Calf injuries

Achilles Tendon

If you experience acute pain in the lower calf area and feel the need to stretch out your calf, or a sharp pain on the inside of your Achilles tendon the chances are you may have damaged your achilles tendon. The most common factors predisposing you to Achilles tendon injuries are:

• Sudden increase in mileage
• speed or gradient
• Reduced recovery time between training sessions
• Change in running surface
• Poor footwear
• Tight calf muscles
• Poor ankle joint range of motion

An Achilles injury is certainly an injury you want to try and avoid at all costs. It is notoriously slow to heal because of its relatively poor blood supply. It also has a slow metabolic rate which is what allows it to carry heavy loads for such long periods but also helps explain why it requires such prolonged rehab to get you back to where you were. But most of the time these injuries are preventable.

Acute tendoachilles "ruptures" aren't uncommon but certainly their risk and frequency increases over the age of 30 in the more ballistic type sports e.g. squash, tennis, netball, basketball, and track. Blood supply to the poorly endowed tendon further decreases with age. Thus it becomes even more important to have a good gradual warm-up, then stretch, before strenuous exercise. There will usually be a sudden onset of sharp pain in the tendoachilles, often an audible "snap" and the feeling of "having been kicked or shot in the calf".

As indicated however, the scenario presented above in a runner will most likely not be a rupture but a partial tear of the tendon or a paratendonitis (inflammation of the layer surrounding the tendon) due to overload. Even these will necessitate several weeks off running and frequently a lot more time than that depending on whether conservative management (i.e. non-surgical) alone is successful.

The prognosis is much better if treatment is instigated early - if the athlete tries to keep running on it, there is a far greater likelihood of much more severe tendon damage, necessitating more prolonged rehab and often surgery.

Treatment

ICE should be started as soon as possible, and rest from anything that hurts it. That will mean stopping doing anything that puts the Achilles on further stretch e.g. avoid shoes with flatter heels. You might want to put a heel raise in the back of your shoe - you can make do with a carpet cut out.

Anti-inflammatories may be very beneficial in the early stages to reduce local inflammation, but don't just use them as painkillers to enable you to run "injured" or you'll be setting yourself up for more long-term problems.

You should still be able to swim, and usually stationary biking will also be pain-free so you needn't lose fitness. There'll be a lot of gym work you can also do, though obviously calf raises, squats, and other standing weights with knees bent under load need to be excluded. If after 4-5 days there's no real improvement, then you should see your sports doctor and physio. If there's a lot of morning stiffness, that indicates a significant inflammatory response to the tendon.

Back to Injury Info