Calf muscle strain injuries are prevalent in many running based sports and contribute to the negative impact that any injury can have on team and individual success. The burden of calf muscle strain injuries can be significant with >3 months time-loss reported for some cases in American football, football (soccer) and Australian Football. Further compounding the impact of calf muscle strain injuries is that athletes are more susceptible to recurrent calf muscle strain injuries and other subsequent lower limb injuries, such as hamstring strains.
During the initial examination of Calf muscle strain injuries, experts valued first identifying the primary muscle involved (e.g. soleus vs gastrocnemius), injury severity and triaging actions (e.g. immediate immobilisation, imaging).
Frequently Asked Questions
What are the symptoms of a calf muscle injury?
Symptoms from soleus injuries are at times cumulative or may not be reported until subacute examination, whereas gastrocnemius injuries are almost always apparent immediately. Gastrocnemius injuries are most common during acceleration, jumping, and sprinting activities whereas soleus injuries are most common during steady-state running or present as gradual onset presentations. Location is often obvious for superficial calf muscle strain injuries and tends to be more gastrocnemius whereas poor localisation is common for deep soleus injuries.
What can be the causes of calf muscle injury?
If there is a history of an inciting incident and the mechanism of injury is acute, this is related to the gastrocnemius. If there is a slow insidious onset, this will often be an injury to the soleus.
Interruptions to or suddenly increased running workloads are likely to result in a calf muscle strain of the soleus. Additionally, unaccustomed heavy strength or explosive loading can reduce resilience to a calf muscle strain injury involving either the soleus or gastrocnemius.
For athletes, pre-season and early competition periods have been correlated with overload related calf muscle strain injury. Changes in a surface or footwear can impact work conditions of the calf and as a result increase the risk of injury due to high work demands on the calf in dynamic activities of elite athletes.
How do you assess and diagnose a calf muscle injury?
Your physiotherapist will perform a number of tests in your initial examination beginning with observation and palpation of the calf and surrounding structures. Stretch tolerance tests including passive dorsiflexion in knee flexion and extension, knee to wall lunge and straight leg stretch at wall may be used to assist in diagnosing as the injured soleus and gastrocnemius may be more sensitive when stretched while the knee if flexed and extended. As the degree of strength loss is associated with severity and position, the physiotherapist may perform isometric contraction in knee flexion and extension and single leg calf raise in knee flexion and extension. It may be warranted to test dynamic function including jumping and hopping such as double leg vertical jump, single leg vertical hop and single leg horizontal hop.
What is the evidence based treatment for calf muscle injuries?
Physiotherapy treatment for a calf muscle injury will begin with normalising gait to regain function. Beginning strengthening early is important to promote healing. Progressive overload should be implemented, starting with body weight and band-based exercises and progressing to heavier loading exercises and eventually dynamic movements. In addition to focusing on the calf, it is important to include exercises for surrounding muscles and joints to prevent detraining and maintain overall strength.
To avoid reinjury, assessing predisposing risk factors can be helpful including addressing deficits in quadricep and glute strength. In addition, avoid excessive eccentric exercises and stretching as it may not be beneficial for the calf and hinder its recovery.
As you progress through your rehab, sport-specific and horizontal loading can be applied to prepare for a return to sport and running. The overall approach is to restore calf function by progressively loading the muscles, targeting the specific injured area, and balancing rehabilitation with overall conditioning and injury prevention.
For patellar tendinopathy, a period of rest or activity modification is necessary to reduce load on the patellar tendon. This involves avoiding deep knee flexion, running and jumping. A gradual progression back to these activities will occur through graded exposure and a progressive overload program aimed at the knee joint. Exercises begin with eccentric partial weight-bear loading of the patellar tendon and strengthening of the hip and knee. Soft tissue mobilisation can be used to reduce pain in early rehabilitation. Once pain has decreased and is manageable, exercises can be progressed to full weight-bearing and weighted resistance. Following this, jumping and other dynamic movements can be reintroduced to prepare for a return to sport, or normal activities.
Corticosteroid injections can negatively affect tendon strength and can lead to tendon rupture. Therefore, these injections are not advised in the management of patellar tendinopathy.
As patellar tendinopathy and quadriceps tendinopathy are overuse injuries, rapid progression should be avoided to limit exacerbation of symptoms.