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  • Lionel Pannunzio PT / SCS

Calf Injuries in Adult Soccer Players | Weston | Florida


Introduction


A‌ ‌calf‌ ‌strain‌ ‌is‌ ‌an‌ ‌injury‌ ‌to‌ ‌the‌ ‌muscles‌ ‌in‌ ‌the‌ ‌calf‌ ‌area‌ ‌(the‌ ‌back‌ ‌of‌ ‌the‌ ‌lower‌ ‌leg‌ ‌below‌ ‌the‌ ‌knee).‌ ‌


Calf injuries are among the most common muscle injuries in the sports of Soccer. What makes this injury very tricky is its high rate of re-injury. If it is not treated right in first time, this muscle injury can linger for months preventing players from playing soccer .





Anatomy‌ ‌of‌ ‌the‌ ‌Injury‌ ‌

A‌ ‌calf‌ ‌strain‌ ‌is‌ ‌an‌ ‌injury‌ ‌to‌ ‌the‌ ‌muscles‌ ‌in‌ ‌the‌ ‌calf‌ ‌area‌ ‌(the‌ ‌back‌ ‌of‌ ‌the‌ ‌lower‌ ‌leg‌ ‌below‌ ‌the‌ ‌knee).‌ ‌ The‌ ‌calf‌ ‌muscle‌ ‌is‌ ‌actually‌ ‌composed‌ ‌of‌ ‌up‌ ‌to‌ ‌9‌ ‌separate‌ ‌muscles,‌ ‌any‌ ‌of‌ ‌which‌ ‌can‌ ‌be‌ ‌injured‌ ‌individually‌ ‌or‌ ‌together.‌ ‌

The‌ ‌gastrocnemius,‌ ‌soleus,‌ ‌and‌ ‌plantaris‌ ‌muscles‌ ‌attach‌ ‌onto‌ ‌the‌ ‌heel‌ ‌bone,‌ ‌and‌ ‌work‌ ‌together‌ ‌to‌ ‌produce‌ ‌the‌ ‌downward‌ ‌motion‌ ‌of‌ ‌the‌ ‌foot.‌ ‌


The‌ ‌other‌ ‌6‌ ‌muscles‌ ‌cause‌ ‌knee,‌ ‌toe,‌ ‌and‌ ‌foot‌ ‌movements‌ ‌in‌ ‌different‌ ‌directions;‌ ‌these‌ ‌muscles‌ ‌are‌ ‌the‌ ‌popliteus,‌ ‌flexor‌ ‌digitorum‌ ‌longus,‌ ‌flexor‌ ‌hallucis‌ ‌longus,‌ ‌tibialis‌ ‌posterior,‌ ‌and‌ ‌the‌ ‌fibularis‌ ‌(or‌ ‌peroneal)‌ ‌longus‌ ‌and‌ ‌brevis.‌ ‌They‌ ‌extend‌ ‌from‌ ‌the‌ ‌lower‌ ‌leg‌ ‌bones‌ ‌around‌ ‌the‌ ‌sides‌ ‌of‌ ‌the‌ ‌ankle‌ ‌and‌ ‌attach‌ ‌to‌ ‌various‌ ‌parts‌ ‌of‌ ‌the‌ ‌foot‌ ‌and‌ ‌toes.‌ ‌

Calf‌ ‌strains‌ ‌are‌ ‌a‌ ‌well-known‌ ‌problem‌ ‌for‌ runners,‌ soccer‌ ‌and‌ ‌basketball‌ ‌players,‌ ‌ gymnasts,‌ ‌and‌ ‌dancers‌ ‌

A‌ ‌calf‌ ‌strain‌ ‌is‌ ‌caused‌ ‌by‌ ‌overstretching‌ ‌or‌ ‌tearing‌ ‌any‌ ‌of‌ ‌the‌ ‌9‌ ‌muscles‌ ‌of‌ ‌the‌ ‌calf.‌ ‌

The‌ ‌muscles‌ ‌usually‌ ‌affected‌ ‌are‌ ‌Gastrocnemius‌ ‌or‌ ‌Plantaris‌ ‌


Calf‌ ‌Strains‌ Statistics‌

Although‌ ‌studies‌ ‌documenting‌ ‌the‌ ‌injury‌ ‌rates‌ ‌of‌ ‌calf‌ ‌muscle‌ ‌tears‌ ‌are‌ ‌no‌ ‌so‌ ‌great,‌ ‌a‌ ‌5-year‌ ‌study‌ ‌of‌ ‌European‌ ‌soccer‌ ‌players‌ ‌revealed‌ ‌that‌ ‌12%‌ ‌of‌ ‌the‌ ‌muscle‌ ‌injuries‌ ‌sustained,‌ ‌were‌ ‌injuries‌ ‌to‌ ‌the‌ ‌gastrocnemius‌ ‌muscle,‌ ‌and‌ ‌the‌ ‌gastrocnemius‌ ‌was‌ ‌categorized‌ ‌as‌ ‌one‌ ‌of‌ ‌the‌ ‌top‌ ‌five‌ ‌muscles‌ ‌injured.‌ ‌(Armfield‌ ‌D,‌ ‌et‌ ‌al.‌ ‌Sports-related‌ ‌muscle‌ ‌injury‌ ‌in‌ ‌the‌ ‌lower‌ ‌extremity.‌ ‌Clin‌ ‌Sports‌ ‌Med.‌ ‌2006;25:803–842.)‌



