Written by David Francis and Samuel Mayes.
A Soleus or a Gastrocnemius strain?
An injury to the calf muscle could be in one of two potential areas: the Soleus or the Gastrocnemius (see diagram).
The Soleus works hard, at low to medium speed, think of it as your “locomotion”, powering your movement.
A tear or strain of the Soleus muscle in the calf is not as commonly diagnosed as a Gastrocnemius strain or tear.
An accurate diagnosis of a Soleus strain is important for prognosis and rehabilitation purpose. Generally a strain of the Soleus muscle will take twice as long to rehabilitate when compared to a Gastrocnemius strain.
An athlete with a Soleus strain may present after a sudden onset of pain, but more commonly after a gradual increase in calf pain or tightness. They may even be able to play out a full game before complaining of symptoms.
Pain from a Soleus strain will often be aggravated during walking and/or jogging, A Soleus strain will typically be felt in the mid to lateral calf, and feel deep in the calf muscles.
On the other hand, a Gastrocnemius strain will usually occur to the medial head of Gastrocnemius, and typically will be felt when an athlete is running, as the Gastrocnemius is under more strain.
Sideline review and differentiation
Physical differentiation can be assessed on the sidelines during a game with muscle length and strength testing with a bent knee compared to an extended knee.
Pain on passive dorsiflexion of the ankle, with a flexed knee would indicate disruption to the fibres of Soleus. This should initially be assessed by a trainer or physiotherapist by manually taking the ankle into dorsiflexion with a bent knee. If no pain is reproduced, the athlete can then perform a bent knee calf stretch to see if symptoms are reproduced.
Pain on active plantarflexion of the ankle with a bent knee may reveal pain or weakness of the Soleus. Again this can be tested manually by a club trainer or physiotherapist by getting the athlete to push down into the trainers hands while the trainer applies resistance. If this does not reveal anything, the player can attempt a single leg, bent knee calf raise.
If pain or weakness is found with any of these tests, the athlete should commence initial injury management using the RICE and HARM principals to assist in best recovery, then consult a physiotherapist.
The key to calf management is to get the correct diagnosis, treatment and proactive rehabilitation as soon as possible (stretching, strengthening, correcting walk/run alignment). If correctly diagnosed and the correct treatment prescribed calf strains can be easily managed with a proactive program, which ensures short and long term benefit, such as successful return to play, and most importantly ensuring that the injury doesn’t become chronic.
For further information, assessment or treatment please contact us at Physioworks Health Group
About Samuel Mayes:
Samuel Mayes is the club Physiotherapist at the Pakenham Lions Football Club. He is the attending physiotherapist for the Casey Cardinia Football Netball Inter League teams. Sam consults at Physioworks health Group Cranbourne and Pakenham clinics.
About David Francis:
Physioworks Health Group Director David Francis is a Specialist Musculoskeletal Physiotherapist & Senior Physiotherapist at Collingwood FC. David specialises in sports injury management, particularly injuries and rehabilitation associated with Australian Rules Football.