Case Study – Calf Tear

Introduction & Anatomy

A calf tear is a common injury among the sporting population. The calf muscle that comes to mind at its mention, is the Gastrocnemius muscle. Gastrocnemius is the prime plantar flexor (standing on your tippy toes) of the foot. However it isn’t the only muscle that’s makes up the calf. The Sloeus, Plantaris and Tibialis Posterior muscles underlies it and all have a role in plantar flexion of the foot. Calf tears predominantly occur through ballistic activities such as sprinting and jumping. The musculotendinous junction is a prime place for tears to occur, however not the only one.

Scenario

Mary, a forty-five year old lady came limping into my clinic. She explained that she had torn one of the muscles on her right calf three weeks ago. She described that she was playing squash at the time, and while stretching to reach the ball, she felt a sharp pain at the right side of her right calf. She rested it for a week but then re-injured it by slipping off a step at her house. Her calf and ankle were now quiet swollen, sore to touch and difficult to walk on. She felt concerned, disappointed, angry and unsure as to why this happened all of a sudden. She was really eager to get back playing squash as it was her “only escape from a hectic work life”.

Analysis

After taking a detailed history of her injury, previous injuries, sporting interests, medical history, I discovered that up to a month and a half ago she was playing squash once a week and that since then she had increased her participation to 3-4 times a week.

Through a dynamic assessment which included a load tolerance of the calf complex, hamstrings, glutes and quads, I was able to identify areas of weakness.

Treatment began with some education on training progression and how her sudden jump in training overloaded her system. I then carried out some soft tissue work and mobilisations to help calm the surrounding muscles down.

Following that we went through some isometric (contraction of the muscle with no movement of the joint) exercises. Isometric exercises are usually used in the early stages of a rehabilitation plan as they strengthen the muscle without stressing the joint. They also act as a natural pain inhibitor. This was followed by some non weight bearing ankle movements to help disperse some of the inflammation and get the joint moving.

The key for Mary was to increase her overall strength so that her muscular system would be able to tolerate the demands she puts on it. With this in mind we increased the load we placed on the muscles every week  through target exercises. Our focus was the lower body but also incorporated some upper body exercises to meet the demands of Mary’s sport.

Conclusion

Within a 3 week period, Mary went from limping into my clinic to being a stronger, more confident tennis player. She is back playing tennis twice per week, with a better understanding of how her body works.