The mainstay of successful calf muscle rehabilitation following a strain is a progressive strength program targeted at both increasing and optimising the load capacity of the calf musculature. Be sure to make and go to all appointments, and call your doctor if you are having problems. The Thompsons test has been shown to have a 96% sensitivity and 98% specificity with regards to detecting achilles tendon ruptures (8). Calf strains can occur to any runner. The exercises may be suggested for a condition or for rehabilitation. The  higher number represented a higher degree of muscle strain; minor, moderate, and complete injury. 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Skip to content. The runner’s goals, possible event timelines and preferences. Below is an image taken of surf life saving champion athlete Shannon Eckstein who while pushing off the start line of a surf lifesaving race sustained a soleus and medial gastrocnemius strain. Updated reliability and normative values for the standing heel-rise test in healthy adults. Additional suffixes are added for the ‘site’ of injury as follows: British Athletics Muscle Injury Classification also uses an additional descriptor included in the classification to denote the site of injury (proximal, central or distal third) relative to the muscle origin. The image below illustrates the large peak muscle force that the soleus generates as a multiple of body weight 6.5-8x body weight, with the gastrocnemius also generating large peak muscle forces of 3.5-4.0x body weight. ‘Calf strain’ is the common terminology runners use when describing a calf muscle ‘tear’. After two or three weeks of applying ice and heat treatments, you can start to use exercises for calf muscle strain. The purpose of these three tendinous structures in the soleus is to act like rigid fibrous ‘struts’ to assist the upper part of the soleus to gain more origin (1). Hébert-Losier K, Wessman C, Alricsson M, Svantesson U. However this is not the case. Runners of all abilities: beginner, recreational, recreationally competitive, and the elite, can incur a calf strain. This is also an early-stage rehab exercise as it can be done with no weight at all, to begin with, if necessary. I often say you don’t want to be too conseravtive or too reckless-however aiming for the ‘middle ground’ can be a good strategy. A calf muscle strain can occur to either of the two primary ‘calf muscles’; the soleus or the gastrocnemius (see anatomy images below): (i) soleus muscle                                      (ii) Gastrocnemius (medial and lateral heads). To progress from jumping up and down, add in moving forwards with the jumps, start small initially and add distance, before progressing to a single leg, Prescription may include: 3-4 sets of 6-10reps. A Guide for Runners: What Is Keto and Should You Try It? The book needs to be thick enough so that you can feel a gentle stretch in each calf. This can also be the case with returning to initial running. Calf Strain Rehabilitation Exercises You can begin gently stretching your calf muscle using the towel stretch right away. Of course the more deconditioned a runner becomes through injury the longer timeframe required to return to full training loads. Calf strain exercises to be done as part of a torn calf muscle rehabilitation program. The assessor needs to monitor quality of movement (any compensation strategies eg bending the knee, rolling onto outside of foot, rocking the body forwards to generate momentum) and symmetry side to side. Introduction. In my clinical experience most runners will not require or benefit from imaging to the region (ultrasound or MRI). Runners tend to clump the two superficial muscles together; the soleus and gastrocnemius and collectively refer to these two muscles as the ‘calf’. Pain on this test may implicate the gastrocnemius (vs soleus). Prescription:. Note that these are high levels of strength. Delgado GJ, Chung CB, Lektrakul N, et al. Rather progressing will depend on the runner/therapist doing so based on clinical criteria being set and assessed against. Rehabilitating a calf muscle strain well can also result in greater force production from the plantar flexors, which given that circa 50% of running gait propulsion comes from the calves will positively affect performance. Common symptoms of a calf muscle injury A calf strain injury may cause immediate pain and the sensation of being struck or kicked on the back of the calf. As prior outlined there is a higher prevalence of calf strains for male runners (5). The slide below from Dr Rich Willy’s presentation at the 2018 La Trobe Running Symposium outlines the changes that happen at the calf between 20 and 60 years of age. You will be told when to start these exercises and which ones will work best for you. This can be done initially on examination of the injured runner who has just sustained a calf injury (if tolerated) or as rehabilitation commences and progresses. Home based exercise has the benefit of low barriers to completion and are good for restoring some early load tolerance to the affected tissue. This too conservative approach can be the work of the supporting therapist or the runners themselves. calf rehab exercises STANDING DOUBLE LEG CALF RAISE TEST. Skipping is an often underrated exercise for runners-and can be very beneficial for runners rehabilitating calf strains. Hold the stretch for at least 15 to 30 seconds. If the runner cannot tolerate single leg testing then double leg testing can be used. Ease off the exercises if you start to have pain. Malliaras in his Mastering the Lower Limb Tendinopathy workshop cites a target of 1.0-1.5x body weight as external load. This reduction in confidence can manifest as fear avoidance of running, fear of loading the calf musculature through required rehabilitation exercise, and prolong recovery timelines. This is the beginning of the next stage of calf strain rehab exercises, as the use of resistance starts. The aim of toe taps is to remain as high on the toes as possible between reps and now drop down with height. Once strength deficits are addressed the recurrence of strains tends to drop off or be completely ameliorated. For runners the injury more frequently arises during faster interval training, racing, or high-speed tempo runs. Adobe Acrobat Reader is required to read PDFs. While being able to complete body weight exercises eg calf raises is a key part of successful calf strain rehabilitation, a common failing I observe in clinical practice is not progressing gym rehabilitation to hard enough levels. These can be performed as single leg calf raises initially to isolate the musculature and give the runner an appreciation of any side to side differences that may exist. Return to the starting position, with your feet even with the step. Step forward with your unaffected leg and place your hands on your thigh for balance and support. From years of clinical observation on assessment the runner who has been experiencing ongoing calf strains will typically have a deficiency in their plantar flexor (calf) strength. They are: The successful rehabilitation of calf strains for runners involves the following stages: The stages are not mutually exclusive, and progression to the next stage is not time dependent. Simply walk around up on the toes with emphasis of weight going through the 1st and 2nd toes. Prescription can vary however a good starting option may be: Week 1 3 walk/runs: 30s (jog/run), 4.5mins walk repeated for 30mins, Each week add 30s of run time while decreasing walk time by 30s, By week 9 30mins of continuous running will be achieved, The above program is quite conservative -there are many instances in practice where I will prescribe larger initial running periods and smaller walking periods for example commencing with 2-5min run times. Keep your knees straight, and lean forward until you feel a stretch in each calf. Start each exercise slowly. A great resource that expands upon the above diagram is a video produced by Kevin Maggs of Running Reform which can be viewed below: In simple terms when the task being performed by the runner exceeds the tissue tolerance or capacity of the calf musculature a strain or injury may result.