Much has been made over the last week over Chris Jones and his calf strain. While we have very little knowledge of all the facts regarding this particular situation, we can speak about calf rehab in general.
There have been several high-profile players in the last month and throughout the season with calf strains. While not a huge muscle group, they can be tricky to rehab given the requirements in athletic movements, and they also show a high rate of re-injury.
First, let’s define what the calf muscle group is. It is actually made up of three muscles – Medial and Lateral Gastrocnemius, Soleus and Plantaris. Also present is the ever talked about Achilles tendon, the connection of this muscle group to the back of the heel bone.
While everyone always assumes that a calf strain can lead to Achilles injuries/rupture, the research actually points to the fact that very few people ever have calf or Achilles pain prior to a rupture. It happens, but it is much rarer than people that don’t have pain.
In all my years, I can remember only one isolated Soleus strain in professional football — never a Plantaris. It is just difficult for those muscles to be isolated, as they are supplemental movers in this equation.
That brings me to my overall point in that when we hear ‘calf strain,” it is almost always involving the medial or lateral head of the Gastrocnemius – the big meaty muscle in the area. While others can be affected, its very rare in my experience to not have the prime movers involved.
So, when it comes to treatment, what are the most effective ways to return a player to action?
For me, swelling control and spasticity reduction are the number one goals within first 48 hours. Most muscle strains will have a component of both, and if you don’t address that right away, I find that there is an overall delay in return to play.
All muscle strains swell, on some level, due to tissue damage and will have a level of hypertonicity (spasticity) due to our body’s protective mechanisms. Consider it to be somewhat analogous to how whiplash feels on your neck – everything tightens down and is uncomfortable to move.
While some may advocate acute rest, I say to actually get them up moving – safely and immediately. That means ambulation in a pool or gravity-reduced treadmill if available. That way, the muscle can be shortened/lengthened in a normal matter with less force applied. Returning normal gait is a paramount to quick return in any lower-body injury, but more so here.
To aid in pain-free early ambulation, a heel lift is often inserted in one’s shoe to reduce the angle of lengthening of the muscle. Also, night splints to aid in longer-term stretching while one sleeps can be helpful as well.
A previous example
I can recall a calf injury in a lineman where we did nearly all of his rehab in the pool, essentially due to his weight, right up until he was ready to return to practice. Force production really matters in this injury and setbacks happen easily.
In my opinion, single leg balance is another key to a return from calf injuries. These exercises and rehab skills can be started almost immediately within pain tolerance as well. These can even be done in pool day one or two post injury. This is essentially the first bit of strengthening work done.
While some skill-position players will note being affected in top-end speed, almost every position will note difficulty with initial burst from a static position. I have found that to be the last component to always return with this injury.
Single-leg plyometrics, even low-level, can mimic the first step or burst nicely. Getting those involved in the total rehab equation quickly if able, again — even in the pool — has always been beneficial in my mind.
Return to play
Return to play is often dictated by the quality of movement that is reported by the player. Skill-position players will define it as “coming out of breaks” or being able to stop without pain. Linemen will typically talk about a “first push/power step” or how it feels when they are engaged with other linemen and pushing maximally through their legs.
A variety of other factors go into return to play as well. Grading of injury — level of muscle damage, position played, symptomatic report, player on-field performance — plays a significant role here. I find that return to play with this injury has a very wide variation, and it is hard to nail down a timeframe due to so many variables that only the player and med staff will have access to. This can be a true “feel it out and see” injury.
No matter the grade or location, these injuries are challenging to rehab quickly for a variety of reasons, as we have spoken about. Typically, even after the player returns to action, they require additional weeks of ongoing rehab to address it.
Aaron Borgmann is the founder of Borgmann Rehab Solutions. He spent 12 years in the NFL as an assistant athletic trainer and physical therapist before joining Arrowhead Pride.