Calf Strains

    Whether you’re a tennis junkie, social football player; training for your first half marathon, or embarking on a new fitness regime of walking or running, a calf strain can be a major hinderance to your New Years fitness plans. 

What is a calf strain?

    The calf complex comprises of the soleus and gastrocnemius muscles and their main role is to point the foot and push off the ground to propel you up and forward during walking, running and jumping. 
    The soleus muscle is the most commonly affected in acute strains as it makes up the bulk of the calf muscle and is subjected to forces that are 6-8 x your body weight when running! 

The severity of tear can be graded from 1-3 with 1 being mild and involving only a few muscle fibers affected. You might feel like you've 'tweaked' or 'pulled' your muscle. The muscle can feel tight and tender, but overall strength and flexibility is well maintained. Grade 2 can involve up to 50% of muscle fibers and will be significantly more painful and have more bruising, swelling, reduced strength and flexibility in the ankle. Grade 3 is a complete rupture of the muscle belly and is much more severe as the muscle will be unable to function and would require a period of immobilization or surgery in order to recover. 

What are the risk factors for calf strains?

• - Older athletes are more at risk of calf strains due to age related changes within the muscle that can reduce the quality of the connective tissue and overall strength.

• - Previous history of tears.

• - Inadequate conditioning and reduced calf muscle strength. This could be due to inconsistent training, starting a training program from a low base level of strength or fitness or from having time off due to holidays, injury, or illness and then progressing back too quickly.

• - Progressing training volume, duration, or intensity too quickly.

• - Ankle flexibility. Tight calves can be obviously be problematic but also ankles that are too flexible can place greater demands on the calf muscle. Flexibility can be measured using a knee to wall test (pictured on the right). Measure how far you can get your foot from a wall while keeping your heel in contact with the ground and your knee cap against the wall. Normal range is around 8-10cm.

• - Soft training surfaces such as soft sand or grass can fatigue the calf muscle.

• - Hills can place more load on the calf as it is required to work eccentrically to decelerate going down hill and create more propulsion up hills.

• - Speed. The calf muscle must work harder to create more forward propulsion as stride length increases. At top speeds however, increased leg turnover or cadence is more demanding on the hip muscles and less on the calf. Increasing speed should be done progressively to help condition the muscle but without exercising it past the point of fatigue which will cause it to fail and tear.

• - Correct footwear is dependent on the individual and their training needs but shoes with a low drop (pitch height difference from the rear foot to front of the foot i.e. 6mm or less I would consider low) and running spikes can place more load on the calf as can shoes that are too soft and flexible.
• 
  

How long does it take to recover?

    This is largely dependent on the severity with Grade 1 tears taking around 3 weeks, grade 2 up to 4-6 weeks, grade 3 could take 10 + weeks

    Other factors that can influence recovery include:

• - Age. You may not be surprised to hear that generally recovery is slower as you get older.

• - History. If you have injured your calf before this could increase the recovery time.

• - Acute care. Getting a diagnosis and management plan in place as soon as possible is important so that you know exactly how much activity you can safely do. Suitable support and compression is also recommended along with elevation and ice if pain and swelling is present.

• - Adherence to a rehabilitation plan. Doing too little is just as detrimental as doing too much so it is important to work closely with a physiotherapist and coach in managing your recovery and training loads.
• 
  

How do I know when I am ready to start running or playing sports again?

    This is usually the first question I get asked as a physio and it depends on the factors mentioned above however, recovery time can be quite variable so having some key indicators of strength and fitness can help to reassure both the patient and the therapist that someone is in fact ready to resume playing sports or running.

    Some quick test include:
- nil pain during everyday activities and walking
- being able to perform small jumps off 2 feet using predominately the ankles for 1 minute pain-free and without fatigue.
- being able to hop 3-4 times pain-free and with good control and form.
- adequate flexibility (knee to wall measure equivalent or within 1-2 cm off the unaffected side)
- be able to perform 25 double legged calf raises pain-free.
- be able to perform 15 single legged calf raises at 1.5 x body weight.

    Now this doesn't mean you can go out and pick back up were you left off. Consideration should be made for how long you have been off, how much cross training you have been able to maintain and your level of strength and fitness prior to injury. Some people will need to start with a progressive walk/jog program, others may manage with a day on/day off plan while others could manage around at 50% of your previous training volume.

    It is extremely important to listen to your body at this stage to avoid reinjury. Be aware of the signs of fatigue such as gradual tightening in the muscle, poor running form, reduced power on push off, or a sloppy foot hitting the ground. One should avoid the risk factors mentioned above until they have regained consistent training and have been able to maintain that for at least 4-6 weeks.

When is a calf strain not a calf strain?

    Other conditions that may be mistaken for a calf strain could be:
- Deep vein thrombosis (DVT). This could be a associated with a high grade muscle tear or due to recent flighting or immobilization. If the calf area is enlarged, red, hot, or swollen you should seek urgent medical advice.
- Peripheral vascular disease. This is more common in older adults, symptoms include frequent cramping, fatigue, tightness, changes in skin color/temperature, and poor tissue/skin/wound healing. See your doctor.
- Varicose veins. Symptoms include achy/heavy legs, burning, trobbing, cramping, or swelling. Visible prominent veins or discoloration around the veins. Itchiness around the vein and worsening symptoms after periods of prolonged sitting or standing. Try compression garments, elevation, or consult a vascular specialist.
- Nerve pain and referred or radicular pain. This could be referred pain from the lumbar spine and sciatic nerve or injury or entrapment to a local nerve. Symptoms may be present even at rest. You could experience tightness and reduced flexibility throughout the sciatic nerve, sharp or hot pains, pins and needles and tingling. If this is referred form the back you may have had a recent of current episode of lower back pain or stiffness. See a Physiotherapist. 

What exercises can I do to help my recovery?

    Click on the link below for some basic rehabilitation exercises that will help to condition your calf and lower leg for a return to sport and walking or running.

Calf strain rehabilitation 

    The severity of your injury will determine what level of exercise you will need to start your rehabilitation at so you should see a physiotherapist for a program that is specific to you. 

For more advice book a consult with one of our Physiotherapist at Peak Pilates and Physiotherapy.