Calf injury or pain is a common occurrence in sports, including running, jumping, hopping, and landing. Your calf muscle group primarily consists of two muscles (gastrocnemius and soleus) attached to your Achilles tendon. Achilles tendinopathy or ruptured Achilles tendons are commonplace but successfully treated.
Calf injuries can occur in both muscle and tendon structures. Excessive forces commonly cause damage during explosive contraction, eccentric control loading or when your calf muscles fatigue. Calf muscle tears are prevalent.
Your calf muscles protect your shin bone from the rear and both sides. However, excessive load through your shin bone (tibia) can result in shin pain and related injuries. Shin pain and injury is prevalent in loading bearing sports.
For specific information regarding your calf pain, please seek the advice of your physiotherapist.
Referred Calf Pain
Calf pain is a common symptom of referred pain, e.g. Sciatica.
Sciatica is a condition caused by a pinched nerve in your lower back. Fortunately, Your physiotherapist can usually treat it successfully with physiotherapy. The occasional patient requires spinal surgery.
Deep Venous Thrombosis (DVT)
DVT’s are the most severe concerns and can result in pulmonary embolism (PE), stroke or potentially death! Your calf assessment should exclude the possibility of a DVT as an URGENT PRIORITY.
Symptoms and signs of Calf DVT include:
- Calf swelling & pain
- Redness & Warmth to the touch
- Worsening leg pain when bending the foot and toes backwards.
- Leg cramps (especially at night or in the calf)
- Skin discolouration
Risk factors for DVT/PE include:
- Prolonged sitting or immobility
- Recent surgery
- Recent trauma to the lower body
- Heart attack or heart failure
- Pregnancy or recent childbirth
- High Altitudes
- Oestrogen therapy or birth control pills
- Advanced age
- Medical conditions that affect the veins
If you suspect a DVT or PE, please urgently consult your doctor or physiotherapist to assess and exclude a DVT or PE.
Calf Pain Treatment
With accurate assessment and early treatment, most calf pain responds quickly to physiotherapy treatment, allowing you to promptly resume pain-free and healthy daily living activities.
Please ask your physiotherapist for their professional treatment advice.
Calf Pain FAQs
Tendinopathy (tendon injuries) can develop in any tendon of the body. You may have heard of tendinopathies referred to as its aliases: tendonitis, tendinitis, tenosynovitis and tendinosis. In simple terms, they are all tendon injury pathologies, so the medical community now refers to them as tendinopathies.
Typically, tendon injuries occur in three areas:
- tendon insertion (where the tendon attaches to the bone)
- mid-tendon (non-insertional tendinopathy)
- musculotendinous junction (where the tendon attaches to the muscle)
What is a Tendon Injury?
Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to occur suddenly, but usually, it is the result of repetitive tendon overloading. As mentioned earlier, health care professionals may use different terms to describe a tendon injury. You may hear:
Tendinitis (or Tendonitis): This means "inflammation of the tendon".
Mild inflammation is actually a normal tendon healing response to exercise or activity loading, but it can become excessive, where the rate of injury exceeds your healing capacity.
The inability of your tendon to adapt to the load quickly enough causes the tendon to progress through four phases of tendon injury. While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.
1. Reactive Tendinopathy
- Normal tissue adaptation phase
- Prognosis: Excellent.
- Normal Recovery!
2. Tendon Dysrepair
- Injury rate > Repair rate
- Prognosis: Good.
- The tendon tissue is attempting to heal.
- You must prevent deterioration and progression to permanent cell death (phase 3).
3. Degenerative Tendinopathy
- Cell death occurs
- Prognosis: Poor!
- Tendon cells are dying!
4. Tendon Tear or Rupture
- Catastrophic tissue breakdown
- Loss of function.
- Prognosis: very poor.
- Surgery is often the only option.
What is Your Tendinopathy Phase?
It is crucial to have your tendinopathy professionally assessed to identify its current injury phase. Identifying your tendinopathy phase is vital to direct your most effective treatment since certain treatment modalities or exercises should only be applied or undertaken in specific tendon healing phases.
Systemic Risk Factors
The evidence is growing that it is more than just the tendon and overload that causes tendinopathy. People with diabetes, post-menopausal women and men with high central adiposity (body fat) seem to be predisposed to tendinopathies and will need to observe their training loads.
What are the Symptoms of Tendinopathy?
Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.
- The pain may get worse when you use the tendon.
- You may have more pain and stiffness during the night or when you get up in the morning.
- The area may be tender, red, warm, or swollen if there is inflammation.
- You may notice a crunchy sound or feeling when you use the tendon.
The symptoms of a tendon injury can be similar or combined with bursitis.
How is a Tendon Injury Diagnosed?
To diagnose a tendon injury, your physiotherapist or doctor will ask questions about your past health, symptoms, and recent exercise regime. They'll undertake a thorough physical examination to confirm the diagnosis. They will then discuss your condition and devise an individualised treatment plan.
They may refer you for specific diagnostic tests, such as an ultrasound scan or MRI.
Tendinopathies can normally be quickly and effectively rehabilitated. However, there is a percentage of tendinopathies that can take months to treat effectively.
