Continuing on our series of common sports injuries, we review calf sprains and related injuries.
Calf injuries are common in sports that involve jumping or a sudden take off.
This covers most running sports but particularly tennis, basketball and football have a high incidence of calf injuries.
The calf complex is formed by the group of muscles at the back of the calf that allow us to tip toe and take off into a sprint from a standing position.
It comprises two muscles, the soleus and the gastrocnemius, with the latter being in two parts.
Injuries involving the calf complex can be divided into those that involve the gastrocnemius muscle primarily or the Achilles tendon formed when the two muscle groups join to form a common tendon at the heel.
Gastrocnemius injuries may be described as sprains, partial tears or complete tears. There is often a sharp pain in the calf and an inability to continue playing.
There may be swelling depending on the extent of injury.
The management for sprains and partial tears involves a period of rest followed by a gradual return to activity as long as there is no pain.
A heel raise in the shoe may be required for a short period and is useful to ease the pain before stretching is commenced.
The stretching and strengthening phase typically takes six to eight weeks before it is safe to return to sports.
A similar approach is used for complete tears of the gastrocnemius but there is a longer period of protected rest before beginning the stretching.
Complete tears may also lead to bleeding in the calf which occasionally requires urgent surgical intervention to remove the blood clot.
Moving down the calf to the achilles tendon, we frequently see sports enthusiasts suffering inflammation in the tendon.
This Achilles tendonitis is commonly seen in track athletes or people who engage in sports involving a lot of running.
The other end of the spectrum is individuals who only occasionally take part in sports and over do it (weekend warriors).
The discomfort is normally felt closer to the heel and is worse during the activity.
Managing Achilles tendonitis involves refraining from the aggravating activity followed by a period of rest.
A gradual stretching programme, called eccentric stretching, is then started and only when pain free should a return to play be contemplated.
Achilles tendonitis is unpredictable in recovery and often prolonged physiotherapy is required before one is able to return to their pre injury level of activity.
For most calf sprains and Achilles tendonitis, steroid injections should be avoided as there is a risk of suffering a catastrophic tendon tear.
When considering calf injuries and tendon inflammation it is also important to consider the Achilles tendon rupture.
This is an acute traumatic event where the tendon ruptures as one is attempting to spring off the toes.
Individuals describe feeling like they have been kicked in the back of the calf and are unable to continue playing and have a limp.
These injuries require urgent medical attention as treatment often depends on how soon one is managed.
These injuries can be managed both surgically and non-surgically depending on the discussion between surgeon and the athlete.
Recovery from an Achilles tendon rupture is normally nine to 12 months with up to 18 months before pre-injury level of activity is achieved.
Although not strictly in the calf, it is also important to briefly consider a rare entity which is exertional compartment syndrome.
The affected athletes, usually runners, complain of pain on the outside of the calf during exercise.
There is a burning pain during running which may be associated with numbness and weakness in the foot.
The pain is relieved by a short rest but steadily gets worse with time. Though a rare cause of calf pain it is often misdiagnosed leaving the athlete or the individual with poor function and frequent pain.
The management starts with physiotherapy and activity alteration aiming for a steady build up to the desired functional level.
If physiotherapy does not resolve the symptoms, a consultation with an orthopedic surgeon is indicated to consider releasing the constricting tissues.
Avoiding calf injuries depends greatly on strengthening and stretching the calf muscles and also managing the intensity and amount of training.
A tight calf complex, which is often seen in our athletes and sports players, is a risk factor and means a stretching program should be part of the daily routine.
It is important to take a break from sports when one experiences sprains or constant inflammation as this is can be a warning sign of an impending tendon or muscle rupture or it may lead to chronic tendon inflammation (tendinopathy).
When trying a new sport, one should gradually build up to it as the new stresses and strains may lead to tendon inflammation and in the worst case scenarios tears.
Physiotherapy is important and should be started early when faced with calf pain to avoid the more devastating injuries.