The two most common injuries I see during our runners leg assessments are Calf muscle strains and ITB. We have run a successful ITB rehab program for a while now. You can read more about it at What is ITB?
The Calf muscle group consists of the Gastrocnemius, Soleus and Plantaris muscles, situated at the back of the lower leg. The function of the Calf muscles is to pull up on the heel bone during the ‘push-off’ phase of walking and running.
Athletes with calf muscle strains typically get them from running, or playing sports like action cricket, where they are required to suddenly accelerate. The group that get injured playing sports such as action cricket, touch rugby e.t.c. are often in their late 30’s and older.
A muscle strain implies damage to the muscle or to the attaching tendons. Damage can also occur in the small blood vessels which cause bruising. The injury is painful, as nerve endings in the area get irritated.
Muscle strain is categorised as follows:
A first degree strain is damage to a few muscle fibres.
With a grade one calf strain, the signs may not be present until after the activity is over. There may be a sensation of cramp or tightness, and a slight feeling of pain when the muscles are stretched or contracted.
A second degree strain is damage to a more extensive number of muscle fibres.
With a grade two calf strain, there is immediate pain, which is more severe than the pain of a grade one injury. It is confirmed by pain on stretch and contraction of the muscle. A grade two calf strain is usually tender to the touch.
A third degree strain is a complete rupture of the muscle itself.
A grade three calf strain is a very serious injury. There is an immediate burning or stabbing pain, and the athlete is unable to walk without pain. The muscle is completely torn, and there may be a large lump of muscle tissue above a depression where the tear is. After a few days with grade two and three injuries, a large bruise will appear below the injury site, caused by the bleeding within the tissues.
First degree strains are the most common type of strain, and do not constitute a medical emergency. Third degree strains, however, do constitute an emergency. These injuries often happen as you sprint off, and you will suddenly feel the tear taking place. There can also be a popping sound with significant swelling etc. You will need to get medical help in such a case.
What to do if you have a first or second degree muscle strain:
You need to respect the injury, as it can quickly escalate into an injury that takes ages to heal. Avoid all exercises that cause pain.
Resting is the common sense approach, but one that is often ignored by competitive athletes. This is unwise, since it does not take much to turn a grade one calf muscle strain into a grade two, or a grade two calf strain into a grade three. As a general rule, grade one calf strains should be rested from sporting activity for about a week, and grade two strains for about 3 -4 weeks. In the case of a complete rupture, or third-degree strain, the calf muscle will have to be repaired surgically, and the rehabilitation afterward will take about 3 months.
Compress the muscle with either compression socks or an elastic bandage. Do not wrap the bandage on too tightly though.
Take non-steroidal anti-inflammatory drugs (NSAIDS), such as aspirin or ibuprofen to reduce pain and improve your ability to move around. Do not take NSAIDS if you have kidney disease, a history of gastrointestinal bleeding, or are taking a blood thinner.
Elevate the injured area to decrease swelling. Prop up a strained leg muscle while sitting, for example.
Go for a few massage sessions. These should typically include time spent on both the calf and hamstring muscles. We have at times found that even lower back tightness can contribute and thus should be released together. Massage will prevent trigger points forming and will help in the break-up of scar tissue. Grade 1 and 2 injuries can be handled by soft tissue massage experts, while grade 3 injuries should be handled by physiotherapists alone. Give me a call. I have helped a number of runners with calf strains via both trigger point release and active release massage. The area responds well to kinesio tape which I can apply as well.
Upon the resumption of running, it is an idea to wear shock absorbing insoles to reduce stress on the calf muscles.
Start a rehabilitation program to strengthen the calf muscle. These can be done with either resistance bands, or via standard calf raises.
You might find the need to strengthen your core muscles as a weak core might make you susceptible to calf injuries. We are able to pick this up as a potential cause during our runner’s leg assessment program. http://sbrsport.me/2012/09/15/runners-leg-assessment/
How to prevent the injury.
- Warm up slowly when exercising.
Stretch the calf muscle at least three times a week.
Be very careful when playing sports that call for explosive movements. You need to heed this all the more as you get older. Warm up and stretch before your game.
Make sure that you are in the right shoes. Excessive pronation can be one of the instigators of such an injury. We can check the degree that you pronate at and recommend the right shoe. Also, make sure that your running shoe is not too old. You should replace shoes every 900 km or so.
Be very careful when choosing “minimalist” shoes. The minimalist shoe movement has kept physios happily busy for a while now.
Avoid wearing high heeled shoes.
Hope this helps.