At Loftus Physiotherapy & Rehabilitation it is common to see a gym member limp out of a half finished class or a trainer bring a client to the clinic desk with sudden calf pain.
Our Physiotherapists have found the common causes for calf pain include muscle cramp, delayed onset muscle soreness (DOMS) and referred pain from the lumbar spine, however, by far the most common cause of pain in the lower leg is a strain to the musculotendinous complex of the gastrocnemius and/or soleus.
Within the health and fitness industry calf tears often occur in typical personal training activities such as shuttle runs (requiring rapid acceleration and change of direction), split jumping (where one leg is thrust backwards on landing), incline running and sprinting. This injury is common in boxing sessions where participants are jumping and hopping on their toes and also in hill work on sand in the popular “Boot Camp” and “CrossFit” activities due to the unstable surface the sand provides and the intense muscle work involved in these sessions.
Physiotherapy examination reveals tenderness localised to the site of the tear and if severe, a palpable defect or gap may be felt. Stretching of the gastrocnemius will also reproduce pain, which is why the patient will usually walk with the foot turned outwards as this limits ankle dorsiflexion and reduces the need to dorsiflex the ankle whilst walking.
There is also a significant number of people who do not have the sharp, stabbing pain associated with the typical calf strain – but report more of an intermittent cramping sensation during exercise. This “cramping” sensation is often due to recurrent minor calf tears which can be linked back to old scar tissue from a previous (and more severe) calf tear – this scar tissue is common in patients that did not undergo adequate physiotherapy rehabilitation following their initial calf injury.
As with all episodes of pain it is essential the client is examined by a Physiotherapist or sports physician as soon as possible. The medical professional will evaluate the extent of the injury, outline an approximate time line for rehabilitation, as well as excluding any more serious problems such as achilles tendon rupture, lumbar spine referral and deep venous thrombosis (DVT).
Once the calf strain is diagnosed and other problems excluded, initial management will aim to reduce pain and swelling. This is best achieved with ice, elevation and compressive bandaging. The patient may also benefit from a small heel raise in the shoe to prevent excessive stretching of the calf when walking, females will typically be more comfortable in shoes with a moderate heel raise.
Gentle stretching to the point of a “tightness sensation” and muscle strengthening can begin after the first 24 hours. The exercise progressions commence with bilateral concentric calf raises and gradually progress to unilateral concentric, adding of weight and finally bilateral and unilateral eccentric lowering over the edge of a step. Final stage rehabilitation will involve plyometric and sports specific drills to ensure complete recovery prior to returning to sport. Soft tissue therapy is an important component of the management plan as residual scar tissue can lead to long term problems and injury recurrence.