If you run or play sport the chances are you may have tweaked or pulled your calf.
The calf is made up of the gastrocnemius , soleus and plantaris muscles and is responsible for pushing you forwards when walking, running and jumping but it is a major shock absorber. Calf muscle tears can prove to be stubborn and sometimes tricky customers to treat.
Overview of Calf Muscle Strain Injuries
calf muscle strain injuries as partial or complete tears of the calf muscle fibers, particularly the gastrocnemius and soleus muscles. These injuries typically occur during explosive movements, sudden changes in direction, or excessive stretching of the calf muscles. Symptoms include pain, swelling, and difficulty with weight-bearing activities. Proper assessment and management are crucial for successful recovery and minimizing the risk of re-injury.
Published recently, the paper by Green et al highlights the importance of the following three factors for successful treatment and prevention of calf injuries :
- accurate diagnosis,
- appropriate treatment strategies,
- and effective preventive measures for calf muscle strains.
In this blog, we will summarize the key findings and recommendations outlined by Green et al., shedding light on the comprehensive approach required to address these injuries and optimize recovery.
Assessment of the calf muscle tear
The consensus from the study by suggests that gastrocnemious type injuries tend to be characterized by a sharper more sudden type of pain and often felt closer to the surface.
The deeper gradual development of a niggling ache or tight feeling in the calf is suggestive of the soleus muscle. Often people complain of tightness during the a run or after running.
Regardless of whatever injury you have sustained a thorough assessment is essential to get you on the right track. It helps get a handle on:
- What part of the calf you have injured as this will direct your treatment.
- what and why it has happened.
- what stage you are at in the healing process
- what needs to be done and when you can expect to be fully fit again.
Without this information you can often go too hard too early with a calf injury. This usually results in more time doing rehab and less time doing the activities you love.
If you want to know more about calf tear anatomy and alternative calf issues check out more information here
Effective calf tear treatment
Stage 1: Early movement and strengthening for calf muscle tears
For some individuals with more significant grades of injury, especially acute tears or in the acute early stage this may be in a non weight bearing scenario and they are likely to require crutches to get around in the first few days. It also likely that the use of ice compression etc is of benefit in this stage , ( read more here for best way to do this )
In the early stage of rehabilitation its about getting appropriate loading and movement without disrupting the bodies healing process. Essentially in this phase your symptoms will be your guide as they will let you know how hard to push.
This involves:
- Normalizing walking pattern and ability to weight bear.
- transfer body-weight forwards and backwards and side to side
- In more acute calf tears non weight bearing holds against theraband or a wall.
- isometric or static holds for the calf in sitting and standing
Stage 2 Foundation strength phase of calf rehabilitation
Once the tissue has got to a phase of healing where it is tolerating weight bearing well and should have a nice mature scar forming, strength training is key. Not only for the calf but the whole lower limb.
Calf raises are the staple in the early stages of calf rehabilitation . As a general rule we progress strengthening of the calf in the following manner:
- work on flat surface first in bilateral stance.
- Bilateral stance with added weight
- bilateral stance over step or slanted board, single leg calf raises
- loaded single leg calf raises.
In the early stages symptoms will guide the intensity, load and volume that you can do. As you progress and symptoms of pain resolve this factor hopefully becomes an non issue.
Its not all about the calf though
The calf needs to be “supported” by better strength in the lower limb muscles as well as the local muscles in this complex. It also needs to be able to tolerate forces other than those directly forwards. At this point it is good to introduce exercises for the lower body that prepare you for higher level function.
Again the progression to these exercises is based on symptoms in the early to mid stage of rehab.
These include:
- Arabesque / Single leg RDL
- Lateral step ups
- directional lunges
Towards the end of this stage the goal is to increase the complexity , loading and functionality of the exercises to prepare for a return t o running or sport.
Getting the spring back in your step after a calf muscle tear
Its not enough just to get the calf muscle strong we need to get it fit for explosive and speed related activities. To do this we need to train not only the muscle system but the elastic components of the tendons related to this tissue.
To do that you need to introduce low level jumping and hopping activities at the right time.
Depending on what you need to get back to will determine how complex and intense this component needs to be. Don’t think if you don’t play sport you don’t need to do this. Its just as important for you integrate this into your rehab as you need to be able to suddenly change direction or cope with coming quickly off a step .
Return to running or sport after the calf muscle tear and have a plan
These are two points that basically overlap as its the last step for some of us in rehab that can be tricky to navigate. This stage requires the introduction of specific skills, drills and strengthening exercise.
You need to be confident that your calf has the required overall ” fitness” to return to sport. You need to be able to combine the strength , power and shock absorption into game day situations or race type intensities.
Tick all these boxes and your calf tear rehabilitation has every chance of success.
Feel free to get in touch or contact us here if you need help with getting back from injury you can contact us here
Thanks for reading
Dave