Guide on how to diagnose your calf pain
HAVE YOU STRAINED OR TORN YOUR CALF MUSCLE?
Calf muscle injuries are one of the most common injuries we see in our physio clinic.
Unfortunately they seem to be most prevalent in the over 40's age category. This, I think, is due mainly to the combined effect of too much sitting (40 year olds have spent more time sitting at work than 20 year olds) and also, as we age, we lose some of the natural elasticity and flexibility in our muscles, especially if you aren't diligent with stretching.
The typical scenario is a 40 something year old runner who is building up for a half marathon, strings together 4-6 weeks of training including a couple of "speedwork" sessions, and then one of their calf muscles goes "ping".
After a couple of days it feels fine to walk on, so they test it with an easy 5km run only to find it goes "ping" again after 5 minutes, and this time they decide to rest for 2 weeks.
2 weeks later, having not done anything proactive to establish the cause of the injury, they go for another easy 5km run. This time the calf was fine.
Hooray they're cured!
The next day they set out for a 10km run to regain some of their lost fitness, and the calf pings again after 3km.
The Half Marathon dream is over!!
Calf strains are not purely the domain of the 40 year plus division, I have seen plenty of 20 and 30 year old runners with repetitive calf muscle injuries as well.
Are your calf muscles stopping you from running?
If so, don't worry. Your running days are not over. There is a "cure" you just have to get the combination of the correct diagnosis and the correct rehabilitation program.
STEP 1 : SELF-DIAGNOSIS - IS YOUR INJURY A TEAR OR A STRAIN?
Calf muscle injuries are one of the most mis-diagnosed injuries by medical practitioners.
I have treated literally thousands of runners who have been told they have torn their calf muscle, yet they can walk without pain in 2 days or less, and an MRI scan or Ultrasound Scan shows no physical tears in the muscle fibres.
Step number 1 in the rehab process is for you to self-diagnose whether you have a "Calf Tear" or a "Calf Neural Strain"
WHAT IS A CALF TEAR?
Muscle tears are categorised into three grades
Grade 2: More extensive damage with more muscle fibers involved. However, the muscle is not completely ruptured. These injuries present with significant loss of strength and motion. These injuries may require 2-3 months before a complete return to sport.
Grade 3: Complete rupture of a muscle or tendon. These can present with a palpable defect in the muscle or tendon. However, swelling in the area may make this difficult to appreciate. These injuries sometimes require surgery to reattach the damaged muscle and tendon.
Mechanism of injury and symptoms of a calf muscle tear:
- A calf tear happens suddenly. It is usually, but not always, due to a change in force or stress on your leg. For example leaping up a step, a sudden change in direction or a sudden acceleration (sprint training)
- A calf tear usually feels like "someone shot me in the leg".
- The pain is immediate, sharp and significant (even in a grade 1 injury)
- The tearing sensation is usually felt across the muscle (not up and down the muscle)
- Calf tears most commonly occur in the medial head of the gastrocnemius muscle - the lumpy bit near the bottom inside part of the muscle.
- There will be swelling and tenderness the severity of which depends on the grade of the tear
- In a grade 2 or grade 3 tear, there will be bruising which appears mostly around the inside of the foot and ankle 1 - 3 days after the injury.
- It will be painful to walk on for a sustained period of time. Typically 10 days in a grade 1 injury and up to 3 months or longer in a grade 3 injury.
- These injuries need rest. Running on them before the muscle cells have repaired causes further (usually more severe) tearing.
WHAT IS A CALF STRAIN?
A lot of people, including medical practitioners, call a grade 1 calf tear a "calf strain". For the purpose of clarity in this article, I want to create a specific definition of a calf strain. This is a very important distinction that you need to understand in order to be able to diagnose and treat yourself correctly.
Definition: A "calf strain" is a nerve related muscle dysfunction.
A calf strain is felt as a strong cramping sensation that is usually felt down the length of the muscle, rather than across it. It can come on suddenly over the course of 2 - 3 steps and can feel like quite a sharp pain rather than just a cramp. A calf strain usually occurs about 15 - 40 minutes into a run and is not due to a change in force or acceleration, it "just happens".
This type of calf strain has a significant neural component, meaning that the sciatic nerve (the nerve that runs from your lower back, down through the back of your leg, through your calf muscle, and into your foot) is involved. The combination of a stiff lower back and tight or lazy glute muscles puts stress on the sciatic nerve which means that the calf muscles' ability to contract and relax efficiently is compromised. This causes the muscle to fatigue and eventually strain or "cramp".
HOW DO YOU DIFFERENTIATE BETWEEN A CALF TEAR AND A CALF STRAIN?
This table will help you to diagnose whether you have a "Calf Tear" or a "Calf Strain"
REHAB PROGRAM FOR A CALF MUSCLE TEAR
Calf muscle tears require time and rest in order for the muscle cells to repair.
Once rested for the appropriate period of time you will reach a point where you can walk and complete all normal daily tasks (including walking up and downstairs and slopes) without pain. Once you can function day-to-day with no pain you can start our: 5 Week Calf Tear Rehab Program
REHAB PROGRAM FOR A CALF MUSCLE STRAIN
Nerve related calf muscle strains usually require 10 -14 days rest from running immediately after the strain occurs. If you are unsure when to start running again, you are best to wait 14 days before returning to running.
It is vital that during this 14 day rest from running period that you undertake a proactive rehabilitation program to reduce any lower back tension and to mobilise the sciatic nerve. If you do not eliminate the cause with the appropriate stretches and stability exercises, the calf strain will recur.
Follow the: 4 Week Calf Strain Rehab Program
If you have an un-diagnosed calf strain or tear we do recommend you seek proper medical advice.
Once you have the correct diagnosis, then the above programs are highly effective to get you back running as soon as possible.
Following a proper rehabilitation program will help you build run specific strength, fix your running technique and help identify any underlying issues that may have caused the problem in the first place.