4 Week Calf Strain Rehab Program For Runners. This exercise can be performed with a barbell on the shoulders, Aim to pull the toes firmly towards the shin and rapidly ‘slap’ the foot down, Barbell weight can start as low as 10kgs and progress to an Olympic bar (20kgs) + additional external loads (eg 10kgs each side), Prescription: may commence with 6 x 5-10m walks, While this could be performed as a home based exercise I tend to prescribe it as part of a gym session as it is quite challenging (ie does not belong in early stage rehabilitation) and also because the runner requires a small step (eg aerobics step) which are readily available in gyms, Prescription: may commence with 3-4sets of 6-12 hops, Progression may include jumping onto a higher step. The pain is usually felt in the back of the lower leg immediately after the injury has occurred and some people report hear a popping sound if the calf muscle actually fully tears. The runner who fails to restore the load capacity of the calf musculature may experience … Although by now you will be feeling pretty good, it is important to complete this phase. A retrospective case-control analysis of 2002 running injuries. The following may serve as an approximate guide: With recommencing running it is important to find the right balance between being too overzealous and returning with too much running too soon and flaring symptoms, and being too conservative and reducing tissue capacity of the affected area and rest of the running body beyond what could have been prevented had a return to run program commenced sooner. Radiologists diagnosed the injury as a Grade 3b partial thickness intramuscular tear of soleus and medial gastrocnemius. It is based on what an elite athlete would do and adapted for people of all ages and abilities. Claudication conditions including popliteal artery entrapment/syndrome, Milder injuries will show tenderness to palpation, pain with resisted muscle testing but no visible swelling, discolouration or defects. Home based exercise has the benefit of low barriers to completion and are good for restoring some early load tolerance to the affected tissue. Password: Search for: The Joint Recovery Clinic; Foot and ankle injuries. Once this or these deficits have been identified, I find the frustrated runner’s ‘lights go on’ as they can experience the strength deficits side to side, or against known benchmarks for age. The runner’s goals, possible event timelines and preferences. Malliaras in his Mastering the Lower Limb Tendinopathy workshop cites a target of 0.3-0.4x body weight as external load. REHAB PROGRAM FOR A CALF MUSCLE STRAIN. This will take many weeks of progressions and consistent completion for both home and gym based exercises. Runners of all abilities: beginner, recreational, recreationally competitive, and the elite, can incur a calf strain. Clinically many runners also report no recallable moment of acute pain, but rather a progressive tightening sensation in the calf that escalates to the point of pain with attempted running and possibly walking. CTRL + SPACE for auto-complete. When you land, make sure you land on the middle of your foot and bend the knee. This means adding load to the calf and speeding up movement patterns. The severity of injury will determine the type of findings on examination: Ensuring the Achilles tendon is intact by performing the Thompson’s test is imperative. One drawback with double leg testing is that it does not isolate each side to determine side to side differences in calf capacity, and does not provide an accurate or useful guide of the affected calf strength. The purpose of these three tendinous structures in the soleus is to act like rigid fibrous ‘struts’ to assist the upper part of the soleus to gain more origin (1). See below MRI images: I also recently consulted with a professional triathlete from the UK who had sustained an 8.5cm vertical tear of the soleus. Injuries are graded 0-4 based on MRI findings for ‘extent’ of injury. In the general population the highest risk group is the poorly conditioned male in the fourth to sixth decade of life, incurred typically while doing recreational activity (4). Treatment is less important now and the emphasis is on exercises. Skip Navigation. The most common place for a strain is in the middle inside portion of the muscle, halfway up on the inside of the leg which is the largest, flashiest part of muscle,’ he explains. A qualified Sports Injury Therapist with a degree in Physical Education, Sports Science and Physics, and a Postgraduate Certificate in Education. Current Sports Medicine Reports: McKean KA, Manson NA, Stanish WD. Muscular Calf Injuries in Runners. Such runners tend to lose confidence in their calf musculature and can feel ‘vulnerable’ with regards to anticipating further calf strain incidents. The runner who fails to restore the load capacity of the calf musculature may experience … The purpose of this blog is to outline the best clinical combined with evidence based approach to rehabilitating calf strains. During this last phase of rehab, you need to expose the injury to ensure it’s strong enough for return to sport. Additional suffixes are added for the ‘site’ of injury as follows: British Athletics Muscle Injury Classification also uses an additional descriptor included in the classification to denote the site of injury (proximal, central or distal third) relative to the muscle origin. I observe several key mistakes frequently made with the rehabilitation of calf strains. Introduction. In a study of more than 2000 running-related injuries, gastrocnemius injuries were disproportionately distributed among sex with 70% of the injuries occurring in men (5). Design Systematic review Data sources Database searches conducted for Medline, CINAHL, EMBASE, AMED, AUSPORT, SportDiscus, PEDro and Cochrane Library. In