Causes and Symptoms

Calf strains can occur during hi-speed motions like running and jumping, or from any type of forceful or uncoordinated movement.

What happens is that the Calf is overstretched causing the tear or strain of the muscle fiber. This injury can be attributed or be related to

  • Poor running mechanics.

  • Improper warm-up.

  • Inappropriate training loads.

  • Lower back pathology or increased tightness in your posterior chain of muscles ( lower back, hamstrings and calf muscles )

  • Fatigue

  • Age Middle-aged or older patient, usually over the age of 40, often present with lower leg muscle injuries following strenuous exercises.

Symptoms



  • Sharp pain or weakness in the back of the lower leg.

  • A throbbing pain at rest with sharp stabs of pain occurring when you try to stand or walk.

  • A feeling of tightness or weakness in the calf area

  • Spasms (a gripping or severe tightening feeling in the calf muscle).

  • Sharp pain in the back of the lower leg, when trying to stretch or move the ankle or knee.

  • A “pop” or hear a “pop” sound at the time of injury (with a Grade 3 calf strain).

  • Weakness in the calf when trying to walk, climb stairs, or stand.

  • Limping when walking.

  • Difficulty performing daily activities that require standing and walking.

  • An inability to run or jump on the affected leg.

  • Bruising: When muscles are strained or torn, muscle fibers and other cells are disrupted and bleeding occurs, which causes bruising. Within a few hours of the injury, swelling can occur, causing the injured area to expand and feel tight and stiff.




Common Calf Strains

A calf strain is caused by overstretching or tearing any of the 9 muscles of the calf.


The muscles usually affected in Soccer players are Gastronemius or Plantaris

1 . Gastronemious Strain

A medial Gastrocnemius strain is the most common cause of acute onset calf pain with the typical symptom described on previous post: pain in the inner part of the lower leg, swelling, bruising, inability to run or jump.

2. Plantaris Muscle Rupture

The plantaris muscle is a thin muscle that runs along the gastrocnemius muscle but is only a fraction of the size. When the plantaris muscle ruptures, often as a result of lunging forward, a sudden, snapping pain in the back of the leg is felt. Swelling and bruising in the back of the leg may occur, along with cramping of the calf muscle.

3. Soleus Muscle Strain

The soleus muscle is located below the gastrocnemius muscle in the calf. Straining of the soleus muscle is commonly a chronic injury that occurs less common in soccer and more frequently in long-distance runners. The pain is often reported as a deep soreness or tightness in the calf that can be reproduced when bending the knee and dorsi-flexing the ankle (pulling your toes back toward your shin) at the same time.








Types of Calf Strains and Healing Time





Calf Strains are graded according to the amount of muscle damage that has occurred:


Grade 1

A mild or partial stretch or tearing of a few muscle fibers. The muscle is tender and painful, but maintains its normal strength. Use of the leg is not impaired, and walking is normal.

Grade 2

A moderate stretch or tearing of a greater percentage of the muscle fibers. A snapping or pulling sensation may occur at the time of the injury and after the injury. There is more tenderness and pain, noticeable loss of strength, and sometimes bruising. Use of the leg is visibly impaired, and limping when walking is common.

Grade 3

A severe tear of the muscle fibers, sometimes a complete muscle tear. A “popping” sound may be heard or felt when the injury occurs. Bruising is apparent, and sometimes a “dent” in the muscle where it is torn is visible.



Time of Healing for Calf Strains

Depending on the severity of the injury, the healing time could be from 1-2 weeks to 1-2 months at times.


As usual with these muscular injuries, healing time does not mean rest. For the contrary, pushing the muscle to the limit of tolerance ( guided by mild pain or discomfort ) is the best path to create a strong and flexible scar tissue strong enough to tolerate the high demands of soccer. The calf muscles create a lot of power to sprint and jump.


Before return to play after a calf strain you must be sure that you have restored not only the range of motion of the ankle and knee, the strength of the Gastrocnemius and soleous but also you have training the injury to tolerate high speed running and jumping on the injured leg otherwise you are setting yourself up for a re-injury.





What to do if you suffer a calf strain?


