Calf strain

[injuryupdate]

I recently received this email:

I have recently suffered a gastrocnemius muscle strain virtually identical to the one described in your case report in the Br J Sports Med 2002. I was particularly interested to read that Mr Waugh was able to play in the fifth Test 19 days following the injury. It is now three weeks since my injury and I am far from Test Match fitness.

I wondered if you had any details of how the injury was treated and what physical therapy or rehabilitation methods were employed.

[injuryupdate]

Steve Waugh was able to play quickly after this injury, although he definitely had not fully recovered. He was able to score a century in his return game even though he couldn't take off, by generally hitting the English bowlers for four and not bothering to run. Times may change next time England play Australia and Mr Waugh is no longer part of the team.

It is interesting to note that Chris Gayle of the West Indies has just scored a century at better than a run a ball in South Africa, despite carrying a hamstring strain, and it was reported that he mainly hit boundaries and didn't run due to the hamstring problem.

Steve Waugh has suffered many muscle strains over the past 10 years and this is one of the main reasons why he has gone from being a genuine all-rounder to specialist batsman, because batsman put less load on their muscles than bowlers.

There definitely wasn't any miracle treatment in Steve Waugh's treatment, although he would have had twice daily physio from Errol Alcott and this would have made a difference in recovery time. He had a fairly low grade strain of the calf, even though it was dramatically visible on stump cam. He definitely returned early and in fact also suffered a venous thrombosis on the flight back from the UK to Australia, so it was not an uneventful recovery.

I would suggest a heel raise and once you are walking comfortably, start gradual strengthening exercises and see a physiotherapist. Beware any acceleration movements until you have equal power and stretch compared to the other side. If you are patient it is likely your calf will end up 95%+ as strong as the other side.

[Coxy]

I think I've suffered a calf strain (you all must think I'm the most injury prone idiot in the world!).

I was at Oztag training on Sunday and felt fine, but after cooling down quite a tightness and soreness developed in my calf, about halfway between knee and heel almost completely centred. It was tender to push in on it. Doing a straight leg calf stretch caused very little pain, but a bent knee calf stretch caused a bit of a twinge.

I iced it and stretched it slowly that night and next morning it felt 100%. Was able to walk with no pain and had no discomfort or tightness.

Last night I had to referee and play Oztag. I warmed up as usual, with light jogging and stretching of major muscle groups in the legs, especially the calves. 10 minutes into the first ref game and I felt that tightness in my calf. I was able to run without pain but on stopping it was fairly tight.

Similarly through the game I played some 45 minutes later it was a bit sore but got better as I got warmer and looser as I played.

However, on returning home it got very very tight and sore. I iced it, took some nurofen, wrapped it in an elastic bandage and elevated it.

About an hour later i felt the most excruciating pain I've ever felt in my life. The calf completely spasmed and cramped. It rolled up into a rock hard, tight ball just below my knee and my foot was locked in a downward flexion. It was enough to bring tears to my eyes.

After a few minutes it released itself and the muscle was quivering and trembling and a consistent pain was across the whole muscle. I kept it slightly stretched as that seemed to be the most comfortable position and alternated ice/room temperature/heat for another hour or two and was doing some gentle massage on the muscle as well.

I slept with it elevated and this morning it was just a bit tight, relatively painless until I stretched it too far. I've been able to walk with a normal gait (only a bit of tightness) and I'm carefully stretching it whenever I get up.

It's not too bad.

Scared the hell out of me though.

Sorry for the length of this again. I always ramble.

[Coxy]

Just a bit of a followup on this. Reinjured it two weeks later at Oztag warming up (how embarrassing). Not badly, but enough to be uncomfortable to walk, but relatively pain free to run.

A week later it was still a bit tight but I managed to referee 2 games and play last night. No real twinge in the calf though the achilles tendon in that leg was a bit tender, probably under a bit more stress with the calf feeling a bit tight.

Only thing I'm noticing is that after that much work both my calves quiver and pulsate for a good few hours afterwards. That's despite light stretching to warm down and gentle massage.

Is that normal? Not symptomatic of something more sinister like DVT?

[injuryupdate]

If you are still running you are not a worry from the DVT viewpoint. You still could have a decent calf tear present though. Good chance to keep recurring if you play OzTag and ref when not fully recovered.

[Coxy]

If you are still running you are not a worry from the DVT viewpoint. You still could have a decent calf tear present though. Good chance to keep recurring if you play OzTag and ref when not fully recovered.

Fair enough. Always the way isn't it? Rest is the best treatment.

[PALES750]

I myself have recently developed a similar calf injury. I've been surfing various websites today and they all have the same advice - R.I.C.E and then some strengthening exercises/stretching when you no longer feel pain.

It is definately a rest injury, otherwise you will recur - I had this problem 2-3 years ago and tried to get back early for the start of the soccer season, but ended up missing another 3 weeks........

I have a question though.... would the harder surfaces that players endure for a typical pre-season (ie. hard summer soocer pitches that have had little watering) have any influence on this type of injury? Like I said, this is the second time i've injured my calf and both times it has been during pre-season.

[Rod Whiteley]

A nice review article which should be required reading for all physios (and anyone else who is "going to get you back and ready before anyone else") appeared a little while ago:
Jarvinen, T. A., T. L. Jarvinen, et al. (2005). "Muscle injuries: biology and treatment." Am J Sports Med 33(5): 745-64.
Muscle injuries are one of the most common traumas occurring in sports. Despite their clinical importance, few clinical studies exist on the treatment of these traumas. Thus, the current treatment principles of muscle injuries have either been derived from experimental studies or been tested only empirically. Although nonoperative treatment results in good functional outcomes in the majority of athletes with muscle injuries, the consequences of failed treatment can be very dramatic, possibly postponing an athlete's return to sports for weeks or even months. Moreover, the recognition of some basic principles of skeletal muscle regeneration and healing processes can considerably help in both avoiding the imminent dangers and accelerating the return to competition. Accordingly, in this review, the authors have summarized the prevailing understanding on the biology of muscle regeneration. Furthermore, they have reviewed the existing data on the different treatment modalities (such as medication, therapeutic ultrasound, physical therapy) thought to influence the healing of injured skeletal muscle. In the end, they extend these findings to clinical practice in an attempt to propose an evidence-based approach for the diagnosis and optimal treatment of skeletal muscle injuries.