Tri physiotherapy

Calf Injuries

A common running injury is a calf strain or a tear. The calf muscles, Gastrocnemius and soleus,  are loaded repetitively and heavily during running.  With every stride we take when running, the calf gets loaded, firstly to absorb the Gastrocnemius-Strainshock of our body weight landing, then to help propel us forward into the next stride.  When running, we take roughly 1500 strides per mile.  Which makes it easy to see that if there is a weakness in the calf complex, or a fault elsewhere in the kinetic chain or running technique leading to increased load on the calf, injury is almost inevitable.

The calf is classified as a global mobilizer muscle, meaning that its main anatomical function is to absorb and then create large motions and forces. It is accompanied above and below by stabiliser muscles which are responsible for keeping the joints  stable – so that it can carry out its main function. However, if stability is compromised, particularly at the foot and ankle complex, leading to excessive pronation, the calf will begin to try and take on a stabilising role also – leading to loading it is not positioned well to cope with.  An example of which would be an overpronating foot or weak glutes causing excessive inward rotation of the knee.

Often a poor warm-up is cited as a reason why athletes sustain calf injuries. Most of us appreciate the necessity for a thorough warm-up.  I often use ‘blue tack’ as an example when describing how muscles and tendons respond to a warm up.  When you try and stretch cold blue tack it is tough and usually breaks, whereas when is has been warmed up it stretches nicely.   It is also important to note that as we age, these elastic properties of tendons and muscles diminish – thus accounting for the increased occurrence of calf strains in the more senior of our athletic population.

A final contributor to soft tissue injuries in runners, especially long-distance runners is dehydration.  Dehydration negatively impacts muscle function by reducing blood flow to muscles and decreasing muscle elasticity or flexibility and endurance.

Grades of strain or tear:

Muscular strains are classified according to their severity in terms of how many fibres have been disrupted or ruptured

Grade 1 Grade 2 Grade 3
This is the least severe of calf injuries. A small number of muscle fibres have been damaged within the muscle. Signs and symptoms of this type of less serious strain may not be noticed until cessation of the activity. Tightness, cramping feelings and slight soreness are common when the muscle is stretched. This is sometimes referred to as a partial calf tear. A greater number of muscle fibres have been torn, but the muscle remains largely intact. More immediate localised calf pain is present during activity, especially walking and running. Often the area is sore to touch. Total rupture. All the muscle fibres have been torn, losing continuity throughout the muscle. This is a serious injury and highly disabling. The athlete will be unable to walk pain free. Often bruising will appear below the tear site and there may well be a palpable bulge where the calf muscle has recoiled upon itself.

Treatment and Rehabilitation:

Initially, the Rest, Ice, Compression, Elevation (R.I.C.E) principal should be followed. Therapeutic Ultrasound, Acupuncture, Sports massage and Taping are all methods used to facilitate soft tissue healing.  Sports massage, however should not be performed until the acute phase has passed (3 days +).  Approximate timescales for rest are; 3 weeks for a grade 1 strain and 4-6 weeks for a grade 2 strain.  Grade 3 tears will most likely require surgery followed by a 12 week rehabilitation programme.

As with any injury, progressive and comprehensive exercise based rehabilitation is key to avoiding recurrence or secondary injuries.  Secondary injuries often occur through compensatory mechanisms which may have become habit during the injured period.  The rehabilitation period is also an ideal opportunity to target those areas that get ignored in weekly training routines.  Core stability and gluteal muscles are a great place to focus on when activity is restricted.  Research has found that the stronger these muscles can become, the more likely a successful outcome is to be reached in terms of injury recovery, injury prevention and most importantly performance.

Rehabilitation Exercises:

Specific single-leg exercises are important to build the strength in the injured limb and to regain balance which will have been lost on the injured side during the injury period.  Here are some suggested exercises. However, I recommend you see a Physiotherapist for a tailored program and appropriate guidance.

Single Leg Standing

SLStStand on one leg keeping your bottom squeezed and core engaged.  Ensure that your pelvis is level, your knee is facing forward and your trunk is upright.  Try not to lock your knee.  If you can successfully hold this position on each leg for 15-20 seconds you are ready to progress to a single leg squat.

This exercise targets your core and glute muscles.

 

 

 

Single Leg Squatsinlge leg squat

The same principles are applied in this exercise as in the single leg stand.  The picture shows the athlete squatting to a chair.  The chair provides a nice prompt to ensure that you are squatting correctly (sticking your backside out and not just bending at the knee).

I suggest that you start by only squatting down as far as you can control your knee (keep you knee cap over your 2nd toe) and keep your pelvis level. This may only be a tiny dip to start with, but it will improve.

Supported Heel Raise

This exercise should be pain-free and should therefore not be considered until you are symptomheel raisers free walking up a flight of stairs.  Begin with 50:50 of your body weight in both feet and raise up on to your toes, if you feel the need you may hold onto a rail/kitchen unit for support.  Complete 3 sets of 10. If this is easy then you may progress on to 60:40, increasing the load in the injured side.  The increases my continue 70:30, 80:20 up to a single leg heel raise.

Calf Stretching

calf stretchesThere are TWO main stretches to perform for the calf complex.  One is for Gastrocnemius (straight knee) and the other is for Soleus and the Achilles (bent knee).  Hold the stretches for 30 seconds as this will promote true lengthening of the soft tissue.

 

Plyometrics

Once improvements have been made in single leg strength and balance, low level plyometric exercises may be re-introduced as a precursor to running.   Jumping, hopping and skipping are all useful to re-introduce the muscle to the dynamic loading needed for running. You should seek professional advice before starting a plyometric program.

Running

Following successfully progressing through the multi-directional plyometric exercises, running may be gradually re-introduced.  A sure way to cause re-injury is to do too much too soon at this stage. Running should not be increased by more than 5% per week in intensity, duration or frequency. Running technique should also be monitored at this time to ensure efficency and avoid overloading of any part of the kinetic chain.

Final Tips

  1. Go and see a Physiotherapist!  If they are any good they will look at you holistically and identify why you have sustained the injury in the first place.  You should then receive bespoke treatment and a rehabilitation program.
  2. Stay hydrated before, during and after sport.
  3. Incorporate Strength and Conditioning into your weekly training regime – focus on Core Stability and Glutes.
  4. Make sure you warm up gradually and cool down properly - cool downs will prevent you getting too tight in your muscles.  Excessively tight muscles will lead to injury.
  5. Have the correct footwear.  If you are running off road you will need a shoe that is lightweight and provides grip on those unpredictable surfaces.  If you are road running your trainer must be up to date, no older that 2 years old or clocked over 500 miles.  Cushioning and the correct level of support is vital when you are running on such unforgiving surfaces.  Many running specialist stores now provide gait analysis to ensure the correct shoe fitting.
  6. Consider compression gear.  Calf guards or compression socks have been proven to reduce muscle vibration and assist with circulation during and after sport.

 

 

 

 

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