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Sunday, January 25, 2015

Calf Strain: General Treatment Thoughts

Lower Calf Strain
by Richard Blake, DPM

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The lower calf above the achilles tendon is comprised of the big calf muscle fibers (gastrocnemius) and the lower smaller soleus fibers seen more to the side in the photo above but going into the tendon

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The lower calf is the beginning of the merging of the calf muscles (gastrocnemius and soleus) before the start of the achilles tendon

The top 10 treatments for lower calf strains are:

1.   Ice pack or massage for 10-15 minutes three times daily initially, and then following activity that may aggravate.
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2.  Avoid non supported heel positions/activities until the pain resolves and the strength returns (like getting off your seat in cycling, etc, except perhaps the downward dog in Yoga).
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3.  Begin re-strengthening the calf muscles as soon as injured, but avoid negative heel positions. Use theraband resistant bands knee straight and bent first, and after building to 2 sets of 25 reps, begin 2 sided calf raises.

Theraband for soleus strengthening ankle plantarflexed knee bent

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I love starting with 2 sided toe raises (calf raises) but do not drop your heel below the plane of the front of your foot.

4.  Stretch the calf by doing the 3 achilles stretches 3 times daily. Go to YouTube and type drblakeshealingsole achilles stretches and you will find them demonstrated.
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Here the heel is on the ground perfectly for the initial knee straight stretch for the gastrocnemius.

5.  Various forms of taping can help take tension off the muscle
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6.  Deep calf massage is crucial for many calf injuries and 6-8 sessions is typically enough. You can begin this process with massage sticks and rolling pins for self massage. You need to find those trigger points and work them out.
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7.  Avoid barefoot as much as possible initially, and consider heel lifts (¼”) and clogs or stable heels to relax the calf.
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8.   Have your achilles flexibility tested when/if you go to PT since many patients actually have too flexible tendons and should not be stretching.
9.   Create a pain free environment even if a removable boot is necessary. For calf problems, the boot must go to just below the knee and use an EvenUp for the other side.
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10.   If the initial injury had some black and blue (ecchymosis), you should try to get to physical therapy sooner than later to help lessen the overall scarring that can settle in and be stubborn to remove.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.