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Calf ContusionInjuries > Lower Leg > Calf Contusion
(Also known as Calf Bruise, Bruised Calf, Corked Calf, Corky, Calf Haematoma)
What is a calf contusion?The muscle group at the back of the lower leg is commonly called the calf. The calf comprises of 2 major muscles one of which originates from above the knee joint (gastrocnemius) the other of which originates from below the knee joint (soleus). Both of these muscles insert into the heel bone via the Achilles tendon (figure 1). The calf is responsible for raising the heel during weight bearing activity and has a rich blood supply. Following a direct impact to the calf, damage to the muscle fibres, connective tissue and small blood vessels of the muscle may occur. This results in a 'bruise' to the calf and is known as a calf contusion. Calf contusions can range from minor contusions resulting in minimal pain and allowing ongoing activity, to severe contusions resulting in significant pain and loss of function. Causes of a calf contusionCalf contusions occur following a direct impact to the calf muscle from an object or person. This most commonly occurs due to a collision with another player during contact sports such as football or rugby, or from an impact from a ball in sports such as hockey or cricket. Signs and symptoms of a calf contusionPatients with this condition usually feel a sudden pain in the calf muscle at the time of injury. In minor calf contusions, pain may be minimal allowing continued activity. In more severe cases, patients may experience severe pain, muscle spasm, weakness and an inability to continue activity. Patients with a severe contusion may also be unable to walk without a limp. Patients with a calf contusion usually experience pain during activities such as walking (especially up hills), running, jumping, hopping, or standing on "tippy-toes". It is also common for patients to experience pain or stiffness after these activities with rest, especially upon waking in the morning. Swelling, tenderness and bruising may also be present in the calf muscle, along with an inability to stretch the calf as far as usual. In severe cases of a calf contusion, a visible increase in size of the muscle may be detected due to bleeding and swelling. In these cases patients may be unable to sleep due to pain. Occasionally the swelling and bruising may track down to the ankle joint or foot and toes. Diagnosis of a calf contusionA thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a calf contusion. Further investigations such as an MRI scan or ultrasound may be required, in rare cases, to confirm diagnosis. Treatment for a calf contusionMost patients with this condition heal well with appropriate physiotherapy. The success rate of treatment is largely dictated by patient compliance. One of the key components is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free (crutches may be required). Activities which place large amounts of stress through the calf should be minimized, these include: running, lunging, jumping, hopping and activities on "tippy-toes". Rest from aggravating activities ensures the body can begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms. Ignoring symptoms, or adopting a 'no pain, no gain' attitude is likely to lead to the problem becoming chronic and can lead to further complications (such as myositis ossificans). Immediate, appropriate treatment is therefore essential to ensure a speedy recovery. Diligently following the R.I.C.E. Regime in the initial phase of injury (first 72 hours) will greatly assist in improving recovery time in patients with a calf contusion. This involves rest from aggravating activities (crutches may be required), regular icing, the use of a compression bandage, and keeping the injured leg elevated above the level of your heart. The use of crutches when walking may be necessary to protect the calf from further damage and to hasten the healing process. Care should be taken not to exercise or stretch into pain as this may lead to further bleeding. The use of heat, massage and the consumption of alcohol in the first 72 hours following injury should also be avoided. A graduated pain free flexibility and strengthening program guided by a physiotherapist is essential to recondition the calf muscle and reduce the likelihood of injury aggravation. In the final stages of rehabilitation, a gradual return to running program is also required to recondition the muscle for running in a safe and effective manner. Prognosis of a calf contusionWith appropriate management, patients with minor calf contusions can usually recover in one to three weeks. With larger contusions, recovery may take four to eight weeks or longer depending on the severity of injury. In rare cases, patients with a calf contusion can sometimes develop myositis ossificans (bony growth in the muscle). This condition is more common in severe contusions (especially those that are managed inappropriately) and may prolong recovery by weeks to months. Physiotherapy for a calf contusionPhysiotherapy for patients with a calf contusion is vital to hasten the healing process and ensure an optimal outcome. Treatment may comprise:
Other intervention for a calf contusionDespite appropriate physiotherapy management, some patients with this condition do not improve adequately. When this occurs, your treating physiotherapist or doctor can advise on the best course of management. This may include investigations such as an X-ray (to assess for myositis ossificans), ultrasound, CT scan or MRI, pharmaceutical intervention, or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition. Exercises for a calf contusionThe following exercises are commonly prescribed to patients with a bruised calf. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily after the initial 72 hour period and only provided they do not cause or increase symptoms. Calf Stretch (Gastrocnemius)Begin this calf stretch with your hands against the wall and your leg to be stretched behind you as demonstrated (figure 2). Keep your heel down, knee straight and feet pointing forwards. Gently lunge forwards until you feel a stretch in the back of your calf or knee. Hold for 15 seconds and repeat 4 times at a mild to moderate stretch provided it is pain-free.
Figure 2 – Calf stretch (Gastrocnemius) (left leg) Calf Stretch (Soleus)Begin this calf stretch with your hands against the wall and your leg to be stretched in front of you as demonstrated (figure 3). Keep your heel down. Gently move your knee forward over your toes until you feel a stretch in the back of your calf or Achilles tendon. Hold for 15 seconds and repeat 4 times at a mild to moderate stretch provided it is pain-free.
Figure 3 – Calf stretch (Soleus) (right leg) Calf RaisesBegin this calf strengthening exercise standing at a bench or chair for balance. Keep your feet shoulder width apart and facing forwards (figure 4). Slowly move up onto your toes, raising your heels as far as possible and comfortable without pain, tightening your calf muscles. Then slowly lower back down. Perform 10 – 20 repetitions provided the exercise is pain free.
Figure 4 – Calf raises
Physiotherapy products for a calf contusionSome of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with a calf contusion include:
To purchase physiotherapy products for a calf contusion click on one of the above links, or visit the PhysioAdvisor Shop. Other Exercises
Find a Physio for a calf contusionFind a physiotherapist in your local area who can treat a calf contusion.
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