By Lindon Beh, Physiotherapist
Are you a runner suffering from calf pain?
The calf complex is made up of two main muscles - the gastrocnemius and the soleus. The gastroc is more superficial and its outline can be seen when you go up on your toes. The soleus is deeper.
The calves have a major role in propulsion (initiating movement). Previously it was thought the gastroc produced more explosive force (sprinting and jumping), and that the soleus was a postural muscle suited better for endurance tasks (jogging, walking, standing).
However modern sports medicine shows that the soleus produces huge amounts of force and is often underdone in rehab programs.
Calf pain and injuries generally follow 3 main mechanisms - 1. Acute injury. 2. Neural tension. 3. Silent Tear
1. Acute Calf Strain/Tear/Pulled Muscle
Calf strains occur during a sudden contraction of the muscle. Common mechanisms include jumping and pushing off during accelerating. If you have suffered a calf strain you will have likely felt a sudden sharp pain, pulling sensation or a cramp/spasm sensation that does not go away.
In severe strains you may not be able to walk or put weight on the injured leg. Bruising may also present a few days after injury. It was previously thought that the gastroc was the most common calf strain but MRI data now tells us the soleus is most commonly strained.
Calf strains are often called ‘an old man’s injury’ (whilst occurrence is higher in males, females are still able to strain the muscle) and unfortunately research shows us that increased age is a risk factor for calf strains. This is due to several reasons:
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As we age we lose muscle mass, strength and explosiveness
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Middle aged men tend to be heavier with increased adipose tissue than when they were younger. Explosive activities now demand more muscle activation and force.
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Middle aged men tend to sporadically play social sports without training. The body behaves in a ‘use it or lose it’ fashion. Explosive activities and sprinting needs to be maintained or you will be deconditioned in those characteristics. If you compare a teenager to an adult, the teenager may be playing sports 3 or 4 times a week whilst the adult may only play once a week. Now the physicality of ball sports becomes very demanding on the body.
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Middle aged people generally take a break from sport and get injured when they return. Related to the above point, if we take a break due to work, travel or having kids our bodies decondition and when we return to sport we may get injured
What Can You Do To Prevent a Calf Strain Injury?
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Stay strong in the calf muscles! Perform high rep endurance sets of calf raises. Most importantly perform heavy low rep calf raises as well!
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Stay conditioned. Try to stay active in the legs and avoid massive time off. If you have a break from sport or are returning from injury, be conservative building up your sporting demands. Recommence running and/or training so your body is conditioned for your sport
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If you do a team sport try to stay conditioned in your change of direction and sprint loads. This is severely underestimated in time away from sport. A steady 5km run has very different conditioning on the body compared to a 45 minute basketball game.
Treatment of Calf Strains :
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Deload and rest for 1 week
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Unlike other muscle strains, the calf benefits from a good deload and rest period for approximately 1 week. In bad strains weight bearing and walking can be painful, crutches may need to be used
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Re-train/improve calf endurance
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Runners will need at least 25-30 calf raises with good technique
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Re-train/improve calf strength
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Heavy calf strength will improve running economy and force production
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Introduce/improve plyometrics and power
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Hopping and plyometrics are beneficial in improving the power of the calf
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Return to running
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Slowly introduce both fast running/sprints and slower steady state running
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This rehab is vital because often injured runners feel great after 2-3 months and spike their training volumes too aggressively then get re-injured!
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Return to sport
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Return to sport training and games if you do a ball sport
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The seated calf raise machine(performed with heavy reps) is fantastic for building soleus strength!
2. Neural Tension and Calf Pain Symptoms
When the nerves that supply the calf become wound up, they may produce calf pain. The sciatic nerve starts from the spinal cord and has a pathway through the glutes, hamstring, calf and into the foot. If there is any nerve tightness along this pathway, pain may be referred into the calf.
Neural pain is different to an acute strain. It may feel like there is a gradual build up of weakness or numbness in the calf, and there may be a history of back tightness as well.
Distance runners may develop this pain, rest for 2 weeks, return to running with nil issues then have a recurrence 2 weeks later. This frustrating cycle may continue no matter how much you roll out the calves, because the nerve issue higher up the chain is never addressed!
Previous back injuries (lumbar stress fracture, disc bulge etc) or occupations with increased sitting may be precursors to neural tension.
What Does Neural Tension Calf Pain Treatment Involve?
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Nerve stretches and glides to loosen tight nerves
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Strength work in the glutes, hamstring and lower back to stop any nerve impingements
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Avoiding constant sitting to get freedom in the lower back and hips
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Progressive calf and lower limb loading
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Progressive running build up
A neural glide exercise to help with neural tension calf pain.
3. Silent Strain, Pain After a Run With No Acute Pull
A relatively new form of calf pain has gained exposure - silent strain. This is when there is a deep calf strain with nil acute pain/incident.
This generally presents after a long bout of exercise (say a game of football or a long run), where there will be lingering calf soreness or tightness that does not go away. The constant activity and fatigue in the soleus muscle has caused a non-acute muscle strain known as a ‘silent strain’.
Clinically we see runners who have a history of getting a silent calf strain, they will rest for 4-8 weeks, slowly recommence running successfully then re-strain 3-4 months later when they build up running volume. This cycle will repeat for months/years until they address the underlying cause.
Silent strains gained exposure in professional sporting environments over the past decade (especially from the AFL). Players would have nil acute incident but would have lingering calf tightness/pain after a game.
Professional clubs have huge medical budgets and were able to refer their athletes for a MRI scan without hesitation. On imaging radiologists discovered small deep calf strains.
It can sometimes be difficult to differentiate a silent strain from neural tension.
Treatment of Calf Silent Strain:
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Deload and rest for 1 week
-
Unlike other muscle strains, the calf benefits from a good deload and rest period for approximately 1 week. In bad strains weight bearing and walking can be painful, crutches may need to be used
-
-
Re-train/improve calf endurance
-
Runners will need at least 25-30 calf raises with good technique
-
-
Re-train/improve calf strength
-
Heavy calf strength will improve running economy and force production
-
-
Introduce/improve plyometrics and power
-
Hopping and plyometrics are beneficial in improving the power of the calf
-
-
Return to running
-
Slowly introduce both fast running/sprints and slower steady state running
-
This rehab is vital because often injured runners feel great after 2-3 months and spike their training volumes too aggressively then get re-injured!
-
-
Return to sport
-
Return to sport training and games if you do a ball sport
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Calf strengthening is vital for prevention and treatment of silent calf strains
How can we help you?
At Melbourne Sports Physiotherapy our goal is to get you moving pain free as soon as possible.
But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert massage therapists so we can help you reduce your pain or stiffness.
If you are showing some signs of this condition or simply want help prevent this from happening in the future then book in with one of our highly experienced Remedial Massage Therapists today!
You can make an appointment by calling or booking online.
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