At Walker and Hall we know through personal experience how any condition affecting the lower leg can have an enormous effect on every aspect of your life e.g., from standing and walking, to commuting to sports and leisure activities.
The most common types of lower leg pain we treat are
Pulled Muscle – Gastrocnemius / Soleus Pain
Shin Splints
Referred pain
If your condition is not listed above please contact us
We have extensive experience in treating these conditions and managing your recovery.
To see how Walker and Hall can help you please see below
Calf Strain (also known as Calf Tear, Torn Calf Muscle, Strained Calf Muscle, Pulled Calf, Gastrocnemius / Soleus Strain, Gastrocnemius / Soleus Tear, Torn Gastrocnemius / Soleus)
A calf strain is an injury characterized by tearing of one or more of the calf muscles and typically presents with pain in the back of the lower leg.
It is one of the most common muscle strains we treat at Walker and Hall and we know through experience that it responds well to the appropriate physiotherapy treatment.
Anatomy
The muscle group at the back of your lower leg is known as the calf. It comprises two large muscles, one of which originates from above the knee joint and is called gastrocnemius, and the other which originates from below the knee joint and is called soleus. Both these muscles insert into the heel bone via the Achilles tendon.
During contraction of the calf, tension is placed through the calf muscle.
When this tension is excessive due to too much repetition or high force, the calf muscle can be torn. This is known as a calf strain.
Tears to the calf muscle can range from a small partial tear where there is minimal pain and minimal loss of function, to a complete rupture which may require surgical reconstruction.
As with all muscle strains, calf strains range from grade 1 to grade 3 and are classified as follows:
- Grade 1 Tear: a small number of fibres are torn resulting in some pain, but allowing full function.
- Grade 2 Tear: a significant number of fibres are torn with moderate loss of function.
- Grade 3 Tear: all muscle fibres are ruptured resulting in major loss of function.
The majority of calf strains we treat at Walker and Hall are grade 2.
Causes of a calf strain
- Sudden muscular contraction – this frequently occurs when you attempt to accelerate from a stationary position, jump or lunge forwards such as while playing tennis, badminton or squash. These strains are also commonly seen in running sports such as football and athletics.
- Overuse – occasionally these muscle tears occur as a result of gradual wear and tear caused with activities such as repetitive jumping, distance running or walking excessively – especially up hills or on uneven surfaces
There are a number of factors which can predispose you to a calf strain and these include
- poor calf flexibility
- inappropriate training
- poor biomechanics or foot posture
- inadequate warm up
- ankle joint stiffness
- calf weakness
- inadequate rehabilitation following a previous calf strain
- decreased fitness
- fatigue
- neural tightness
Signs and symptoms of a calf strain
- Pain – usually felt as a sudden sharp pain or pulling sensation in the calf muscle at the time of injury. In minor strains it may be minimal allowing continued activity but in more severe cases you may experience severe pain, muscle spasm, weakness, and an inability to continue activity
- You may experience pain during activities such as walking – especially uphill, going up and down stairs, running, jumping, hopping, or standing on tip toe. It is also common to experience pain and stiffness after these activities with rest, especially when waking the following morning
- Swelling, tenderness and bruising may also be present in the calf muscles and in cases of a grade 3 tear a visible deformity in the muscle may be evident
- Limp – with a severe strain you may walk with a limp or even be unable to weight bear on the affected leg
How Walker and Hall can help you
A thorough musculoskeletal examination is required to determine the extent of the damage to the calf muscles. This is essential if the optimum recovery is to be achieved.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for a calf muscle strain are
- R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression and keeping the calf Elevated (providing this is comfortable)
- Advice with regards to the use of heel wedges and crutches
- Pain relieving techniques e.g., electrical therapy such as ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
- Knee and ankle joint mobilising techniques e.g., gentle stretching and muscle release techniques
- Home exercise programme – a graduated mobilising, strengthening and balance programme to ensure an optimal outcome
- Advice with regards to a graduated return to activity and sport. A minor calf strain will usually recover within 1 – 3 weeks whereas a more severe calf strain may take 4 – 6 weeks or longer depending on the severity of the injury
- Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist
Shin Splints (also known as Medial Tibial Stress Syndrome, Tenoperiostitis of the Shin, Inflammatory Shin Pain)
Shin Splints is a condition characterized by damage and inflammation of the connective tissue joining muscles to the inner shin bone (tibia).
It is a condition we treat a lot at Walker and Hall and we know through experience that it responds well to the appropriate physiotherapy treatment.
