Tips and Golden Nuggets for Assessment and Management of Calf Strains
With preseason in Rugby League starting I have noticed that there is an increase in the number of soft tissue injuries, especially calf or achilles related injuries. As part of my research and ongoing rehabilitation, I thought it would be nice to highlight some tips and nuggets that I have utilised in my practice on the field and in clinic, with some advice and references from a fantastic paper by Green et all 2022 which outlines some go to strategies from expert clinicians in assessment and management of calf related injuries..
Lets start from the top:
- There are three calf muscles the gastrocnemius, soleus and plantaris. But how can we differentiate them during our assessment? Symptoms from soleus injuries are often cumulative and not typically reported until examination, whereas gastrocnemius injuries are almost always apparent immediately. Gastrocnemius injuries are more likely to occur during acceleration, jumping, and sprinting activities, and you may experience a ‘shotgun’ feeling in the back of your leg. Plantaris can also have this shotgun sensation but you are able to push on with activity. Soleus injuries are more common during steady-state running and with more gradual onset presentations.
1. Load the calf early.
We want to load the calf as soon as possible, whether that be isometric and at mid-range or any comfortable range of isotonics within a nice pain threshold. This is important to help build resilience and confidence. Some clinicians say that you start to strengthen from day 2 or 3 onwards pending the injury and that the optimal starting point for calf loading to be specific to what they can tolerate. For example if they can tolerate a double leg calf raise, then start them on double leg calf raise.
2. Try to normalise the walking pattern as the first step to normalise movement.
From Green et al (2022) paper once clinician says that we should; “Get them walking normally as quickly as possible. Get them with normal stretch left versus right as quickly as possible, both gastroc and soleus. And, like I say, ‘load it.’ And it will be more ‘capacity-loading’. Load it safely, pain-free, a number of times throughout the day.”
3. Use activation exercises to ensure inhibition does not negatively impact higher-load activities.
If they have injured their gastrocnemius muscle, it is not uncommon for it to be inhibited and for your soleus or flexor muscles to take over when loading after a calf injury. Thus we should recommend activation exercises with a band in a NWB (non-weight bearing position) when tolerable.
4. It is important to condition uninjured areas at the highest intensity possible without compromising the calf.
This will typically involve conditioning and strength work of the upper body/core or lower limb that does not excessively stretch or load the calf particularly in the early phases of rehab. If their exercises are not causing them pain then there is no reason to stop them doing these exercises in the gym. This means that if you can engage glutes/hamstrings/quads/hip flexors then try to train them concurrently as part of rehabilitation without overloading the calf then do so!
5. Try to avoid excessive eccentrics and prolonged passive stretching.
Another clinician from Green et all 20222 paper likes to think that “Range of motion probably takes care of itself. I think that, yeah they might have a painful lunge stretch to begin with but I see that as more an assessment tool rather than an impairment that I need to work on specifically.” This is why we don’t typically prescribe passive stretching as a treatment
6. Have a foundation of single-leg calf raise capacity prior to loading strengthening
There are plenty more tips and nuggets to run through with other types of injuries, but I hope you enjoyed some of these in relation to the calf.
Keep an eye out for more upcoming blogs!
Green, B., McClelland, J. A., Semciw, A. I., Schache, A. G., McCall, A., & Pizzari, T. (2022). The Assessment, Management and Prevention of Calf Muscle Strain Injuries: A Qualitative Study of the Practices and Perspectives of 20 Expert Sports Clinicians. Sports medicine – open, 8(1), 10. https://doi.org/10.1186/s40798-021-00364-0
Jamie Cheok – BeFit Training Physio Coogee
Jamie Cheok is a physiotherapist based in Coogee in the Eastern Suburbs of Sydney. Jamie has successfully treated musculoskeletal problems on the basis of a thorough assessment and diagnosis coupled with evidence-based rehabilitation programs tailored to the needs and goals of each individual. To book a consultation, click the link below.