Calf Pain

Calf pain is a common complaint among runners of all ages but is most frequent in masters athletes. Calf pain affects many athletes and occurs commonly in runners.

Causes

Calf pain arises from numerous etiologies including vascular, neurologic, skeletal, and musculotendinous sources. Calf pain in runners usually results from musculotendinous origins, with the gastrocnemius among the most common of all muscle injuries.

Symptoms

• A sudden pain is felt in the calf, and the patient often reports an audible or palpable "pop" in the medial aspect of the posterior calf, or may have a feeling as though someone has kicked them in the back of the leg.
• Substantial pain and swelling usually develop during the following 24 hours.

Physiotherapy treatment aims:

• to limit bleeding
• pain
• prevent complications.

Physiotherapy management for calf pain

• Tape or a compressive wrap can be applied and the leg elevated where possible. 
• Conservative treatment includes gentle passive stretching, isometric then moving onto concentric exercises. In the latter stages, massage and electrotherapy can be used. 
• If major bleeding has occurred, the use of NSAIDs has to be carefully controlled as they have an anti-platelet effect which can increase bleeding, just as the premature application of heat and massage also can. 
• Gentle passive stretchingexercises without pain to maintain range of motion in the plantar flexors.  In the latter stages, once inflammation has resolved, applying superficial heat simultaneously with a low load static stretch improves the flexibility of muscles. 
• Isotonic exercises for the antagonists tibialis anterior, and the peronei are recommended as well as light exercises for the injured muscle. Gentle movements, within pain limitations, in the first few days following injury will help to promote healing, 
• Shoes with a low heel are recommended to encourage improved heel-toe gait.
• When the calf muscles can be fully extended pain free, a switch can be made from gentle passive stretching to active stretches, in both a flexed knee position (soleus) and a straightened knee position (gastrocnemius).
• Gradual loading/strengthening exercises of the calf muscles should be given in order to have a full recovery. The sooner loading exercises are commenced the more rapidly recovery will be.
• Return to sport and specific plyometric exercises should be commenced before full return to sport.                                                                                                      

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