SALT ROCK PHYSIO TALKS CALF STRAINS

Calf Strains in Runners

As you start thinking about the various races in 2016 and training begins, we would like you to also make every effort to avoid any injuries in the pre-race work up and during the race itself. To lower your risk of injury you need all of three things: a strong body, good form and the right shoe. A runner’s best defence is a strong body. Strong muscles, ligaments and tendons will guard against impact, improve form and aid in developing a consistent gait. When the body is strong, the muscles are better able to brace for impact before the foot strikes the ground. The gluteal (buttock) muscles and the core contract to steady the pelvis and the leg. The foot and ankle muscles are activated at the same time and this provides a solid foundation to land on.

So we need to look at how we can reduce the load on the gastrocnemius as the foot contacts the ground. This is achieved by improving running form. That is, making sure that you get proper hip extension from the hamstrings and glutes so the leg passes under the body in a bent position, which takes pressure off the gastrocnemius.

What is a calf strain?

A calf strain is pain in the calf, as well as swelling, tenderness and muscle tightness, resulting from sudden overloading of the muscles and the muscle being stretched beyond it limits during speed work, hill running or running on uneven trails. It is a very common injury and it can range from mild stretching to partial tearing to a complete tear. If the strain is not severe, symptoms may not be present until the run is over. With a slight strain there can be feeling of cramp or tightness and slight pain when the muscles are stretched or contracted. With a Grade two calf strain where a number of muscle fibres are damaged or torn, the pain is usually sudden in onset and it can be very severe and sore to touch. A complete tear is a very serious injury and there is immediate pain and the runner will be unable to walk without pain.

Treat grade one and two strains with ice and anti-inflammatories. The ice is aimed at reducing the bleeding and secondary tissue damage. Wrap your calf with a bandage to provide compression. It should be tight enough to provide relief but not so tight that it cuts off circulation. This will also assist with limiting bleeding and swelling.  

Athletes don’t want to hear this, but calf strains require rest in order to recover. The rest period can range from a few days to several weeks depending on the severity of the injury. Your health practitioner will advise you accordingly. Many runners carry on running even after the initial signs of a calf strain. This further exacerbates the injury and a grade one injury can easily progress to a grade two injury if not given adequate rest.

Causes

·      Ineffective warm up and warm down routines

·      Excessive hill work

·      A sudden increase in mileage

·      Previous calf injury

·      Dehydration

·      Over pronation – the foot rolls over too much while you run, putting excessive pressure on the calf muscle and Achilles tendon

Calf Muscle Strain Prevention

·      Perform warm up exercises before you run

·      Do cool down exercises after you run

·      Stretch to maintain muscle length

·      Strengthen the hips and glutes to ensure that you generate enough power to prevent the leg from being straight as it passes underneath the body.

Strengthening exercises

Theraband Drive Back

With your foot or heel attached to a cable machine, stand facing the structure. Balance on one foot (it's OK to hold on to another object for balance) and bring your leg slightly in front of you. Drive backwards with your foot in the band. Focus on generating the movement from your glutes and hamstrings. Slowly bring the leg back up and repeat. Complete 20 to 25 reps with each leg.

Single-Leg Glute Bridge

Lie flat on your back with one leg bent, foot flat on the floor (or a stability ball for added difficulty), and the other leg flat on the ground. Slowly lift your pelvis off the ground by contracting your glutes and core while keeping your shoulder blades flat on the ground. Complete 15 to 20 reps on each leg.

Donkey Kicks With Theraband

Start on all fours. Insert a theraband so one end is wrapped around a fixed support and the other around the bottom of your foot. Extend your leg back and up, focusing on contracting with your glutes. Complete 15 to 20 reps on each leg.

     

Straight Leg Bounds

Run forward by keeping your legs straight and driving through the ground with your hips and glutes. Begin by running 50 meters. Progress until you can run 100 meters.

Lunges

Lunge forward with one leg. Focus on keeping your core muscles tight throughout the movement. Don't let the knee of your front leg bend past the tip of your toes. Advanced runners can perform this exercise holding a medicine ball and twisting when they bring their leg out for added difficulty. Work your way up to 15 repetitions on each leg.

Calf Stretches

1.  Standing calf stretch (gastrocnemius)

Stand about three feet from a wall and put your right foot behind you ensuring your toes are facing forward. Keep your heel on the ground and lean forward with your right knee straight. Rotating the toes in and out slightly will target the medial and lateral parts of this muscle separately. Hold this for 30 seconds. 

2. Standing calf stretch (soleus)

Stand away from a wall and put your right foot behind you and be sure your toes are facing forward.  Lean forward at the ankle while bending the right knee and keeping your heel on the ground. Because the knee is flexed, tension is taken off the gastrocnemius and placed on the soleus. You should feel the stretch lower down. Hold this for 30 seconds.

3.  Standing calf stretch (tibialis posterior)

In the same position as the soleus stretch, bend the back knee (right) inwards so that it is behind the left knee. You should feel the stretch move from the soleus to the inner part of your lower leg near the ankle. Hold this for 30 seconds.

SALT ROCK PHYSIOTHERAPIST SHARES A HER HUMBLING EXPERIENCE, VOLUNTEERING IN UGANDA

A month in the life of a Ugandan

Date of volunteer placement: 1 November 2015 to 27 November 2015

Name of Volunteer: Jacqueline Madombwe, Physiotherapist at Tiffany's Shopping Center in Salt Rock

Name of Host Organisation: Hopeline

My trip to Uganda was an absolutely amazing and enriching experience. It 

opened my eyes to challenges that our fellow Africans face that we cannot 

even imagine. The most inspiring part was the stoic way in which the 

Ugandans bear their challenges. This is not to say the Governments should 

be allowed to neglect their obligations to their citizens, but Ugandans have not 

allowed their hardships and their disappointment with their leaders to change 

who they are. They remain good and honest people at heart with the most 

beautiful African smiles to welcome all visitors. Truly inspiring!

