The key to calf injuries is what lies beneath...

INJURY in sport, like life, is not always what it seems. While many of the injuries that we have to treat are straightforward sometimes an injury poses a diagnostic dilemma which requires all the skills and experience of the sports doctor or physiotherapist.

In fact, some sports injury clinics, like ours at Hampden, employ a mix of staff each with a different area of experience and expertise allowing referral between practitioners to give the best care for the injured sportsman or woman.

Knee pain, for example, may result from a problem outwith the knee joint such as from the hip or abnormal foot biomechanics.

Those who have suffered from sciatica will be aware that though the back is the source of the problem the discomfort may be felt down the leg and into the calf.

Indeed, ongoing calf pain, especially with no history of trauma, should always prompt a search for other possible causes for the injury.

The calf is actually made up of a group of muscles, the biggest of which is the gastrocnemius.

They arise from above the knee and become the Achilles tendon which inserts into the back of the heel bone.

Injury to the calf muscles most commonly result from a sudden contraction of the muscle with an increase in tension often following sudden acceleration such a sprinting in athletics or football or lunging as in tennis or squash.

The diagnosis is often straightforward – a sudden sharp pain or tightness in the calf with localised pain and tenderness, swelling and bruising. Following a calf injury pain is aggravated by going uphill (or up stairs), running or standing on tip-toe. A good clinical examination will confirm the diagnosis with ultrasound or MRI scanning used where the signs are less clear.

The key to the treatment of a calf injury is a graduated physiotherapy programme but it is also important to look for any underlying causes, which if not corrected, will lead to reoccurrence.

Remember pain is an important warning symptom which makes sure we don’t return to activity too early. Early use of ice, compression and elevation with anti-inflammatory medication if tolerated is recommended.

The use of a heel raise will minimise excessive stretch of the healing muscles.

We have recently installed one of the anti-gravity treadmills at Hampden which allows clients to exercise on the treadmill with a significantly reduced impact – speeding up the rehabilitation and allowing a quicker return to sport.

With appropriate management calf tears will normally heal in two-six weeks depending on the degree of damage – complete tears can take up to six months.

As discussed earlier it is important to look above and below the injured part – assessing the foot or back in the case of a calf strain.

Could it be that that nerve irritation in the lower back may be resulting in what is called referred pain to the calf?

As you will imagine it is sometimes difficult to persuade someone with calf pain that the source of the pain is actually in their back!