• Lionel Pannunzio PT / SCS

Do you keep pulling your calf ...? Learn more about Calf Muscle Injuries in Adult Soccer Players


Introduction


If you are over the age of 40 and have had a calf strain your risk of sustaining a second injury is really high and without treatment is even higher up to 60 % of chances of having a second injury. Soleus Muscle Injuries may take up to 6-8 weeks to heal sometimes.





Type of Calf Injuries



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


The 3 more common muscles injured in soccer are: soleus muscle, plantaris muscle and Medial Gastrocnemius ( MG)


The vast majority of the injuries are in the Soleus Muscle which is a very large muscle that functions as the powerhouse of the lower leg.


Soleus Muscle

The soleus muscle is located below the gastrocnemius muscle in the calf.

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.

Soleus injuries are very difficult to recover from and may require more time to heal.



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.



Medial Gastrocnemius

A medial Gastrocnemius strain is another common cause of acute onset calf pain with the typical symptom described as pain in the inner part of the lower leg, swelling, bruising, inability to run or jump. This is called “Tennis Leg”



Soleus Muscle, Not your typical Mechanism of Injury...


One can think that muscle injuries happen only with sudden movement like shooting a ball , accelerations or quick change of directions but the calf injuries sometimes occur with a gradual onset which means the muscle injury happens over a period of time and not with one episode.


The typical example is a Soleus strain that happens during warm up or the patient starts feeling a sharp pain the following day to a soccer match without remembering any injury per se.


Steady running or jogging can also trigger a Soleus strain.



Signs of a Calf Injury





Calf Strains: How long Does it take to Heal ?



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.



Soleus Muscle - High Reinjury Rate


If you are over the age of 40 and have had a calf strain your risk of sustaining a second injury is really high and without treatment is even higher up to 60 % of chances of having a second injury.


Because of this high reinjury rate is that you will benefit from recovering under the guidance of a physical therapist to reduce this risk to a minimum and guarantee and successful return to play.


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 Gastrocnemious 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 can I do to help the healing process ?


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 (video 1), 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 (video 2). As soon as tolerated we start with resistance training using bands




Strengthening Phase


The goals of this phase is to start loading the muscle and restore the strength of these powerful muscles progressively


My two 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.


Calf Raises on Step


The goal of this exercises is to continue loading the muscle and to challenge the muscle in the whole length of its fibers.

Adding a step helps to achieve these goals. It is very important you go from one extreme of the movement to the other. Challenge yourself to get to the end of both movements. In this way the scar tissue forming inside the muscle to repair the injury, will align in the line of stress / force and will get stronger in the whole range.

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.




  • 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: 3️ seconds to get to the top position, hold for 2️ seconds, 3 seconds to return to starting position



Return to Play , How and When ...?


Heavy Lifting

The soleus muscle must endure 7-8 times your bodyweight therefore heavy lifting is required to restore the capacity of the calf complex. This is the part that most people neglect or miss, reason why they get re-injured as soon as they return to play.


Field Training

Another common denominator I see in calf injuries is the lack of Field work before allowing players play again .

Besides getting the muscle stronger the Soleus muscle injury will require a progressive return to play program that must include field work.

I like to expose my clients to multiple drills that will challenge the calf complex little by little .

The different components of this stage are accelerations, jumps , quick change of directions, sprinting full speed and kicking / shooting.

The injured player has to demonstrate me they can handle the demands of soccer match before allowing them to play.

Finally the return to play must be in instalments, 15-20 first , followed by two 25-30 minutes and then a full game in a 2-3 week period.

Maintenance and prevention

Once the recovery is completed, I recommend my clients to continue exercising



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




Do you want more information on muscle injuries ?


Click the link below to get access to our PDF E-Book where you'll find valuable information about Muscle Injuries in general and Calf Injuries in Particular


Muscle Injuries in Soccer Players





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