Anatomy
There are several muscles which lie at the back of your lower leg and are collectively known as the calf muscles. Several of these muscles lie deep within the calf (tibialis posterior, flexor digitorum longus, flexor hallucis longus and soleus) and attach to the inner border of the shin bone (tibia). The connective tissue responsible for attaching these muscles to the tibia is known as the tenoperiosteum. Every time the calf contracts it pulls on the tenoperiosteum. When this tension is too forceful or repetitive, damage to the tenoperiosteum occurs. This results in inflammation and pain and is known as medial tibial tenoperiostitis – commonly referred to as shin splints.
Causes of shin splints
- Repetitive and prolonged activities – activities that place strain on the tenoperiosteum may cause shin splints. These include excessive walking, running and jumping – such as an increase in training or running, and are often seen in runners and footballers. It frequently occurs in association with calf muscle tightness or biomechanical abnormalities, such as excessive pronation – flat feet, or supination – high arch, or in those with inappropriate footwear. Athletes more commonly develop this condition early in the season following a period of reduced activity (deconditioning) and when training surfaces are generally harder.
There are a number of factors which can predispose you to shin splints and a few of these are
- excessive training or activity
- poor foot posture – especially flat feet
- inappropriate footwear
- inadequate warm up
- training on hard or inappropriate surfaces
- muscle weakness – especially the calf muscles
- tightness in specific joints – such as the ankle
- tightness in specific muscles – especially the calf
- poor lower limb biomechanics
- poor training technique or methods
- leg length differences
- poor balance
- being overweight
- deconditioning
- poor core stability
Signs and symptoms of shin splints
- Pain – usually experienced along the inner border of the shin. In less severe cases you may only experience an ache or stiffness along the inner aspect of the shin that increases with rest, typically at night or on waking first thing in the morning, following activities which place stress on the tenoperiosteum. These include excessive walking, running – especially up hills, on uneven surfaces or in poor footwear such as flip flops, jumping and general weight bearing activity. In the early stages of the injury the pain may also ease with the activity as the tissues warm up
- As the condition progresses, you may experience symptoms that increase during sport or activity, affecting performance. You will typically experience pain on firmly touching the inner border of the shin bone particularly at the junction of the lower third and upper two thirds of the bone.
- Thickening, lumps and muscle tightness – these may be felt in the area of pain
- Swelling, redness and warmth – these may be experienced in severe case
- Limp – once again this is mainly associated with severe cases of shin splints and may reduce as you warm up
How Walker and Hall can help you
A thorough musculoskeletal examination is required to determine the extent of the shin splints. This is essential if the optimum recovery is to be achieved.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for shin splints are
- R-I-C-E – For the first 48 to 72 hours the standard soft tissue treatment of R-I-C-E is used. This involves Resting from aggravating activities, the regular use of Ice, the use of a Compression and Elevation (providing this is comfortable)
- Pain relieving techniques e.g., electrical therapy such as ultrasound and interferential therapy, gentle ankle joint mobilising techniques and soft tissue massage to the calf muscles to reduce pain and muscle spasm
- The use of supporting tape
- Advice with regards to the use of orthotic / shock absorbing insoles
- Biomechanical assessment and correction
- Home exercise programme – a graduated flexibility (especially of the calf muscles), balance, strength and core stability programme to ensure an optimal outcome
- Advice with regards to a graduated return to active sport depending upon the improvement achieved during treatment
- Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist
Referred Pain
Not all lower leg pain is necessarily coming from the lower leg. Occasionally, pain felt in the lower leg can be referred or caused by a problem in another area of the body such as the back or spine. This is called referred pain.
What is Referred Pain?
Referred pain occurs when pain is experienced in an area away from the actual injury or problem. This is not uncommon, an example being sciatica, where pain is felt down the leg whilst the problem is in the back, or a heart attack, where the pain is felt in the shoulder, arms and neck.
What structures can refer pain into the lower leg?
The following structures have the ability to refer pain into the lower leg
- The lumbar and sacral spines (from the 4th lumbar spine to the 1st sacral vertebra – L4 to S1). Any problems affecting the intervertebral discs, ligaments, nerves and muscles of this area of the spine can mimic a lower leg problem.
- The hip joint
- The knee joint
- The muscles of the hip and pelvis area
- The muscles of the thigh
How can Walker and Hall help you distinguish between a lower leg problem and referred pain
At Walker and Hall you will receive a thorough musculoskeletal examination which will examine all the structures that could possibly be responsible for the lower leg symptoms.
It is only following such an accurate examination and diagnosis that a treatment plan can be devised to address your problems.
You will be involved in all stages of your treatment given every opportunity to ask questions.
