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Calf Injuries

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  • Date: 17/02/2015
  • Posted By: Beraldo Lilli

Calf Injuries (Gastrocnemius and Soleus strains)

The calf muscle is a powerful muscle located at the back of the lower leg and is involved in standing, walking, running and jumping. The calf muscle has 2 components gastrocnemius and soleus with a slip of another muscle plantaris.

 

Anatomy

The calf muscle is located behind the tibia (shin bone) and works across both the knee and ankle joints. It extends from the base of the femur (thigh bone) behind the knee, to the calcaneus (heel bone).  The muscle inserts into the Achilles tendon. The muscle's main role is to plantar flex the foot (point toes away from yourself ) and to assist in flexing (bending) the knee.

 

Risk

The calf muscle is commonly injured in sports which require quick acceleration from a stationary position and quick halts in movement, such as in tennis or squash. In many such cases the injury is caused through sudden eccentric (lengthening contraction) overstretch.  An example of this is when your foot suddenly drops into a hole and the ankle drops into dorsiflexion (point toes upward toward yourself ).

The most common place to incur this injury is at the muscular tendinous junction or MTJ of the muscle roughly halfway between the knee and the heel.

A calf strain may also be more likely in athletes who have tight calf muscles.

Prevention

  • Keeping calf muscles strong so they can absorb the energy of sudden physical stress.
  • Stretching out calf muscles before physical activity, i.e. calf raises. Gradually including weights or additional resistance over time.
  • Learning the proper technique for exercise and sporting activities. This will decrease stress on all muscles, including calf muscles.
  • Undertaking training prior to competition to ensure readiness to play.
  • Undertaking fitness programs to develop strength, balance, coordination and flexibility.
  • Gradually increasing the intensity and duration of training.
  • Allowing adequate recovery time between workouts or training sessions.
  • Wearing the right protective equipment including footwear.
  • Checking the sporting environment for hazards.
  • Drinking water before, during and after play.
  • Avoiding activities that cause pain. If pain does occur, discontinuing the activity immediately and commencing RICER.

 

Signs and symptoms

  • A sudden pain at the back of the leg, particularly at the muscular tendinous junction.
  • Difficulty in contracting the muscle or standing on tiptoe.
  • Pain and swelling or bruising in the calf muscle.
  • Pain on resisted plantar flexion or contracting the muscles against resistance.
  • If the Soleus muscle is damaged pain might be incurred lower in the leg and when contracting the muscle against resistance with the knee bent.

Calf strains are graded in three categories according to their severity.

Grade Descrription

1 (mild) Sharp pain felt druing or after activity, may be unable to continue activity

2 (moderate) Unable to continue activity. Return to play 10 -12 days after injury

3 (Severe) Unable to continue activity. Usually severe pain at the junction between the Achilles tendon and the belly of the muscle. Return to play 16 to 21 days after injury. Usually severe pain at junction between Achilles tendon and belly of the muscle.

Achilles tendon ruptures usually occur much lower than at the cuff muscle belly or the musculotendon junction. Usually an inability to plantar flex the foot (point the toes down)or perform a calf raise.

If surgery is required return to play at approximately six months

The immediate treatment of any soft tissue injury consists of the RICE protocol – rest, ice, compression, elevation. RICE protocol should be followed for 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.

Rehabilitation and return to play

As pain reduces, gentle exercise and stretching can usually begin in addition other therapeutic interventions to reduce the risk of injury recurrence. Recovery can often be quite a slow process.

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