Calf muscle tear

The issue for this patient was not the dramatic sniper shot but a rather dull gradual build-up of tightness in the inside of the left calf muscle. This was related to playing badminton specifically but it had been troubling him whilst walking the dog as well over a few weeks.

There was no specific sharp pain but a gradual weakness and ache in the calf as well as a feeling of not trusting it. The patient had previously strained the muscle a few times playing squash but had not had a problem in at least 8 years.

The patient denied any lower back issues but had suffered a disc prolapse 15 years before.

Examination

Examination showed a slightly wasted calf suggesting it was not being used well and had probably not been for some time. The patient was unable to get fully up onto tiptoes on the single leg and could not do more than 10 repetitions before failure. The right could do 20 or so. The lumbar spine was tight to flexion and especially to right side bend and testing neural mobility showed that there was tightness in the sciatic nerve in the left leg.

The calf itself was tender and tight with a specifically very thick lump of scar tissue in the belly of the muscle. This was clearly an old issue which had become acute again. General stability and strength around the foot and calf were poor.

This issue is a combination of lower back tightness and neural irritation as well as an old fibrous, inflexible piece of scarring in a weak muscle. All these elements need to be addressed.

Treatment – evidence base Ref 1 and 2.

We started treatment by mobilising the lower back and sciatic nerve to give the best neural supply to the calf we could. This gives us the best chance of strengthening in the calf, which we also started with a comprehensive program for the patient to work on at home and in the gym.

We also started the manual therapy to the scar tissue to improve its flexibility and elasticity and thus its tolerance for loading.

Strength and tissue change takes 3-4 weeks and the patient was exceptionally diligent with his work at home. The manual therapy was not the most fun part of his day but as the tissue improved the tenderness reduced and tolerance to badminton and walking improved greatly.

The lumbar spine was also improved by a few sessions of mobilisation and, as the patient described, he did not realise just how tight it had gradually become until it was no longer as tight. Gardening became much more enjoyable!

We finished with this patient working on a dynamic hopping and mobility program for the scar tissue and the lower back. The scarring and the lumbar wear and tear cannot be restored to brand new but they can be managed by regular exercise and this will enable the patient to continue to enjoy badminton and walking the dog with all the associated benefits it has for overall health.

The message is really to not allow a simple thing as a tight calf affect your play or health. There are always things that can be done!

Mark Buckingham

Ref 1. The evidence base for the rehabilitation of muscle injuries.

Ref 2. Physiotherapy ideally at 7 days and onwards! Get it seen soon for good repair!