I spent one month living with the community in the Northern Buikwe District, in 

a little town called Lugazi. I was volunteering for an NGO called Hopeline, 

which mostly works with women and orphans in the areas of healthcare, 

education and empowerment. 

 Buyantete Women’s Group 

During my stay, I met a women’s group in an area called Buyantete. 

These women faced challenges that stemmed mostly from the 

Ugandan society being polygamous and men having multiple wives 

and ultimately neglecting these families. The women are left to source 

money to care for the children. Clinics are few and far between and 

there is no free healthcare. As you can imagine, they have serious 

health challenges. They are not able to negotiate safe sex or 

contraception and as a result they have on average 8 children each. 

This just increases the burden of poverty and a lot of these children 

actually don’t grow to adulthood as they succumb to various childhood 

diseases. Disability is still highly stigmatised so disabled children will 

often be hidden away until they succumb to various medical conditions. 

Most of the villagers are living well below the breadline and survive on 

one meal a day. Children are constantly turned away from school due 

to failure to pay fees so the education that they receive is rather 

sketchy. 

Based on their needs I gave health education talks. I taught the ladies 

how to make oral re-hydration solution, discussed importance of 

immunisation and how to keep their babies alive and healthy. We also 

discussed various contraceptive methods although obtaining funds to 

buy the contraceptives remained a challenge. 

Education was given on conditions such as cerebral palsy. This 

encompassed the importance of attending antenatal clinic and the 

importance of early intervention if a child does have developmental 

delay or cerebral palsy. 

Physiotherapy is a service that is not accessed by the masses at all. 

Only an elite few are able to access physiotherapy as it is only found in 

the private sector in the bigger cities. 

 Mayindo Women’s Group

I also met a group of women in Mayindo village. They had similar 

challenges to the Buyantete women. I spent most of my time with the 

Mayindo women and during these visits I would give health education 

talks. I taught the ladies how to make oral re-hydration solution, taught 

them about malaria and typhoid, discussed importance of food and

hand hygiene, discussed hand washing. We also discussed income 

generating projects. I felt that the ladies were operating very much on a 

subsistence level and relying too much on volunteer donations. I 

encouraged them to start thinking bigger and use the donations they 

received as a base and make efforts to grow their projects into viable 

businesses. I assisted with the start-up for a project where the women 

will keep chickens and sell the eggs. Hopefully, they will grow this and 

be able to sustain themselves and help other women in need in their 

community from the profits from this project. 

 Hopeline also supports a local school called Nkoko Bright. 

I was given the P6 (grade 6) class to mentor and among other things we talked

about self esteem and values. We discussed HIV and abuse. I 

identified a boy in the P6 class who is 17 years old. He lives alone and 

does odd jobs in the community to raise money for school fees, rent 

and food. His parents are alive but they abandoned him some years 

ago. His determination really touched me and before I left I paid his 

school fees and exam fees for P7 and I also paid for his uniforms as he 

had no uniform and the shoes he was wearing were so torn they were 

barely covering his feet. This is just one boy who I was able to assist 

yet his story is so common in Uganda, it’s heartbreaking. What is even 

more heartbreaking is to find such a boy is not too proud to be in a 

class of 11 year olds when he is almost an adult. Rather than turning to 

the streets, he is so determined to keep trying to get an education as 

he sees education as his only hope for a better life. This is the same 

determination that I saw in most Ugandans that I really admired.

Hopeline started another school in a village called Kkoba, which is 

where the founder of Hopeline, Tony Wonyoike, is from. This remote 

village has absolutely nothing, except this school which provides free 

education to orphans.

 I also visited a Medical Centre a couple of times.

 I assisted in the laboratory with taking bloods for malaria and HIV tests. I also did health 

education with the patients in the waiting room. I talked specifically 

about malaria and typhoid and de-hydration. The patients received it 

very well and they were involved and asked lots of questions. I feel it 

was very fruitful and I hope that the nurses at the Medical Centre will 

take more time to do health education. I also sat in during patient 

consultations and gave advice with regards to exercise where ever it 

was appropriate. The staff and patients both welcomed this as they had 

never had any exposure to physiotherapy or exercise principles.

 The time that I spent in Uganda was not just about me teaching them, 

but I had many new experiences and learned a few things from the 

community as well. For instance I learned how to ride on the Boda 

Boda, which is the main form of public transport. There were many 

laughs on our boda boda trips to the villages. 

The ladies taught me how to weave and make the various craft items which 

they sold in an effort to earn an income. I also went along to the fields and 

helped with the agricultural side of things. It was very different from what I was 

used to but a very humbling and educational experience.

And there was time for fun too. We took trips to Jinja which is a tourist resort 

30 minutes drive from Lugazi. Uganda is the most beautiful country I have 

been to in Africa. I was able to take a boat ride on the Nile and see the source 

of the river Nile, which is in Jinja.

“As you simplify your life, the laws of the universe will be simpler; solitude will 

not be solitude, poverty will not be poverty, nor weakness weakness.” Henry 

David Thoreau.

My experiences in Uganda made me think a lot about poverty. In the face of 

true adversity and poverty, I began to see a lot of our complaints as petty. 

“These days there is a lot of poverty in the world, and that's a scandal when 

we have so many riches and resources to give to everyone. We all have to 

think about how we can become a little poorer.” Pope Francis

I was shaken completely out of my comfort zone. A physio going to volunteer 

in a country where the majority of the population have never heard of a 

physio, much less seen one.