Sports Medicine
Sports Injury Prevention & Rehabilitation

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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 two 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.
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 contusion
Calf 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 contusion

Patients 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 contusion
A thorough subjective and objective examination from a physical therapist 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 contusion
Most patients with this condition heal well with appropriate physical therapy. 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 RICE 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 physical therapist is essential to recondition the calf muscle and reduce the likelihood of injury aggravation. In the final stages of rehabilitation, a return to running program is also required to recondition the muscle for running in a safe and effective manner.

Prognosis of a calf contusion
With 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.

Physical therapy for a calf contusion
Physical therapy for patients with a calf contusion is vital to hasten the healing process and ensure an optimal outcome. Treatment may comprise:
  • soft tissue massage (after the initial 72 hour period)
  • electrotherapy (e.g. ultrasound)
  • joint mobilization
  • stretches
  • anti-inflammatory advice
  • the use of crutches
  • applying a compression bandage
  • the use of protective padding to the calf muscle to prevent re-injury
  • ice or heat treatment
  • exercises to improve the strength and flexibility of the calf
  • education
  • activity modification advice
  • establishment of an appropriate return to activity or sport plan

Other intervention for a calf contusion
Despite appropriate physical therapy management, some patients with this condition do not improve adequately. When this occurs, your treating physical therapist 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.