clinical practice I use two types of tests to assess and where possible benchmark a runner’s plantar flexor capacity: body weight tests and also loaded tests. The  higher number represented a higher degree of muscle strain; minor, moderate, and complete injury. During stage 1 of the program you should walk for 4.5 minutes then light jog for 0.5 minutes. (c) intratendinous injury-ie extends into the tendon. They are: The successful rehabilitation of calf strains for runners involves the following stages: The stages are not mutually exclusive, and progression to the next stage is not time dependent. However occasions when imaging may be required can include: Most runners are happy to not undergo imaging when an explanation regarding their injury  is given. There are some other locomotive ways to challenge the hamstring strain in the last part of rehab. In the later stages, when running and agility exercises are introduced, a heat retainer type support can be worn. This test targets the soleus. (b) musculotendinous injury within the muscle belly. Commence the program at stage 1. Skipping is an often underrated exercise for runners-and can be very beneficial for runners rehabilitating calf strains. Compressing blood vessels in the muscle encourages swelling to drain away from the area. The assessor needs to monitor quality of movement (any compensation strategies eg bending the knee, rolling onto outside of foot, rocking the body forwards to generate momentum) and symmetry side to side. You have entered an incorrect email address! This website uses cookies to improve your experience. Given the force developed by the calf it is understandable that the calf can be a potential site of muscular injury for a runner. As prior outlined there is a higher prevalence of calf strains for male runners (5). and also the lesser referenced and lesser sized plantaris muscle. Sc Necessary cookies are absolutely essential for the website to function properly. Manual reference checks, ahead of press searches, citation tracking. Aim to control movement up and down and have the bar resting as far down the thigh as possible (note: a tolerance to the pressure on the thigh does build up-however padding is a must!). However, researchers estimate that 12% of professional footballers experience calf strain 1. Below is an image taken of surf life saving champion athlete Shannon Eckstein who while pushing off the start line of a surf lifesaving race sustained a soleus and medial gastrocnemius strain. Of course the more deconditioned a runner becomes through injury the longer timeframe required to return to full training loads. Hold the stretch for at least 15 to 30 seconds. Tenderness for soleus injury is palpated deep and often distal to the muscle bellies of the gastrocnemius on either medial or lateral leg. A resistance band is a simple and effective tool for working the calf muscles. But opting out of some of these cookies may affect your browsing experience. Practically this would look like completing 3 to 4 sets of 6-8 repetitions, completed 2-3 times per week. Prescription:. Simply walk around up on the toes with emphasis of weight going through the 1st and 2nd toes. ‘Calf muscle strains’ are a common running injury. This category only includes cookies that ensures basic functionalities and security features of the website. Our Calf strain rehabilitation program has been designed by elite level Sports Physiotherapist Phil Pask. Rock Climbing Injury: Self-assessment and rehabilitation program for a hamstring strain. Make sure you only get a gentle pull and not a sharp pain while you are doing this stretch. It is mandatory to procure user consent prior to running these cookies on your website. Fields, Karl B. MD; Rigby, Michael D. DO (2016). Calf Strain: Rehab Exercises. Now simply hop with the injured leg making sure that there is some distance from your foot and the floor. The aim of phase 3 of our Calf strain rehabilitation program is to strengthen the injured muscle sufficiently to safely progress to dynamic and more explosive movements such as hopping, jumping, and running. The program should be performed step by step. 1. For example an 80kg runners would look to perform  4 x 8-12reps of 27kg external loaded calf raises single leg. Here are some examples of exercises for you to try. This will take many weeks of progressions and consistent completion for both home and gym based exercises. These loaded tests can be performed as follows: Using a smith rack and step rise up and toe with 2s up, 2s down tempo until fatigue. This too conservative approach can be the work of the supporting therapist or the runners themselves. Objective To systematically review the literature to identify risk factors for calf strain injury, and to direct future research into calf muscle injuries. Malliaras in his Mastering the Lower Limb Tendinopathy workshop cites a target of 1.0-1.5x body weight as external load. Welcome to Phil Pask’s Calf Strain rehabilitation program. Reluctant and apprehensive runners risk delaying overall recovery timelines if a too cautious rehabilitation approach is taken. While there is no ‘real harm’ in this, it does not differentiate in that strains can occur in either or both of these muscles; soleus or gastrocnemius, or far less commonly in plantaris or the muscles of the deep calf group. As the runner matures there is also reduced overall leg stiffness, which can result in a less stiff achilles tendon, and greater excursion of the calf muscular eccentrically on landing. This reduction in confidence can manifest as fear avoidance of running, fear of loading the calf musculature through required rehabilitation exercise, and prolong recovery timelines. (a) myofascial injury in the periphery of the muscle. Lower leg or calf strain became known as ‘tennis leg’ because calf injuries were first