A calf (gastrocnemius) strain occurs typically when a sports person attempts to accelerate by extending the knee from a stationary position with the ankle in dorsiflexion, or when lunging forward, such as playing sports with fast change of direction e.g. tennis, squash, and badminton. Also, sudden overstretch such as running onto a kerb and the ankle drops suddenly is another common mechanism for this injury. The inside of the muscle (medial head) is shown to have a longer insertion into the achilles tendon. Therefore, the medial head may have a greater capacity for force generation resulting in a greater susceptibility to injury compared to the lateral side.
A calf strain typically results in acute, stabbing or tearing sensation, usually either in the belly of the medial head or mid-lower 1/3 of the muscle (musculotendinous junction). Pain is also produced via palpation, stretch, and resisted contraction. In grade III tears there is often a palpable tear in the muscle. Calf strain can be graded as shown below.
|Grade||Symptoms||Signs||Average time to return to sport|
|I||Sharp pain at time of activity, may be able to continue
|Pain on calf raise or hop||10-12 days|
|II||Unable to continue activity
|Active plantarflexion pain
Significant loss of ROM
Calf raise pain
|III||Immediate sever pain at musculotendinous junction||Tear is palpable||6 month after surgery|
Treatment & Rehabilitation
Initial treatment of calf strains aim to reduce pain and swelling. Treatment usually consists of RICE, TENS, and pain killers. Crutches may be required if you’re unable to fully weight-bear through the injured leg. Additionally, a heel wedge can initially be used to reduce the stretch and force through the injured leg but should not be continued for an extended period of time as this may lead to chronic shortening of the muscle.
Gentle stretching of the calf to the level of a feeling of tightness can begin soon after the injury, as well as foot and ankle ROM exercises. Muscle strengthening should start after 24 hours, this involves progressive exercises, commencing with both leg concentric calf raises (upward movement), followed by single leg calf raise with gradual introduction of weights and, finally, eccentric calf lowering gradually increasing speed, then adding weights. Low impact cross-training such as cycling or swimming can be commenced as soon as pain allows. When weight-bearing contraction is pain free, soft tissue therapy can begin at the sight of injury to encourage correct healing of the muscle and to reduce scar tissue production.
Sportspeople should undergo a supervised, graduated return to sport program. Progression through weight-bearing activities to graduated running programs should be incorporated. Also, running programs should include sprint or, change of direction, and change of pace while continuing with eccentric strengthening.
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