As mentioned earlier in this article, it is important to know what phase your tendinopathy currently is. Your physiotherapist can assist not only in your diagnosis but also guide your treatment to fast-track your recovery.
Before you seek the advice of your physiotherapist or doctor, you can start treating an acute tendon injury at home. To achieve the best results, start these steps right away:
- Rest the painful area, and avoid any activity that makes the pain worse.
- Apply ice or cold packs for 20 minutes at a time, as often as 2 times an hour, for the first 72 hours. Keep using ice as long as it helps.
- Do gentle range-of-motion exercises and stretching to prevent stiffness.
When to Return to Sport
Every tendinopathy is different, so please be guided by your physiotherapist assessment. Be patient, and stick with the treatment exercises and load doses prescribed by your physiotherapist. If you start using the injured tendon too soon, it can lead to more damage and set you back weeks! It may take weeks or months for some tendon injury to heal and safely cope with a return to sporting loads.
To minimise reinjuring your tendon, you may require some long-term changes to your exercise activities. These should be discussed with your physiotherapist. Some factors that could influence your tendinopathy risk include:
- Altering your sport/activities or your technique
- Regular prevention exercises.
- Closely monitoring and record your exercise loads. Discuss your loading with your physiotherapist and coach. They will have some excellent tips.
- Always take time to warm up before and cool down / stretch after you exercise.
While most acute tendinopathies can resolve quickly, persisting tendon injuries may take many months to resolve. Long-term or repeat tendinopathies usually have multifactorial causes that will require a thorough assessment and individualised rehabilitation plan. Researchers have found that tendon injuries respond differently to muscle injuries and can take months to solve or potentially render you vulnerable to tendon ruptures, which can require surgery.
For specific advice regarding your tendinopathy, please seek the advice of your trusted healthcare professional with a special interest in tendinopathies.
Foot & Ankle
- Achilles Tendon Rupture
- Achilles Tendinopathy
- FHL Tendinopathy
- Peroneal Tendinopathy
- Tibialis Posterior Tendinopathy
Hip & Groin
- Shoulder Tendinopathy
- Shoulder Impingement
- Rotator Cuff Calcific Tendinopathy
- Rotator Cuff Tear
- Bicep Tendinopathy
- Swimmer's Shoulder
Wrist & Hand
What is Therapeutic Ultrasound?Therapeutic ultrasound is an electrotherapy modality that has been used by physiotherapists since the 1940s. Via an ultrasound probe through a transmission coupling gel in direct contact with your skin, ultrasound waves are applied. Therapeutic ultrasound may increase:
- healing rates
- tissue heating
- local blood flow
- tissue relaxation
- scar tissue breakdown.
How Could Ultrasound Help?Ultrasound increases local blood flow. This increase may help to reduce local swelling and promote soft tissue healing rates. A higher power density may soften scar tissue.
Specific Ultrasound UsesMastitis or blocked milk ducts successfully respond to therapeutic ultrasound. The effect is quite dramatic, with improvement within 24 to 72 hours. The most common conditions treated with ultrasound include soft tissue injuries such as muscle, ligament injuries or some tendinopathies. Phonophoresis uses ultrasound in a non-invasive way of administering medications to tissues below the skin. This method may assist patients who are uncomfortable with injections. With phonophoresis, the ultrasonic energy forces the drug through the skin.
What is an Ultrasound Dose?A typical ultrasound treatment will take from 3-10 minutes. Where scar tissue breakdown is the goal, this treatment time could be much longer. During the procedure, the head of the ultrasound probe is in constant motion. If kept in continuous motion, the patient should feel no discomfort at all. Some conditions treated with ultrasound include soft tissues injuries such as muscles or ligament injuries, tendinopathy, non-acute joint swelling and muscle spasm.
How Does an Ultrasound Work?A piezoelectric effect, caused by the vibration of crystals within the ultrasound head of the probe creates the sound waves. The ultrasound waves generated then pass through the skin cause a vibration of the local soft tissues. This repeated cavitation can cause deep heating locally though usually no sensation of heat will be felt by the patient. In situations where a heating effect is not desirable, an athermal application occurs. Athermal doses are typical during acute fresh injury and the associated acute inflammation.
When Should Ultrasound be Avoided?Contraindications of ultrasound include:
- local malignancy,
- over metal implants,
- local acute infection,
- vascular abnormalities,
- active epiphyseal regions (growth plates) in children,
- over the spinal cord in the area of a laminectomy,
- over the eyes, skull, or testes
- and, directly on the abdomen of pregnant women. Treatment ultrasound differs from diagnostic ultrasound!
7 Ways to Prevent a Future Leg Injury?You may reduce the chance of leg injury by following these seven simple tips:
- Warm-up before you exercise.
- Warm down when you finish. Warm down usually includes some simple stretching exercises and plyometric drills.
- Wear well-fitting shoes, boots or braces that provide excellent joint support.
- Tape or brace your ankles/knees in high-risk sports such as football, basketball, volleyball and netball.
- Avoid activities on slippery, wet or uneven surfaces, or in areas with poor lighting.
- Strengthen your leg muscles and regularly use a wobble disc or balance board
- Maintain general functional fitness.