Calf Muscle Strains Rusutsu

Calf muscle tears are particularly common in middle-aged male skiers and they are often injured in a fall over the ski tips when the bindings do not release. The knee is positioned straightened while the skier then often contracts the calf muscle at high force to stop the fall. As the calf muscle is fully stretched it is unable to contract with force and a tear occurs.

If the muscle is torn near the top section of the calf, many people think they have sustained a knee injury, as the pain is at the back of the knee. Skiers can often ski down without being aware they have an injury. However, once people click out of the skis, pain increases and it can be difficult to walk. Then once ski boots are removed, the pain increases in the standing position, and walking may be even more difficult. Patients will often rotate their foot to the side while walking which assists to avoid the ‘toe off’ phase of gait and avoids pressure on the calf.

The calf muscle consists of two separate muscles the gastrocnemius and the soleus. In skiing, it is usually the gastrocnemius that is injured. The soleus tends to do most of the work while skiing as it functions when to knee is bent. As the knee only becomes straight when a skier is falling over the tips, many skiers can be educated on how to ski safely with a gastrocnemius that is not functioning at 100%.

We are fortunate that physiotherapy makes a huge difference to the function of skiers with calf muscle tears. Firstly we teach people several techniques on how to use the uninjured section of the calf (the soleus) and avoid loading the gastrocnemius. We have some heel raises, and compression sleeves. We also use ultrasound, soft tissue techniques and the Game Ready compression and ice machines to reduce swelling and promote healing. Gait re-training and ski-specific rehabilitation are also very beneficial.

Flying internationally soon after a calf muscle tear puts the patient at a higher risk of DVT. We work together with the patient to reduce that risk and often work with insurance companies to ensure the patient returns home safely.

There is a saying in snow sports injury management that people with calf muscle tears can ‘ski before they can walk’. This is because walking well requires the knee to be straight, but skiing is done almost exclusively with a bent knee. We discuss all the risks and perform fit-to-ski assessments and help the patient to decide if they can ski again on the same holiday. For most calf muscle strains, if the patient is motivated and works diligently, we can usually return people them skiing in less than 3 days.