Monday, 16 July 2012

Calf Strain


Calf strain was touched on in my one of my previous posts on consequences of soft tissue injury, however because it such a common injury for runners it’s worth a slightly more in-depth look.

Quite basically the calf muscle has two parts to it: the upper portion consists of the gastrocnemius (these are the power muscles you see in sprinters) and the soleus which is the endurance part of the calf which attaches to the achilles tendon.

The most common site of an acute calf strain is the medial head of the gastrocnemius (upper portion) or the junction between the upper and lower parts ‘the gastro-soleul junction’. They may also occur in the junction between the tendon and muscle (musculotendinous junction).

Onset

Calf strains usually appear during the course of one or two runs and make it impossible to run. These do not warm up and simply get worse. If you have a strain that does warm up it is more than likely to be neural tightness/irritation.

Causes
  •         Increase in intensity (faster interval training)
  •            Increase in volume
  •            Change of training surface (track/road)
  •            Decrease in recovery time (fatigue short and long term)
  •             Poor dorsiflexion (calf range of motion)
  •             Previous injury (calf)
  •             Pronation (amount and rate)
  •             Biomechanics
  •             Neural tightness (are you  ‘wound up’ through the neural structures 

Treatment

As I will always say, you need to find the causative factor involved in the calf strain – calves rarely ‘just go’ for no reason especially in such a repetitive load based sport such as running. There may be more than one factor.

Soft tissue therapy can be applied to focal areas of thickening and increased tone. Gentle joint mobilisation techniques and stretching can be applied to areas of restricted range of motion.  Neural mobilisation and self-guided nerve stretching techniques are often helpful in the recovery from a calf strain to reduce potential fibrosis around a nerve (tethering)

Biomechanics – control of hip/knee/foot is paramount to optimal stability and decreased injury risk. The gait cycle is quite complex and it may be a good idea to have a biomechanical analysis if you have access to this as part of your management. Remember, running is a skill - some pick this up well while others do not.

Just because someone has been running for along time it does not mean they have acquired the skill – you can become efficient at being dysfunctional!

Management

Management relies on identifying the factors that cause the calf problems in the first place.  Let’s look at the possible causes and pair them up with the appropriate treatment options:

  • Increase in intensity  manage appropriate recovery with programming
  • Increase in volume  manage appropriate recovery with programming
  • Change of training surface  monitor surface type
  • Decrease in recovery time  monitor load and employ recovery techniques such as hot/cold therapy and water therapy
  • Poor calf range of motion  soft tissue therapy, joint mobilisation, stretching   
  • Previous injury  soft tissue therapy to areas of focal thickening, maintain neural mobility. Strengthening the area of previous injury will also help with a strong mobile scar
  • Pronation  glute medius and tibialis posterior strengthening, orthoses (podiatrist)     Neural tightness  self guided neural stretching
  • Biomechanics  professional advice/musculoskeletal screening 
Site of strain

Important factors in the prognosis and recovery time are the site of the tear, the size of the tear and the type of tear (longitudinal, oblique, horizontal). Let’s briefly look at these:

The site of the tear is important due to the types of tissues involved and their recovery times. A tear in the musculotendinous junction will involve tendinous and muscle tissue (as the name suggests) recovery time is increased.

The size of the tear is quite obvious - more tissue separation needs a longer healing time as there is more tissue destruction to deal with. The response from an inflammatory point of view will be larger.

The type of tear is extremely important. For example we have seen in our clinic a 15 cm tear in the soleus that was longitudinal in direction with symptoms of mild pain. Conversely a small 3 cm tear in a horizontal direction across different tissue can be extremely painful with a lengthy recovery time. A similar case is likely with a tear in an oblique direction.

The treatment and management of acute calf strains lies in those factors that cause or contribute to the injury.

Until next time,
Jimmy

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