Calf Muscle Strains
This blog will cover calf muscle strains, and a simple protocol for rehabilitating them.
Calf muscle injuries are notoriously tricky to rehab, and there is currently no universally agreed recovery protocol, even amongst the world's leading sports injury specialists. If you have a calf muscle strain, it’s worth trying to get your rehab right, as calves are particularly prone to being re-injured. One study showed that 19-38% of athletes who get calf strains will get them again.
First off, you need to be sure that you actually have a calf muscle strain and not another medical problem. There are other conditions that affect the back of the lower leg, including serious ones like having a deep vein thrombosis, so always get advice from a healthcare professional to rule these out.
What we think of as the calf muscle is actually three separate muscles that work together, namely the gastrocnemius, soleus and plantaris muscles. The reason this is important, is that the rehab exercises are slightly different depending on which muscle you have strained.
The most commonly injured muscle is gastrocnemius (the medial part), followed by soleus, which is found underneath it. Sometimes both are injured at the same time. It’s quite rare for plantaris to be injured.
Calf muscles - gastrocnemius and soleus.
The gastrocnemius muscles contain lots of fast twitch muscle fibres and are usually injured suddenly during explosive type activity like sprinting and jumping. Typical activities where gastrocnemius injuries are seen include, rugby, basketball, ballet, and athletics (sprints and jumps).
Soleus injuries tend to be harder to pinpoint in the calf and are often more insidious in onset, with no sudden tearing. They are often associated with increased running workloads seen with long distance runners and walkers and footballers.
What to do in the first 24-48 hours after your strain?
Once you are satisfied that you have a calf muscle strain and not another problem, you should implement the following:
Rest,
Ice (first day only*)
Elevate leg
Minimise NSAID* use, e.g ibuprofen. Use paracetamol instead.
Put a compression bandage on your calf. There is evidence this can speed recovery.
*With regard to the NSAID and ice use advice, I discuss the reasons for this approach here in more detail.
The next few days
Gentle walking is usually ok, but on flat hard surfaces only.
No running or sport.
Avoid any stretching.
Be careful when climbing stairs or using ladders as this can over stretch the injured muscle.
Avoid any massage work on the calf in the 1-2 few days post injury - it may cause further bleeding.
Rehabilitation exercises
The focus of rehab exercises is on regaining strength in the injured muscle, and less so on stretching. As a guide to the standard recovery timeline, professional athletes with intensive medical support usually take around 3 weeks to return to play following a calf strain.
The exercises start with non weight-bearing working of the muscle and then progress to calf raises and finally hopping and jumping. Running should only be re-introduced once you have successfully progressed through these stages.
Other considerations
Along with the rehabilitation exercises there are other factors to consider that might optimise your healing further.
Red Light Therapy - There is strong evidence that using red light on injured tissues promotes wound healing and tissue repair. I’ve talked about the science behind red light therapy in a previous blog here. You can either purchase your own red light device or find a practitioner (like me) who uses one. Although cheaper models are freely available, I use a hand-held light from this company as well as a larger machine from this company.
Nutrition - To make sure your body has the vitamins and minerals it needs to repair and replace the injured muscle you should consider taking a quality supplement that contains the following, all of which have a role in collagen synthesis.
Vitamin C, Vitamin D3, Vitamin A, Vitamins B6 and B12, copper, zinc, magnesium.
In addition, collagen powder is worth considering. The body initially patches up your injured muscle with Type 3 collagen and then as healing progresses it replaces it with type 1 collagen. There is some evidence that supplementing with collagen peptide powder can help with muscle repair. My preferred product which I have been using for years is this one, which contains both Type 1 and 3 collagen.
Osteopathy
Finally, there is also a role for osteopathic treatment in the rehab process, particularly when it comes to trying to future-proof your calf muscles. If you are someone who repeatedly gets calf strains, there may be something bio-mechanically going on which is causing this.
I would assess the mobility and function of the lower back, hips, knees and feet as they can all have an effect on calf muscle function. In particular, a stiff low back, tight hamstrings and feet that overpronate can all put a strain on calf muscles.
If you live in the East Grinstead or Forest Row area and have a calf muscle injury and want help getting back to sport, then book an appointment to see me at Osteo Studio.
Cliff Russell
Registered Osteopath