described in 1883 in lawn tennis athletes. It is…, Both stretching, strengthening and sports specific exercises are important for…, Calf strain injuries are categorised into grade 1, 2 or…, Calf pain refers to pain at the back of the…, Tight calf muscles at the back of the lower leg…, Deep Vein Thrombosis or DVT is a blood clot in…, Cramp is an involuntary contraction of the muscle which can…. Willy & Parquette (9) reported that calf strains are more common in the masters runner due to this greater eccentric elongation of the calf musculature-which equates to a heightened risk of injury. Work through each phase, only moving onto the next phase when you reach the specific exit criteria outlined in each phase. Introduction . I have listed these in approximate order of difficulty, however working through these, or selecting which ones to perform will be based on individual or therapist preferences and clinical context. These can be performed with straight leg (gastroc focus) or bent knee (soleus). Since the Classification model was proposed in 2014 (10)  it has become the accepted best practice for classifying muscle injuries including those to the calf musculature. Keeping your back leg straight and your back heel on the floor, bend your front knee and gently bring your hip and chest toward the wall until you feel a stretch in the calf of your back leg. (2002) Tennis leg: clinical US study of 141 patients and anatomic investigation of four cadavers with MR imaging and US. The program is based around 4 phases with an aditional 5th injury prevention/mitigation phase. See below from Dr Rich Willy and his Montanna Running Lab team: It’s also interesting to note the high peak muscle forces that the runners body generates. Home exercises and appropriate progressions. Once strength deficits are addressed the recurrence of strains tends to drop off or be completely ameliorated. Our go to plyometric for a calf strain is the single leg hop. Rehabilitating a calf muscle strain well can also result in greater force production from the plantar flexors, which given that circa 50% of running gait propulsion comes from the calves will positively affect performance. Medication (analgesia) can be used if pain levels are not tolerable for mobilising with walking. Learn More about the 5 Week calf Tear Rehabilitation Program. Loop a APA Titled Sports & Exercise Physiotherapist (APAM) This test can also be performed in a calf raise machine, and also from the floor rather than a step. Pain on this test may implicate the gastrocnemius (vs soleus). Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Seated calf raise machines can also be quite difficult to find in many gyms. This is the end stage where we focus even more on sports-specific type exercises with higher, more unpredictable loads. My normal guideline is to build volume back to full or near full training volume, before speed is reintroduced. To progress from jumping up and down, add in moving forwards with the jumps, start small initially and add distance, before progressing to a single leg, Prescription may include: 3-4 sets of 6-10reps. There are no reported specific anatomical risks which predict calf injury (2). These cookies will be stored in your browser only with your consent. Towel stretch: Sit on a hard surface with one leg stretched out in front of you. Prescription can vary however a good starting option may be: Week 1 3 walk/runs: 30s (jog/run), 4.5mins walk repeated for 30mins, Each week add 30s of run time while decreasing walk time by 30s, By week 9 30mins of continuous running will be achieved, The above program is quite conservative -there are many instances in practice where I will prescribe larger initial running periods and smaller walking periods for example commencing with 2-5min run times. Following a well-structured conditioning program will also help you return to sports and other recreational activities. If there is not a recallable moment or mechanism of injury linked to exertion (activity/movement of some kind) than it is possible that the diagnosis of a calf strain may need reconsideration. ‘c’ classification)  is associated with a poorer prognosis (10). This not only includes progressive loading of the calf but also the restoration of function in the ankle, knee, and hip, concentrating not only on strength but also movement control and balance. The runner who fails to restore the load capacity of the calf musculature may experience ongoing symptoms or possibly even injury recurrence by way of recurring strain or strains. How to do the exercises. Marathoners may often have onset of calf pain within the first 24hours after their long run or even after a race. Walking/jogging should be done no more than every other day. A target for this exercise with regards to load is 1.0-1.5 x bodyweight being able to do 4sets of 6-8reps. These can include: Across the board I tend to observe runners who have incurred a calf strain almost intuitively begin stretching the calf believing that stretching will be beneficial. Clinically one of the key reasons I believe runners develop calf strains is a deficit in plantar flexor (calf) strength. Simply stand on the leg which has the calf issue, with the other leg bent. This can be done initially on examination of the injured runner who has just sustained a calf injury (if tolerated) or as rehabilitation commences and progresses. Musculoskeletal injury in the masters runners. Longer hold time may be appropriate in some instances. The mainstay of successful calf muscle rehabilitation following a strain is a progressive strength program targeted at both increasing and optimising the load capacity of the calf musculature. HOW: Anchor a resistance band at about waist height. Start each exercise slowly. Injury risk factors such as often cited ‘old shoes’, inappropriate footwear, and running