Treatment



Physical‌ ‌therapists‌ ‌treat‌ ‌individuals‌ ‌with‌ ‌calf‌ ‌strains‌ ‌by‌ ‌reducing‌ ‌pain,‌ ‌restoring‌ ‌muscle‌ ‌strength‌ ‌and‌ ‌ flexibility,‌ ‌and‌ ‌increasing‌ ‌their‌ ‌recovery‌ ‌speed.‌ ‌


Acute Phase - Early Strengthening






Acute Phase (1st week aprox.): The goals of this phase is to control pain and inflammation and to start moving the injured fibers as tolerated.

Reduce Pain.

Including ice for 1st 1-2 days , also ultrasound, electricity, taping, heel lifts, and hands-on therapy.


Improve Motion.

Gentle Range of motion exercises as tolerated: I like Gastrocnemius activation with ankle pumps , first with the knee in flexion to relax the calf muscle and allow more ankle excursion and then with knee straight to challenge more the injured fibers inside the muscle.

Improve Strength.

Band resisted Calf exercises.

As soon as tolerated we start with resistance training using bands for plantar flexion and Gastrocnemius Strengthening.

Soleus Exercise: As soon as tolerated we start with resistance training using a light weight to resist this muscle contraction and promote healing.





Strengthening Phase




Strengthening Phase: The goals of this phase is to start loading the muscle and restoring the strength of these powerful muscles progressively My favorite exercises are:

Weight Bearing Isometrics Bilateral

Setup Begin in a standing upright position with your hands resting in front of you on a wall. Movement Slowly raise your heels off the ground and hold that position



Weight Bearing Isometrics Single Leg

Setup Begin in a standing upright position with your hands resting in front of you on a wall. Movement Bend one knee up to 90 degrees, then raise your other heel off the ground and hold that position


Gastrocnemius Resistance Training - Bilateral

Setup Begin standing at the edge of a step with your heels hanging off the edge. You may hold onto a stable object for support. Movement Raise up onto the balls of your feet, then slowly lower your heels down off the edge of the step and repeat.

Tip Make sure to maintain your balance during the exercise. Keep your movements slow and controlled. Use the following pace: 3 seconds to get to the top position, hold for 2 seconds, 3 seconds to return to starting position .




Soleus Strengthening






Another crucial component of the rehabilitation process after a calf strain is the Soleus Muscle, very important because of its function as the powerhouse of the calf musculature. Soccer requires repetitive sprints throughout the game.


The force generated by your body during these high intensity activities must be absorbed and dissipated by your muscles, joints and tendons .


A 2012 study measured the peak forces generated by your lower extremity muscles during running at different speeds. (Mechanics of the Human Hamstring Muscles during Sprinting. Schache AG1, Dorn TW, Blanch PD, Brown NA, Pandy MG. Med Sci Sports Exerc. 2012 Apr;44(4):647-58).


They found that the SOLEUS muscle works hard to make you run fast and to absorb your bodyweight at the same time. For example at 25 km/hr the Soleus is generating a force of 8.7 times your body weight while the gastrocnemius only 3.23 times your bodyweight. So it is more than clear that strengthening your Gastrocnemius only will only take you ⅓ of the road to your recovery and that Soleus strengthening is mandatory when recovering from a Calf Strain

Also from the same study we can infer that Soleus Strengthening should be part of every program to rehabilitate muscles injuries of any type in your lower extremities. So do yourself a big favor and start thinking 𝐒𝐎𝐋𝐄𝐔𝐒.



How to train the Soleus ?


Setup Begin standing on a small step or platform with your heels off the edge, holding onto a stable object for balance.


Movement Bend your knees, then raise both heels up, and then lower down slowly


Tip

Make sure to maintain your balance during the exercise. Keep your movements slow and controlled.

Use the following pace: 3 seconds to get to the top position, hold for 2 seconds at the top, 3 seconds to return to starting position.

In the video I show them using a weighted vest but you should start with your own body weight and progress to a vest or backpack once you can knock down 10-12 good quality repetitions.





Conclusion:


  • Calf muscles are very common in Soccer players.

  • Healing time depends on the severity on the injury but usually 3 to 6 weeks is a good estimate

  • Resting for 3-6 and returning to play will not help . You need to restore the size, strength and power of the calf musculature. Use the videos above as guidance for training

  • Be sure you work on Gastrocnemius strengthening

  • A good return-to-play training with field work is mandatory if you want to avoid another injury



Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries. With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located  in the beautiful City of Weston, where he treats Soccer Player, Runners and Athletes of all ages

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Lionel Pannunzio

Physical Therapist

Board-Certified Sports Specialist

Owner of White Bay Physical Therapy

“Keeping Athletes in the game”



If you want more information about soccer injuries we sure to take a look at our blog archives with plenty of useful information for soccer players




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