Calf strain? Pulled calf? Tennis leg? Old man calf?
The calf is made up of 3 muscles (medial & lateral gastrocnemius, soleus and plantaris), and injury can occur in any one, or combination of these muscles. The calf muscles perform an extraordinary job when we run: taking forces in excess of 3.5 times our bodyweight!
Calf injuries are common in recreational & competitive athletes in addition to those with physical jobs. They typically occur during sudden ballistic movements such as sprinting or jumping, and in sports or activities where these movements are common, such as tennis (this injury is often referred to as “tennis leg”), soccer, basketball, AFL and running up hills.
However, it’s not just the explosive events that we see calf injuries, as they are also common in longer duration events such as long-distance running: calf strains are the most common injury sustained during a marathon race.
Calf strains are the second most common soft tissue injury in the AFL, with only hamstring injuries being more common. There is considerable variation in recovery time post calf injury, ranging from 4 to 102 days in AFL players.
Older athletes and runners (40+) are at higher risk of calf injuries, and this has led to this injury often termed “old man calf”.
Often those experiencing a calf strain will feel a sudden pain during activity but sometimes there may not be a pop or tear, it may just gradually feel “tight” or sore during or after an activity. The pain is often aggravated by raising up on the tiptoes. Higher degree tears will often make walking difficult, with some unable to bear weight on the leg.
What should you do if you suffer a calf strain?
Firstly get a DIAGNOSIS! It’s important to know exactly what has been injured. Once you have a diagnosis, then get a PLAN moving forward! A thorough assessment will ensure that treatment and rehabilitation can address any issues identified, and reduce the chances of you suffering another injury, and get you back out there as soon as possible.
It’s vital to see your health practitioner to firstly assess and diagnose your problem and secondly to create an INDIVIDUALIZED rehabilitation program.
Here is an example of some of the things that we will get patients to do optimize recovering from a calf strain:
Anti-inflammatories? Care should be taken with using non-steroidal anti-inflammatory drugs (NSAIDs) after a calf strain. They may be used to reduce pain and swelling, but usage is not without complications and NSAIDs may suppress the natural healing process (Vuurberg, G., et al.2018).
Ice and compression can be useful to help with pain. Apply ice to the injured area with an ice pack for 15 minutes at a time. This can be reapplied every 2 hours in the early stages. Compression bandages can be worn throughout the day and night for the first week to also assist with bleeding that occurs with a muscle strain.
Avoid alcohol: consuming alcohol post injury will delay healing, so it should be avoided during recovery.
Do you need to have scans? Unlikely, calf strains can usually be diagnosed via an appropriate examination. But in rare instances, an MRI may be ordered.
Crutches: it is not unusual to have difficulty walking after a calf strain, so crutches may be needed until you are able to walk properly. Be aware that the fluid from the leg drains to the ankle; so don’t panic if you notice swelling and bruising in the ankle after a day of being up and about.
What is our unique approach to calf strains?
At Health & High Performance we pride ourselves on a thorough examination to ensure an accurate diagnosis to then lead to targeted treatment, allowing you to get back to sport as soon as possible.
Firstly it is important to have a thorough discussion about your problem and some of the factors that may have contributed to it. This can include training errors (doing too much too soon & inconsistent training) or insufficient recovery (ie. high stress and poor sleep).
Using our state of the art technology, the AxIT system, we are able to measure calf strength to assist in predicting and guiding return to play. By restoring adequate calf strength, you will increase your chances of a successful return to play. Read more about the AxIT system here.
Consideration of the role that other areas played in your calf injury: for instance, foot strength, low back pain, hip problems, or even previous ankle sprains may contribute to your calf injury. Your examination with us will cover all these areas, and your management plan will include solutions to these additional issues.
Rehabilitation & return to sport
“Every calf injury is unique, treatment should be too”
Immediately commencing rehabilitation: from Day 1 there will be exercises you can perform to hasten your recovery. These exercises are prescribed according to criteria (what you can/can’t do) not just based on time. In a 2017 study by Bayer et al, they compared commencing rehab at 2 days versus 9 days, and found that those starting rehab 1 week earlier, returned to their sport a staggering 3 weeks earlier! Click here to read more
Below is a guide of some exercises that can be used for rehabilitation of calf injuries. Your sports chiropractor should individualize these exercises after a thorough assessment.
Early rehab exercises
In this video we include a few exercises that can be used early in the rehabilitation from a calf strain
Gastrocnemius biased exercises
Exercises that target more the gastrocnemius muscle can be seen in the video below.
These exercises include:
Double leg calf raises with weight, Single leg calf raises with weight
Step up calf raises
Soleus biased exercises
Exercises that target more the soleus muscle can be seen in the video below.
These exercises include:
Foot strength exercises
Your feet are your foundation, and the importance of foot strength in calf function can not be underestimated. It is also important not to neglect the smaller plantarflexors of the ankle including the flexor digitorum longus, flexor hallicus longus, tibialis posterior, peroneus longus and brevis
Some exercises seen in this video which can be used to strengthen these foot muscles & long flexors include:
End range calf strength
End range calf strength can be a reflection of adequate soleus muscle strength. The larger of the calf muscles, the soleus, is important for running as it takes 6.5-8 times body weight during running (Dorn 2014).
In this blog, we discuss how to test and strengthen this end range strength. Click here to read
Just a simple calf raise?
here are so many alternatives and modifications for this simple exercise that can all serve a different purpose. Check out the video below for some great alternatives!
Progression to plyometric exercises is very important for return to sport after a calf strain. In this blog and the video below we discuss some of the plyometric exercises that can be used. Click here for the blog.
Return to running
Injured your calf & wondering when & how to resume running? In our blog, we discuss the steps you need to fulfill to make a successful return!
At Health and High Performance, we are advocates of criteria based rehabilitation: this means that you must meet criteria to progress, not simply how long you’ve been injured for.
Click here to read the blog on the criteria you must meet to ensure a successful return to running
Want more info?
Please head to our blog which contains a number of calf specific articles. Click here
Free E-Book & Video
"5 Keys to Injury Free Running"