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Calf muscle tears from a pilates perspective: Treatment and exercise to promote healing

Now that it’s summer many people head outdoors to enjoy activities such as running, cycling and tennis to name a few. Spring and early summer are also the time of year that we start to see injuries like a torn muscles in the leg, e.g. calf muscle tears, ruptured Achilles tendon or a torn hamstring. Most muscles have a similar pattern when you tear them. Essentially you feel like something has hit you hard in the muscle and you will sometimes hear a popping sound. Soon the affected muscle becomes painful and then swelling and bruising develop. The degree of severity of the muscle strains is classified between a Grade 1, Grade 2 and Grade 3. The terms can seem reasonably vague, as they are not referring to a specific percentage of muscle torn.

Grade 1:     This is when the muscle incurs some small micro tears in the muscle fibres. Recovery is generally about two to four weeks provided you do not reinjure the muscle and that you follow instructions.

Grade 2:     This is when the muscle fibres have partially torn. It takes approximately four to eight weeks to recover from this type of tear, provided you follow the rehabilitation instructions.

Grade 3:     This is when the majority of muscle fibres have been torn or ruptured. This means either the tendon is separated from the muscle belly or the muscle belly is actually torn into two parts. Severe swelling and pain and a complete loss of function characterises this type of strain. Full recovery can take three to four months and, in some instances, surgery may be needed.

How to treat a muscle tear

There are four stages to muscle repairs (including calf muscles) and the body follows these stages of repair. Remember you can’t fast track them and need to respect the various stages and exercise appropriately during these various stages if you are to recover. The healing process is:

Destruction phase:     The destruction phase starts with the actual trauma that causes the tear. At this stage MICE – Muscles (gentle pain free muscle activation), Ice, Compression and Elevation is your best option. If the injury is to your leg it is important to be non or partial weight bearing. In this early stage topical anti-inflammatory creams may help minimise pain and swelling. However, in the first 48-72 hours (i.e. the destruction phase) it is best to avoid anti-inflammatory medications as they can encourage more bleeding.

Inflammatory phase:     The inflammatory phase is when the torn blood cells start to repair and the cells destroyed during the destruction phase start to be removed from the system. During this time it is important to maintain RICE (Rest, Ice, Compression and Elevation). This phase normally lasts up to about three to four days. Compressive bandages and strapping can help at this point of the healing process.

Repair and remodelling phase:     The repair and remodelling phase is when the myofibrils of the muscle start regenerating and connective tissue scars are formed in the gap between the torn muscle fibres. In the first ten days after the trauma this scar tissue is the weakest point of the affected muscle. Accordingly, it is important to take care around this period of time so that you do not re-rupture the muscle.

Vascularisation of the injured area can take some months. Essentially this phase is when new capillaries originate from the remaining injured blood vessels and find their way to the centre of the injured area. Successful vascularisation depends on early mobilisation of the muscle as it stimulates the vascularisation process.

What should you do during the various stages of healing?

During phases 1 and 2 you should practice MICE. You should start moving the muscles and keeping the scar tissue soft and pliable during the first six weeks. Remember that the muscle is at its most vulnerable at around the ten-day post injury mark. During this time it is important to incorporate appropriate stretches, massage and mobilisations of the muscle and scar tissue.

What about exercises?

Strength should be restored progressively with resistance exercises. Pilates is great for this because the various springs can be used to create appropriate resistance. The general rules with exercise for rehabilitating damaged muscle are that you start with concentric muscle work (that is a shortening and strengthening in the belly of the muscle) and then adding in an eccentric muscle exercise (that is a lengthening of the muscle as the joints affected by the muscles move apart from each other). The next phase of exercise rehabilitation is to restore proprioception (that is the sense of where your joint is in space) and agility. This is where things like wobble boards and other uneven surfaced objects can help in restoration of the muscle’s strength and agility.

Example of exercises for a torn calf muscle

When a person presents with a torn calf muscle it is most likely that they would have torn the medial head of the gastrocnemius. Once it has been iced and rested you will probably need to see a physiotherapist or musculoskeletal therapist in order to minimise a build-up of scar tissue. At around two to three weeks after the injury you should be looking at:

Step 1:     Maintaining movement of the toes (remember the tendons of the calf muscles attach to the toes). Try toe wiggles or theraband lifts. Lift each toe using a theraband and create a small amount of resistance as the toe is pressed back into the ground.

Focus on lengthening out the heel and pressing the heel away for 10 to 15 second holds.

Step 2:     Seated on a Wunda chair (or bent down in a squat) lift up onto the toes and lower the heels with appropriate resistance.

Progressively add in soleus and gastrocnemius stretches, including static holds and then calf presses and prances on the reformer or CoreAlign

Step 3:     Finally start adding in exercises where the person has their feet on balls on the reformer, or other exercises that start challenging proprioception and agility.