Caroline in Bromsgrove, England asks:
"I am a tennis player and have strained a muscle in my calf (inner side rather than outer), which is sufficiently painful to make me unable to put my heel down when I walk. My questions are: How will I know when to start the stretching exercises? What stretching exercises should I do? How will I know when to start taking weight bearing exercise?"
Marc Bernier at the Alabama Sports Medicine and Orthopaedic Center (ASMOC), replies:
"Following a Calf strain gentle stretching can usually be performed within the first few days (so long as it is pain free) in the form of active range of motion (AROM) exercises. In order to 'stretch' the calf muscles in this fashion, simply sit on the floor with your knees straight and bend your foot towards you using the muscles on the front of your shin. Hold this position for 5-10 seconds, and perform 30 times. This should be done in a pain-free manner throughout the day as a way to maintain some flexibility during the acute phase of the injury. Once you are comfortably able to do this exercise without pain, it should be safe to progress to more specific flexibility activities.
"In order to understand how to stretch the Calf complex it is helpful to know about the anatomy.
"The calf complex consists of two main muscles: the Gastrocnemius muscle (which crosses the knee joint) and the Soleus muscle (which doesn't cross the knee joint). These muscles are stretched in a similar manner, with one modification: to emphasize the Gastrocnemius, the knee must be in a straightened position; to emphasize the Soleus, the knee must be in a bent position.
"So long as the AROM stretches are pain free, the first stretches I recommend are 'towel stretches', which allow you to control the intensity of the stretch easily. This is performed with the knee extended and flexed to stretch both muscle groups.
"The next stretches are 'wall stretches' which entail leaning into a wall while keeping the heel on the ground. Once again, this is performed with the knee extended and flexed. Additionally, it is recommend that you place a very small rolled towel under the inside part of your foot to allow the stretch to be performed in a "neutral" position, preventing the foot from pronating (turning inwards). This provides for a more efficient and functional stretch for the calf musculature.
"The final stretches are performed on a 'slantboard'. A variation of this stretch is to perform it by placing the foot up against a wall in a standing position. While performing the slantboard stretch, it is also recommended that a small rolled towel be placed under the length of the inside part of the foot.
"Weightbearing exercise for strengthening can be initiated once the acute pain has subsided, usually within 3-10 days, depending upon the severity of the injury. The key to the strengthening program is to ensure it is a gradual program that begins with seated heel raise activity, progressing to full weightbearing exercises, and finally sport-specific training."