FIX with K 👩🏼 Calf injury – Muscle strain / tear

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The main anatomy to look at with the calf includes two muscles; gastrocnemius and the soleus. The soleus is the deeper of the two muscles and is a very thick flat shaped muscle. The gastrocnemius sit over the top and has two heads, medial and lateral and it is the one that we can visibly see when you do a calf raise. The other important structure is the achilles which is the tendon than attached both the soleus and gastrocnemius to the heel bone and acts as the anchor that allows these muscles to do their active work to move the ankle. Important areas to note with regards to injury is the junction between the muscle belly and the achilles tendon as this is a common area of injury.

What is a muscle strain or tear:

Muscles are equipped to manage a certain amount of stress and load and generally experience small amounts of micro tearing of their fibres when they undergo optimal stress. This then results in them repairing and ultimately increasing their strength and capacity in a healthy way.

When a muscle is exposed to a load that is outside its capability whether that is a peak force that is too high in one movement, or repeated overuse stress, it can cause extensive muscle fibre tearing. This is more than what we would consider a normal muscle damage response to exercise and results in inflammation, pain, impaired function and delayed recovery.

A calf strain is the same as a tear which basically describes damage to the fibres of a muscle beyond what is considered normal. It is categorised as mild, moderate or severe and these are determined based on the number of damaged fibres, tear size or the functional limitations experiences.

What are the symptoms of a muscle strain/tear:

With a calf muscle strain they are most commonly experienced in the moment at the point when the last overloading mechanism occurred and is accompanied with an acute sharp pain within the calf itself. The pain is usually pin-point and you can easily relay onto someone when the injury occurred and where you felt the pain. The grade of the injury will be closely related to the amount of pain you will feel, with more mild strains generally being less painful that more severe strains. Keep in mind that everyone has different pain thresholds and some people may experience less pain that others but may still have a severe injury that should be assessed and managed by a health professional.

Some calf strains will be associated with bruising which is a sign of bleeding within the muscle and are generally a sign of more severe injury within the tissue. Bruising may remain for a while after the pain has reduced within the calf.

Reduced function and capability of the calf which can include stiffness, weakness and reduced range of motion through the ankle. Difficulty weight bearing and walking normally with the more severe injuries where the strain has caused a tightening and locking of the muscle which inhibits it normal function.

What are the causes of calf strain/tear:

• Exposure to a single movement or push off that is beyond the peak force limits of the calf muscle. For example, a calf raise where weight is too heavy, sprint or jump where the force going through the calf is too much for the tissue to manage and results in tearing.

  
  

• Repetitive exposure to forces that overtime has caused

  
  

• over and over and in the end there is a force that causes the final blow that results in tearing of the muscle.

  
  

• Cold muscles that have not been warmed up can result is strain because they are not pliable and prepared to manage the load they are exposed to. Athletes that train early in the morning, or at night where conditions are colder are most susceptible to these injuries if they do not complete a proper warm up to prepare their muscles for activity and the stresses they will have to endure throughout their sport.

  
  

• Fatigue is a big cause for muscle strain also. If a muscle has been exposed to a training session, long day on feet, walking up multiple stairs etc and has an element of fatigue and the muscles peak limits are reduced as they are tired. If they are then exposed to a force that they may usually manage well, because of their fatigue and reduced capacity they may experience a strain at the end of a session or day where damage is then caused within the muscle.

  
  
  
  

Management of a calf strain/tear:

Initial management includes:

• Ice – on off ice over the area for 24hrs to help reduce the inflammation and encourage reductions in swelling and aggravation at the tissue level

  
  

• Compression – wearing a tube grip compression tubing over the calf can help reduce pain, inflammation and also reduce swelling if present.

  
  

• Reduce load – reduce high activity that could cause more damage or pain, and only work within pain free limits for first 3 days. Limiting activity and allowing the damaged area to reduce in inflammation before beginning a restrengthening program.

  
  

  After first 72hrs and when symptoms are reducing:

  
  

• Begin some gentle normal walking gait and some gentle calf exercises to encourage blood flow, improve mobility and stimulate healing and recovery of the strain.

  
  

• Exercises can include – calf raises standing and seated, plantar flexion against a resistance band, plantar flexion with no resistance. You want to begin these exercises as early as possible without increasing in pain and symptoms.

  
  

• As the strain improves, gentle massage to reduce the scar tissue formation and increase blood flow is important. It also will reduce the tension in the surrounding muscle which tightens as a protective response to injury.

Progressively rebuild strength and then start to introduce the plyometric and jumping exercises to expose the calf to the stresses it may experience during sport or daily activities. Using pain as your guide for when to progress through the program is the best idea and ensure that you do not push through pain more than 2/10 as you may delay the recovery and healing time of your injury.

For guidance and support on an individualised rehabilitation program reach out to your physiotherapist who can assess the injury and advise on the best management plan.

Services at RIGS that can help with the recovery of your calf strain/tear:

• Cryotherapy daily in the first 3-5 days after your injury to help encourage reduction in pain and inflammation and encourage blood flow and healing.

  
  

• Compression therapy used initially on a lighter pressure and gradually increase to help flush out swelling, and encourage tissue release in surrounding muscles and help improve mobility and blood flow for healing.

  
  

• CWT for improved mobility and reduction in body weight to encourage pain free exercise and hydrotherapy for strengthening.

  
  

• HBOT can be used to improve the healing rate of the tissue by increasing oxygen absorption and delivery within the body which helps with increasing healing rate of the muscle.

Combining these services with a structured rehabilitation program is the best option for getting you back to function and performance as quickly as possible. Please reach out if you would like any assistance with your injury and how to manage it.