Neal Reynolds has worked as physiotherapist to Premiership and England International teams. Here he discusses how a full time professional team might approach the initial treatment of calf strain injuries.
With calf strains you need to look at the mechanism of how they do it. This is not always clear with calf strains. It can be just jogging, or can be jumping or sprinting.
The first thing to do after a calf strain is to apply the PRICE protocol. Protection; rest; ice; compression; elevation. Straight away you should use ice and a compression bandage, often before even assessing the injury. This is done for 20 minutes.
Then an assessment takes place. There is a big difference between tearing the Gastrocnemius and Soleus muscles. The Gastrocnemius is more pin-pointed pain. The Soleus is more of an ache when walking in the lower end of the calf.
This injury does need protecting as everytime they walk they use the calf muscles quite a lot and it will be sore everytime they try to walk. It can take a week or 10 days to be able to walk pain free again. Neal doesn't recommend doing any strengthening until after it is pain-free to walk.
Ice and compression should be continued for a couple of days every 2 hours for 20 minutes. After this, hot and cold can be used to flush out the muscle and then electrotherapy such as ultrasound and laser.
Sports massage can be used in the form of light effleurage to help flush out the muscle. You shouldn't be trying to break down the very immature scar.
Calf muscles can be very troublesome because they are used do much in walking around, that it is difficult to rest them thoroughly.
Stretching can begin once it is pain free. With the Soleus this is done with a bent knee and for Gastrocnemius a straight knee. It is much easier for a patient to stretch it themselves rather than the therapist stretching it for them.
Calf strains react really easily so it is important that all exercises are pain free. The next stage is going up and down stairs where the calf is loaded even more. Neal doesn't worry too much about the strengthening side of things as the calf is continually loaded when walking. He would work on eccentrics later on - a calf raise with the focus on the down stage.
In the later stages, again the calf is different to other muscle tears. Jogging is harder, than for example sprinting, especially for Soleus muscle tears. Once you are past jogging you are pretty much there.
In the gym, plyometrics and jumps etc can be performed as a test to make sure they are ready to jog. If they can hop 50 times on the injured leg without pain, then they are ready to jog. Neal advises to hold back off the running as soon as possible and once this is painfree, everything else comes pretty quickly.
Testing outside is more about endurance, making a rehab session a lot longer. This tends to be when a calf tear happens, in endurance events, when the muscles are tired.
Calf injuries do reoccur quite often, usually because people do too much too soon. People often complain of an ache, which actually means the muscle isn't right, but it is often ignored. But ignoring it and carrying on results in the development of a hard lump of scar tissue which prevents the muscle acting as normal and is difficult to break down with massage.
Calf strains usually occur during endurance events, although often quite early on in the competition. This shows that a warm-up is very important. There are two muscles in the calf which stretch differently. It is important to target both, so stretch once with the knee straight and again with it bent. Warm-down is just as important as the calf muscles are often sore or painful the next day.
Strength in the calf muscles is important, using calf raises as a strengthening exercise can help prevent the injury. However, few people actually have 'weak calves' as we use them all the time. Injuries are usually more related to not performing a good warm-up, or fatigue or tiredness in the muscle from a previous game.
The overall condition of the calf is more important than the individual strength, when it comes to preventing calf injuries.