Rehabilitation after a Calf Injury
An injury to the upper part of the inner calf is a relatively common injury resulting from a sudden push off with foot involving some force. Sporting activities are the most common cause of calf strains, with sports involving running, jumping and strong push off the most likely candidates, although it can occur in functional movements. If an athlete performs sports intermittently such as weekends they may be more at risk due to reduced fitness and tissue preparedness. The most critical position is when the rear leg is extended straight and the foot is pushed up into dorsiflexion, as in a lunging movement on the front foot. In this position the calf muscle is at its maximum stretch.
Once at its maximum stretch the calf is vulnerable to contracting strongly and this can overstress the tissue of the muscle and result in a tear. This occurs more often in men and typically from the thirties to the fifties and acute tears result in the patient presenting for diagnosis and treatment. The calf muscle pushes the foot down and propels the body weight in walking, running and jumping. Most calf strains happen at the junction of the muscular and tendinous parts of the calf.
The onset of the injury is sudden and often the patient feels they have been hit hard on the back of the calf, with significant pain and immediate inability to perform further athletic movements. Walking may be impossible if the tear is large and placing the foot on the ground may stretch the torn muscle more than the person can bear, with elbow crutches often required during the initial acute period. Early physiotherapy management involves reducing the swelling and pain by compression, icing, rest and painkillers, with elevation of the limb and limited bearing of weight.
Once the pain and acute inflammation have settled to a degree the physio can begin to get the patient to contract the calf muscle gently, moving the foot downwards. This puts gentle force through the torn muscle but avoids any stretch which would be counterproductive. As the calf improves the physiotherapist progresses the patient to graded weight bearing and active upward movement of the foot to stretch the calf gently. Progression of physio treatment involves more vigorous movements, increased weight bearing work and active gym rehabilitation involving dynamic work, balance and stretching before returning to sport.
Author: Jonathan Blood-Smyth