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By Ashlee Batters (BchiroSc, MChiro),

Calf pain is common in sports that include running, jumping, hopping and landing. This blog explains how to treat and prevent calf injuries.
The calf is made up of three major muscles (triceps surae), the gastrocnemius originating from above the knee joint, the soleus which originates from below the joint and the plantaris which all meet at the Achilles tendon. The gastrocnemius is a powerful muscle serving both the knee and ankle joint, inserting into the Achilles tendon with the soleus to create plantar flexion of the foot (pointing toes down) and assist with knee flexion (bending the knee). It is involved in running, walking, jumping and standing.

image of calf muscles

Calf strains

The most common injury of the calf generally occurs in sports or activities requiring fast acceleration from a stationary position and quick halts in movement such as tennis or netball. The injury occurs when the calf muscle is forcibly lengthened while contracted (also known as a sudden eccentric overstretch). This type of strain typically occurs about halfway between the knee and heel at the musculotendinous junction of the gastrocnemius. This muscle is much more vulnerable to injury as it crosses both the knee and ankle joint, as well as being made up of mostly “fast-twitch” muscle fibres.

Symptoms and signs:

Immediate pain, sudden cramping and sometimes an audible pop are common symptoms. Strains are more common in athletes with tight calf muscles from either lack of appropriate warm-up or chronic muscle imbalances eg. Tight hamstrings.

The smaller calf muscle (soleus) has “slow twitch” fibres and only crosses the ankle joint with much less injury risk. Soleus strains are generally less painful and classically present with calf tightness, stiffness and pain that gradually worsens. These injuries are typically provoked by walking or jogging.

Treatment for calf strains:

In order to determine appropriate treatment, all muscle strains are graded using a specific classification system. Factors such as clinical presentation, injury severity and swelling can assist in determining an injury grading of 1 (mild strain) to 3 (partial/complete tear). Having an accurate diagnosis and early treatment will be vital in your recovery time and ability to return to your normal sport/activities.

In the initial 3-5 days after your injury, known as the acute phase, treatment is aimed at reducing inflammation and pain, while preventing any injury complications. At Tweed Coast Chiropractic, typical treatment in the acute phase may include:

If your injury does not improve as quickly as expected, your practitioner may need to re-examine or refer you for diagnostic imaging. Injuries lasting 4-6 months or Grade 3 strains (50-100% disruption of the muscle) may require surgical review. Once your injury is outside the acute phase, treatment will include more active rehabilitation such as:

After the acute phase, pain levels can significantly decrease which often leads to many patients returning to sport or pre-injury activities too soon. This commonly results in delayed recovery and further injury. It is important to follow the prescribed exercises and advice as per your Chiropractor, to ensure a successful recovery.

Tendinopathies/overuse injuries

Overuse injuries of the calf are commonly known as Achilles tendinopathy or tendinitis. The Achilles tendon is a band of tissue connecting the calf muscles (gastrocnemius, soleus and plantaris) to your heel bone. These injuries can range from inflammation around the tendinous tissue to structural degeneration of the tendon (tendinosis). Overuse injuries are extremely common in runners and middle aged people. They commonly occur with a sudden increase in the intensity or duration of training such as sprinting, or in those who play recreational sports such as tennis or netball but only play once a week.

Symptoms and signs:
  • Initial dull ache in the back of the leg or heel after activity
  • Prolonged activity may lead to more severe pain, especially with longer runs, hiking or sprinting
  • You may also notice pain and stiffness in the mornings which improves with mild activity
  • Risk factors for overuse injuries can include:
  • Higher incidence in males
  • Older age
  • History of physical issues such as flat feet, obesity and muscle imbalances ie. Tight calves
  • Training conditions Poor footwear, cold weather, hilly terrain, inadequate stretching, change in training load
  • Medical conditions: Those with psoriasis or high blood pressure have a higher risk
  • Medications: Some antibiotics such as fluroquinolones have been associated with a higher rate of tendinopathy
Treatment at Tweed Coast Chiropractic may include:

Soft tissue therapy
Dry Needling and or Acupuncture
Shockwave therapy
Joint mobilisation
-Active stretching
Graded strengthening
-Activity modification and retraining
Gait retraining
Taping

Most cases of Achilles tendinopathy respond well to conservative treatment with your Chiropractor, however in more rare cases, injuries can lead to a complete rupture/tendon tear which may require surgical intervention.

Prevention

Whether you are an elite athlete or simply enjoy a hit of tennis with friends, it is important to take a few steps in protecting yourself from calf injuries. These can include:

  • Dynamic muscle stretches before physical activity ie. Calf raises. These can utilise body weight or additional resistance over time.
  • Learning the correct technique for exercise and sporting activities to limit stress on all muscles ie. Keeping calf muscles strong to absorb the energy of sudden physical stress
  • Participating in appropriate training and fitness programs to develop strength, balance, coordination and flexibility
  • Gradual increase in the intensity and time spent training
  • Allowing adequate recovery and stretch time between training sessions
  • Appropriate supportive footwear
  • Staying hydrated
  • Avoid pain provoking activities, always stop, apply RICE and seek assistance from your Chiropractor at Tweed Coast Chiropractic