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  • Kris Krotiris

Understanding Calf Injuries: To Scan Or Not To Scan?

Updated: Jul 11, 2023

Whether you're an athlete, a fitness enthusiast, or simply someone who enjoys an active lifestyle, calf injuries can be frustrating and debilitating, often leading to restricted mobility and an inability to continue to engage in physical activities. When faced with a calf injury, an appropriate rehabilitation program is essential, however the question often arises: Should you opt for a scan or not?


In this blog post, we delve into the world of calf injuries, exploring the intricacies of their diagnosis and the dilemma of whether or not to undergo medical imaging scans. We'll explore the signs and symptoms of calf injuries, their common causes, and the role that diagnostic imaging plays in their assessment. By gaining a deeper understanding of this topic, you'll be better equipped to make informed decisions regarding your own health and treatment options.


Signs and Symptoms:

Signs and symptoms of calf injuries can vary depending on the specific type and severity of the injury. One common indication is pain localized in the calf muscle or along the back of the leg. This pain can range from mild discomfort to a sharp, intense sensation that worsens with movement. Swelling, tenderness, and bruising in the affected area may also be present. In more severe cases, individuals may experience difficulty walking or bearing weight on the injured leg. Additionally, calf injuries can manifest as a popping or tearing sensation at the time of injury, accompanied by a sudden inability to continue the activity.


Causes of Calf Injuries:

Calf injuries can occur due to various factors. Those that have been proven to have a significant contribution to injury include:

  • Sudden increase in activity level or intensity

  • Overtraining (training or exercising more than your body can recover from)

  • Under-training (not preparing your body adequately for the demands of your sport or activity)

  • Inadequate warm-up routine

  • Calf muscle weakness

  • Prior history of calf injury

  • Age (older = increased risk)

  • Insufficient recovery

Some factors which may contribute to the occurrence of a calf injury include:

  • Inefficient biomechanics/running technique

  • Improper footwear

  • Muscle imbalances around the ankle, knee, hip and core

  • Impaired calf flexibility

A seperate blog post could be written about each of the above points, we will revisit some of these important points for a detailed discussion sometime in the near future! For now, lets move on to the different types of calf injuries, how they might be diagnosed and how they could effect your prognosis.


Types of Calf Injuries:

Injuries can occur to different parts of the calf complex or other muscles within the posterior compartment of the leg. The involvement of muscles will influence rehab exercise selection and the time needed to recover and safely return to training and competition. Clinical testing by an experienced sports physiotherapist or sports doctor can give a reasonably accurate indication of which muscles are involved. Consideration should be given to:

  1. The Gastrocnemius: The gastrocnemius muscle is the larger, more superficial muscle in the calf. A tear in this muscle can result from sudden movements, forceful contractions, or direct trauma. Gastrocnemius tears typically cause sudden pain, a popping sensation, swelling, and difficulty walking or flexing the foot. This muscle is divided into a medial and lateral part, with the medial part most commonly injured.

  2. The Soleus: The soleus muscle is a deeper calf muscle that lies beneath the gastrocnemius. Strains in the soleus are often characterised by a more insidious onset, with athletes often describing a gradual onset of symptoms during physical activity.

  3. Mixed: Sometimes, both the Gastrocnemius and the Soleus are involved.


Other Considerations:

  1. Plantaris Tendon: The plantaris tendon is a small but non-essential tendon located behind the knee. This tendon can be a source of pain during high-intensity exercise.

  2. Achilles Tendon: The Achilles tendon is a strong fibrous cord that connects the calf muscles to the heel bone. It plays a vital role in walking, running, and jumping.

  3. Flexor Hallucis Longus Muscle: The Flexor Hallucis Longus muscle is a deep muscle located in the lower leg. It runs along the back of the leg and functions to flex and stabilize the big toe.

  4. Medial Tibia (shin splints): Shin splints, also known as medial tibial stress syndrome, is a common condition characterised by pain along the inside of the shinbone (tibia).

  5. Vascular: A Deep Vein Thrombosis (DVT) is a condition where a blood clot forms within a deep vein, typically in the leg. It can cause pain, swelling, and redness in the affected area.

What does this mean for my recovery?

Each structure requires a specific, targeted rehabilitation plan and carries a different recovery time and risk of re-injury. This makes an accurate initial diagnosis critical, especially with any indication a more severe injury/condition (e.g. Achilles Tendon rupture or DVT) may be the cause of symptoms.


There are also subtleties within each injury type which can influence your recovery time. Assuming the Calf Complex (Gastrocnemius, Soleus or mixed) is the source of pain, the following two characteristics are thought to influence time taken to return to unrestricted activity:

  1. Myofascial Injury: A myofascial injury typically involves the muscular tissue of the calf. It refers to an injury or dysfunction within the muscle fibers themselves.

  2. Connective Tissue Injury: Dense connective tissues form a scaffold to support the muscle fibres within the calf. This scaffold is composed of the epimysium (the connective tissue sheath surrounding the muscle) and the aponeuroses (a tough, fibrous sheet-like structure that connects the calf muscles to the Achilles tendon. It helps distribute the force generated by the muscles during movement.), The integrity of the connective tissue scaffold is therefore vital for muscle to function normally. This type of injury is thought to take longer to heal and may have a higher risk of recurrence when compared to a muscular tissue injury in isolation.

Calf Aponeurosis Injury
Image of the Calf aponeurosis scaffolding

With all this in mind, should I get a scan?

There are a number of factors to consider when deciding if a scan is necessary. With the understanding that each structure in the lower leg carries with it a different prognosis, it highlights the importance of an accurate diagnosis, and this is where medical imaging may be required. The following questions should be asked:

  1. Is there any indication of a severe injury/condition requiring immediate medical attention such as a ruptured achilles tendon or a DVT?

  2. Are you an athlete that needs an accurate diagnosis to improve the effectiveness of your rehabilitation planning to return to sport as quickly and safely as possible?

If you answered yes to either of these questions, then imaging techniques such as ultrasound or magnetic resonance imaging (MRI), when carried out and interpreted by an appropriate and experienced health professional, can accurately identify the structure involved and the subtleties of the injury.

Pictures from a Calf MRI

Calf injuries can be very frustrating, leading to unwanted time on the sidelines. By understanding the causes and getting an accurate diagnosis and appropriate rehab plan, you can minimise the time you spend injured. If you're currently experiencing pain related to a calf injury or have a history of recurrent calf strains, engaging with a health professional with an intricate understanding of the above factors should be your first step to recovery.


For more information about anything you've read in this article, give us a call on 0415 889 903 or send us an email at admin@prosportphysio.com.au to chat to our physios about all things calf injuries!

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