Physical Therapy After a Calf Strain
A calf strain involves injury to or tearing of the muscles in the back of your leg below the knee, primarily the gastrocnemius and soleus muscles. Calf strains are common among athletes who perform stop-and-go movements with quick bursts of speed, such as sprinters, football players, and soccer and tennis players. Physical therapy can help reduce pain, restore muscle strength and flexibility, and increase the speed of recovery through a progressive rehabilitation program to prepare the athlete for a safe return to sport.
Anatomy of the Calf Muscles
The calf muscles are located on the back of the lower leg and consist of three main muscles: the gastrocnemius muscle, the soleus muscle, and the plantaris muscle. Typically, the gastrocnemius and/or the soleus muscles are the muscles involved in a calf strain. These muscles travel down and join the Achilles tendon, which inserts into the heel bone. The gastrocnemius muscle is the larger muscle at the back of the lower leg, while the soleus muscle is the smaller muscle located lower down on the leg and under the gastrocnemius. These muscles help to flex and bend the foot, ankle, and knee.
The gastrocnemius muscle is made up of two heads (a medial and a lateral head) and is a two-joint muscle, crossing both the knee joint and the ankle joint. The gastrocnemius muscle is comprised of type 2 muscle fibers, which are fast-twitch and are used for speed and power-based activities. Ninety-six percent of the soleus muscle is made up of type 1 muscle fibers, which are used for endurance-based activities. When running, the soleus is loaded with 6 to 8 times our body weight.
What does a Calf Strain Involve?
A calf strain involves injury to or tearing of the muscles in the back of your leg below the knee, primarily the gastrocnemius and soleus muscles. Calf strains are common among athletes who perform stop-and-go movements with quick bursts of speed, such as sprinters, football players, and soccer and tennis players. Research has shown that the strongest risk factors for a calf strain are the athlete’s age and history of a previous calf strain or leg injury. Calf strains are most prevalent among athletes in their 20s and 30s, affect men more than women, and can present as a recurrent injury in 19 to 30% of cases.
There are three grades of muscle strain, graded based on the amount of muscle damage that occurs:
Grade 1 involves a mild, partial stretch or tearing of a few muscle fibers. It causes tenderness and pain in the affected muscle, but muscle strength and walking ability remain normal.
Grade 2 involves moderate stretching or tearing of more muscle fibers such that the muscle is very tender with bruising and noticeable loss of strength. The individual may limp when walking.
Grade 3 involves a severe or complete tear of the muscle fibers as well as visible bruising, significant pain, and inability to put weight on the affected leg.
The gastrocnemius muscle is more susceptible to strains as it crosses two joints and is used for speed and power-based activity. It is more often injured when the knee is in an extended position (knee straight and ankle in dorsiflexion) such as when sprinting or when playing soccer, football, or tennis. With a gastrocnemius strain, you may hear an audible pop and popping sensation, sharp throbbing pain that comes as you walk on the injured leg, difficulty rising on your toes post-injury, and swelling in the calf.
The soleus muscle is an endurance muscle and is more commonly strained when the knee is in a flexed or bent position during an endurance-related activity. The onset of pain is generally gradual involving a dull ache that progressively worsens. With a soleus strain, a dull ache develops and gradually worsens behind the lower leg closer to the Achilles; pain increases when pushing down with the foot while the knee is bent; and pain worsens with activity and subsides with rest.
Rehabilitation After a Calf Strain
Physical therapy can help reduce pain, restore muscle strength and flexibility, and increase the speed of recovery through a progressive rehabilitation program to prepare the athlete for a safe return to sport. The therapist first conducts a thorough evaluation to determine the extent of the injury, including a medical history review, observation of the patient’s current walking and stair climbing abilities, testing of the calf and lower extremity mobility and strength, and assessing movements that worsen the injury. Surgery is rare for a calf strain as conservative treatment with physical therapy is effective in restoring function and returning individuals to activity and sport in the majority of cases.
There are generally five phases of calf strain rehabilitation:
Acute injury treatment: The focus is on preventing further structural damage by resting the injured area and using ice, compression, and elevation to minimize pain and swelling.
Early rehabilitation: The therapist begins gentle range of motion exercises and early loading of the muscle, progressing from isometric movements (which are static contractions that promote early facilitation and blood flow to the area for healing) to isotonic movements (full motion of muscle shortening and lengthening). The therapist may also do manual therapy soft tissue mobilizations to enhance the mobility of the injured area and reduce pain.
Intermediate rehabilitation: As symptoms improve, the therapist progresses the athlete to heavier loading challenges and calf strengthening, introduces plyometric training, and begins a progressive return to running, building in volume and intensity.
Return to functional training: At this point, the athlete is ready to integrate sport-specific functional training, working to enhance running fitness, volume, and intensity and improve sports-related calf capacities (strength, endurance, power, and plyometric qualities).
Return to sport protocol: The athlete must complete a return to sport protocol involving specific tests to determine athlete readiness for the rigors of their sport, testing strength and joint stability, speed and agility, plyometric abilities, and running mechanics.
Have you experienced a calf strain? Work with a physical therapist to restore strength and function and return to your safely and as quickly as possible!
