News & Tips
Easter Calf Pain
EASTER CALF PAIN
Autumn is here, calf pain appears. As the weather cools we will see the return of two of our favourite patient groups. The first is the over 35 soccer player and the second the recreational fun runner gearing up for the season.
The most common type of calf pain seen at this time of year is not an acute tear but more a chronic tight overloaded calf. An acute tear is characterised by sudden stabbing pain in the calf when twisting or sprinting, usually pushing off with an extended knee. Whereas an overloaded calf is felt as a progressive tightening of the calf, perhaps halfway through a run or in the second half of a soccer game. Pain and tightness might build so that the activity needs to be stopped, or possibly continued but with ongoing pain. The calf may then be then sore for a couple of days, pain occurring with walking or on stairs. After a few days, it has usually mostly resolved. However, the next time soccer or running is attempted the calf problem will reappear, possibly even earlier in the activity. This can become a vicious cycle.
This article deals with a chronic overload of the calf rather than acute tear, but the reason for the occurrence is often the same.
Background to the overloaded calf:
Easter is a period where there is a rapid increase in activity in our over 35 soccer players, due to a sudden increase in training and games. This in combination with reduced rest periods between games and little preseason fitness training is the perfect storm for a calf overload. These calf issues are generally seen more at the start than at the end of the season as people are fitter to play later in the season.
The calf muscle is more likely to become overloaded due to three factors 1) weakness, 2) sub-optimal biomechanics or 3) rapid increases in training load with inadequate recovery. Often it is a combination of all of these things.
1. Weakness:Sportspeople choose varied ways to increase their fitness. They may add additional runs in the week, run further than previously, add speed work or hills. They may get over-zealous at the gym. These rapid increases in loading can cause problems for the weak calf. A basic assessment of calf capacity can involve a single leg calf raise to fatigue. A basic rule you should be able to do 30 single leg calf raises at a slow pace (3 seconds up, 3 seconds down) before fatigue. If you are unable to do this, calf strengthening should be part of your programme.
2. Biomechanics:Physiotherapists are always looking for biomechanical reasons for calf overload. The list is extensive, and may relate to the feet, knees, hips, and back. It is important to consider the whole kinetic chain when assessing running mechanics. A common finding is reduced gluteal and quadriceps strength whereupon the calf is required to provide too much runningpropulsion. Poor hip stability due to weak gluteals can also result in the calf working as a stabiliser and as well as propulsive muscle leading to fatigue and pain. Changes in running style can also overload the calf. Progression to forefoot running increases calf loading by over 10%. Transitioning to minimalist shoes with a zero drop also results in significant increases in calf load. Altering running technique in this way is not necessarily good or bad, but sufficient time is needed to adapt. Such changes should also not be made at a time of increased training load, e.g., in preparation for a race. Gait analysis and physical examination can highlight significant biomechanical issues, weaknessand tightness. This can serve as the foundation for a strength programme to help you avoid injury.
3. Training load:Suddenly realising it’s Easter, and time to get fit, as the first competition is only two weeks away is not the best approach to pre-season training! Equally, swimming all summer may have helped maintain some cardiovascular fitness, but it won’t prepare you for leaping on to the sports field without some land-based preparation. Of course, maintaining fitness and strength is recommended throughout the year, but we would recommend sports-specific training for any competitive sportsperson at least six weeks prior to playing.
4. Managing the overloaded calf:Recent onset mild calf pain/tightness can sometimes be managed by simply reducing some load i.e., missing one or two games or cutting out the long run and the hills. Treatment of the fatigued calf can include stretching, massage or dry needling to remove knots in the muscle so it can function better. Strengthening exercises are also appropriate. For the more problematic calf overload, more serious strengthening needs to occur. To achieve true strength gains, muscle fatigue needs to be induced by exercises. It can take six weeks to realise those gains. Calf strengthening with weight or a calf raise machine allows traditional strength thresholds to be used. Such as 10 to 15 reps to fatigue 3 to 4 sets two to three times per week. Once the calf is stronger, it also needs to be incorporated into functional exercises, e.g., cutting and weaving for soccer players. Preseason training should include strengthening key running muscles – calves, glutes, quads and core. Runners should increase using the 10% rule, and try not to have more than one hill or speed session per week. Strength and speed gains come slowly, don’t force these changes. We hope you get to stay in the paddock this Easter and don’t end up on the couch with the eggs!!
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