Calf strain is the most common cause of calf pain while other causes of calf pain can include muscle cramp, delayed onset muscle soreness (DOMS) and referred pain from the lumbar spine. The most common cause of pain in the lower leg however is a strain to the musculotendinous complex of the Gastrocnemius and/or Soleus.
Within the fitness industry calf tears often occur in typical 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 also common in boxing sessions where participants are jumping and hopping on their toes, also in hill work on sand in the popular “Boot Camp” activities due to the unstable surface the sand provides and the intense muscle work involved in these sessions.
Examination of calf strain 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 rehabilitation following their initial injury.
As with all episodes of pain it is essential you are examined as soon as possible to evaluate the extent of the injury, outline an approximate time line for rehabilitation, as well as excluding any other 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. You 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 calf raises, gradually progressing to the adding of weight and finally lowering over the edge of a step. Final stage rehabilitation will involve 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, something you really want to avoid…