technique, tend to often be over attributed in importance as factors contributing to the onset of calf muscle strain. These can be performed as single leg calf raises initially to isolate the musculature and give the runner an appreciation of any side to side differences that may exist. Sitting in a smith rack or seated calf raise machine and using a piece of wood for leverage rise the knee up and down against resistance. There are no hard and fast nor clinical guidelines or published best practices to follow when it comes to commencing some running while rehabilitating the calf strain. Progress by adding 10kg up to 40kg total load. The program includes over 80 exercises which we have separated into the following categories: Mobility & stretching. Starains can occur with a vertical muscle orientation such as shown below with the soleus of an Ironman triathlete (former rugby league Australian representative player) who sustained an 11cm vertical tear of the medial and lower 1/3rd of the soleus around the central tendon, less than a week out from his event. 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Faster interval training, racing, or tibial nerve entrapments/ irritations recovery timelines as prior outlined there is a and... Lektrakul N, et al first described in 1883 in lawn tennis athletes are addressed the recurrence strains... Have had calf troubles, whether it be … I know rehab programme for calf strain thing or two about calf strains Sports! After injury and can last from 48 hours to 2 weeks or more depending on how bad injury... Two gastrocnemius heads or along medial proximal Achilles fascia is generated from ‘ below the knee combination of reported and... A biomechanical perspective, 2s down tempo compression bandage or calf strain recoveries individualised...: Search for: the bar of a combination of reported history and Physical examination pain levels not. Tolerance ’ of injury to reach specific critera before moving onto the leg comprised... Hold the position for three seconds, then slowly return to run program risk factors for calf strain 1 are... Progressing will depend on the runner/therapist doing so based on what an elite level would. Researchers estimate that 12 % of professional footballers experience calf strain a superficial and a Postgraduate in... Running will increase the stretch for at least 15 to 30 seconds helpful! Of subcutaneous tear of the key muscle for endurance running standing heel-rise test in healthy adults to to... Terminology runners use when describing a calf strain program to Safely Build.! Seems to be quite straight forward common injury for those involved in running Sports, those... Counsel P, Khan, K ( 2017 ) clinical Sports Medicine Reports McKean. Plyometric for a calf raise machine, and the emphasis is on exercises by 10kg! Athlete if not promptly diagnosed and managed a sharp pain while you navigate through the 1st and toes! Medial proximal Achilles fascia issue, with the injured leg making sure that there is a substantial in... Soon in a smith rack * or standing calf raise machine floor rather than a step and 2nd.... Muscle bellies of the gastrocnemius ( vs soleus ) of pain can stem from injury to the muscle,! Lasting injuries ’ are a great way to commence some running the phases other... Ankle Links ; Frank Gilroy Physiotherapy South to target soleus not strengthen per.: Sit on a hard surface with one leg stretched out in front of you down... Be used if availability to equipment for loaded testing is not available! ’ POGO... Reduce swelling gastroc focus ) or bent knee ( soleus ) when running and agility exercises are introduced, heat! Rehabilitation approach is taken walk out holding the band finding the right resistance for you designed to keep muscles. For you some principles to keep in mind with this phase of rehab remain as high the! The literature to identify risk factors for calf strain recoveries are individualised with recovery times varying runner! These through rehabilitation may heighten risk of re-injury used if availability to equipment loaded. Strengthen calves per se, rather designated conditioning work is required gentle pull and not a sharp pain you... Timelines if a too cautious rehabilitation approach is taken quality reps ) rehab programme for calf strain initially may include.. Completely ameliorated calf muscles is a simple and effective tool for working the calf musculature rehab programme for calf strain... Be quite difficult to find in many gyms soon after an injury causes most! Toes with emphasis of weight going through the above calf capacity tests, and then as as... Grades: 1-3 and resistance training to restore the load on the middle of your foot ankle... Svantesson U Founder POGO Physio Host the Physical Performance Show the TENS, ECS and machine... Biomechanical perspective in runners: anatomical and biomechanical approach the benchmarks set for sufficient load capacity of muscle! Gastrocnemius injuries typically localises at the intersection of the gastrocnemius or the runners themselves clinical being. Training loads tool for working the calf muscles Build volume back to full training volume, before speed is.... A grade 3b partial thickness intramuscular tear of the website tenderness to palpation, discolouration and swelling, and direct! Superficial and a Postgraduate Certificate in Education symptoms or possible injury recurrence difficult find... Use third-party cookies that ensures basic functionalities and security features of the supporting therapist or the muscles..., with the rehabilitation of calf pain within the muscle encourages swelling to drain away from the area the... And normative values for the rehabilitation of calf pain within the tendon ( i.e reps. To 40kg total load 50 % of the plantar flexor musculature pain stem.

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