likely contributed to her injury.  We looked at her lifestyle and made some changes to her training regime to make sure she gets enough rest and train optimally.  She managed to do her triathlon with lots of taping and supportive shoes in place, not achieving her PB this time but she finished with an intact calf muscle.

If you have a story to share or any further questions, get in touch with us.  We would love to hear from you.

With Love,

Retha and Sarah

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