Basketball players, runners, dancers, no one is safe when it comes to experiencing a calf strain.

Exhibit A- Kevin Durant of the Golden State Warriors, the best of the best when it comes to basketball players and all-around athletes. He has a top team of trainers, physicians and coaches around him. He was side-lined for a month, missing multiple finals games with what seems like an innocent diagnosis: calf strain. Only to return for a last round finals game, and tear his Achilles tendon.

What did they miss?!

He probably got cleared too early to return his sport, as many professional athletes are. There are many causes of calf strains and commonly they go deeper than the surface thought of “my calves are just tight”.

The literal definition of a strain is an overstretching or pulling to a degree that causes damage. Here is your mechanism for a vast variety of soft tissue injuries. Calf strains particularly affect much of the population, especially runners and those that participate in high impact sports, or people that increase activity too quickly.

Like with Kevin Durant, it can often go hand in hand with Achilles pain (or in the extreme case a tear). That’s because the Achilles tendon is the connection of the calf muscle to the heel. Each time we contract the calf, the Achilles tendon is with pull on the heel, thus downward movement of the foot is made possible.

What does a calf strain feel like?

A calf strain will typically feel like a sharp pull in the calf. Because the actual function of the calf (in conjunction with the bottom of the foot) is to facilitate the push off of the foot in a gait cycle, pain will occur with this movement.

Pain with walking uphill and up or down stairs is also a symptom of calf strain as these both concentrically and eccentrically load the calf muscle. Swelling, heat and redness of the calf can occur in acute stages of a calf strain.

Rule out the serious stuff

While the symptoms may seem fairly harmless, it’s important to get a diagnosis that what you have is indeed a calf strain. DVT or deep vein thrombosis is a more serious condition that can have similar symptoms including pain, swelling, heat and redness of the calf. This condition is caused by a blood clot in the leg, that can then travel to the lungs causing a pulmonary embolism. There are some easy tests your doctor can do to rule this out.

Nerve root compression from a disc herniation at the level S1 in the spine can cause radicular pain that travels to the calf. Referral pain like this can often be misdiagnosed as a calf strain as symptoms can present similarly.

Another cause of calf pain is rhabdomyolysis. This is a serious condition in which muscle tissue breaks down from a direct or indirect muscle injury. This death of muscle tissue releases a protein into the bloodstream and can lead to kidney failure.

Calf strain causes

Often times, we commonly see underlying issues that eventually lead to excess strain on the calf, predisposing the calf to injury. These include:

•      High arches aka supinated feet
•      Overtraining
•      Wearing high heels
•      Bunions
•      Wearing shoes that are too old
•      Wearing shoes that are too tight especially in the toe box
•      Spending too much time on a stair master
•      Too much training on treadmills and ellipticals
•      Weak glutes and hamstrings
•      Poorly fitting shoes
•      Old ankle sprains
•      Old stress fractures or neuromas in the feet

Foot biomechanics is a large part of these underlying issues. Old sprains, stress fractures or neuromas limit the foots mobility in the push off phase of gait (the part where your foot literally pushes off the ground) and limits supination. These are both necessary to create a rigid arch in the foot for the windlass effect, the tensioning of the big toe and plantar fascia allowing for push off.

How do I heal a calf strain?

There is always an underlying compensation or contributing factor to calf strain. Simply massaging the calves, icing or resting may help temporarily, but won’t get to the root cause of the problem.

We utilize Neurokinetic Therapy as a way to assess which muscles are overworking and need to be released and which muscles are underworking and need to be strengthened. Typically, with calf strains, we find the glutes and hamstrings to be weak or inhibited and the calf muscles to be tight and overworked. Active release technique is an effective soft tissue treatment used to specifically release the area of the calf muscle.

Replacing old footwear is an important component when treating calf strains and preventing re-injury. Gait retraining is a necessary part of treatment, particularly facilitating adequate ankle and big toe mobility to allow for push off. In our runners we utilize Anatomy in Motion specific rehab as well as specific training with a running coach that uses the pose method.

When dealing with a calf strain, it’s important to look from the core out and the feet up, to ensure proper mobility and stability and to prevent re-injury. When we look from the core out we assess core stability, which allows for pelvic stability, necessary bracing and proper movement of the spine. When we look from the feet up we analyze foot biomechanics as they have far reaching effects up the chain to the rest of the body. Together the two make a key combination in treating and preventing calf injury.

If you have any more questions, please get in touch with us at hello@urbanwellnessclinic.com or call us at 212-355-0445.

In Good Health,

Dr Adriana Lazare