Patient Information Sheet – Calf Strain

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CALF STRAIN (also known as tennis leg)
BY Dr Chris Milne, Sports Physician

What is it?
It is a strain of one of the muscles of the lower leg. Usually it is the medial gastrocnemius muscle that is injured.

What causes it?
It usually occurs when you are running fast or changing direction. Because the gastrocnemius muscles pass over two joints, they have a difficult job to do and are prone to overload when they are lengthening against resistance.

Symptoms – what you notice

  • Pain – in the inside of the calf, about halfway between the knee and ankle. The pain is usually of sudden onset, and severe enough to make you stop running straightaway.
  • Weakness of toe-off action (ankle flexion).
    You may notice tracking of blood below the skin a few days after the injury. This is a good sign, as it helps the injured muscle heal.

Signs – what the doctor finds

  • Tenderness over a 2-3cm length of tissue, usually at the junction between the lower end of the calcaneal muscle and the upper end of the achilles tendon.
  • Pain and weakness on resisted ankle flexion (toe-off action).
    There may be some evidence of referred pain from the low back.
  • In rare cases, there may be a contour defect over the injured area. This is easier to see when the muscle contracts against resistance.

Investigations
Usually none are required. If the injury is not healing as expected, an ultrasound scan may be ordered.

Treatment

  • First aid – an ice pack applied over the injured area is useful. Take Panadol or anti-inflammatory tablets.
  • A graduated physiotherapy rehabilitation programme is the main part of treatment.
  • An orthopedic felt wedge put under the inside part of the heel can help in the early recovery phase. It acts as a chock and takes some tension off the injured calf muscle.
  • Surgery is hardly ever required, unless there is a significant tear of the upper part of the achilles tendon.

Recovery time
Average recovery time is 2-4 weeks. Don’t be tempted to push things too quickly, as recurrent strain in a partially healed injury is quite common.

Recovery sequence

  • Step 1 Ice packs, pain relief, orthopedic felt wedge in footwear.
  • Step 2 Physiotherapy treatment to restore full range of motion of the knee and ankle, then build strength and endurance.
  • Step 3 Don’t run, but you should be able to start swimming or cycling a few days after the injury. Keep doing upper body weights and calf raises.
  • Step 4 Restart running, beginning slowly on grass.
  • Step 5 Build up pace and add stop-start routines.
  • Step 6 Run figure eights.
  • Step 7 Perform cutting and turning exercises.
  • Step 8 Team training and skill sessions.
  • Step 9 Resume playing, half a game at first.
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