January 13, 2019

Tennis Elbow (Lateral Epicondylitis)→

January 13, 2019/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

Most people who get tennis elbow don't play tennis! In fact, less than 5% of all cases of tennis elbow occur in people who play tennis. Tennis elbow can happen to anyone who repeatedly uses their elbow, wrist, and hand for their job, sport, or hobby.

Tennis elbow is a painful condition caused by overuse of the "extensor" muscles in your arm and forearm, particularly where the tendons attach to rounded projections of bone (epicondyles) on the outside or lateral aspect of the elbow. The muscles you use to grip, twist, and carry objects with your hand all attach to the "lateral epicondyle" at the elbow. That's why a movement of the wrist or hand can actually cause pain in the elbow.

Prolonged use of the wrist and hand, such as when using a computer or operating machinery —and, of course, playing tennis with an improper grip or technique—can lead to tennis elbow. It can happen to athletes, non-athletes, children, and adults. It occurs more often in men than women, and most commonly affects people between the ages of 30 and 50.

Signs and Symptoms

Symptoms of tennis elbow can occur suddenly as a result of excessive use of the wrist and hand for activities that require force, such as lifting, twisting, or pulling. Forceful activities—like pulling strongly on a lawn mower starter cord—can injure the extensor muscle fibers and lead to a sudden onset of tennis elbow.

More commonly, though, symptoms of tennis elbow develop gradually over a period of weeks or months as a result of repeated or forceful use of the wrist, hand, and elbow. If you work as a grocery store cashier, you might have symptoms of tennis elbow as a result of repetitive (and often too forceful) typing—combined with continuous lifting of grocery bags.

Your symptoms may include:

Pain that radiates into your forearm and wrist
Difficulty doing common tasks, such as turning a doorknob or holding a coffee cup
Difficulty with gripping activities
Increased pain when you use your wrist and hand for lifting objects, opening a jar, or gripping something tightly, such as a knife and fork
Stiffness in the elbow
Weakness in the forearm, wrist, or hand

How Is It Diagnosed?

Tennis elbow usually occurs due to repeated movements. As a result, other muscles and joints in this region of the body may be affected as well. Your physical therapist will perform a careful examination not only of your elbow but of other areas of your body that might be affected and might be contributing to your pain. Your therapist will perform special manual tests that help diagnose the problem and help detect conditions such as muscle weakness that might have led to the problem in the first place. For instance, the therapist might ask you to gently tense or stretch the sore muscles to identify the exact location of the problem. Rarely is an x-ray required to diagnose this condition.

How Can a Physical Therapist Help?

The First 24 to 48 Hours

For the first 24 to 48 hours after acute onset of your pain, treatment includes:

Resting the arm by avoiding certain activities and modifying the way you do others
Using 10-20 minute ice treatments
Using elastic bandages or supports to take the pressure off of the painful muscles

Your physical therapist will decide if you should use a brace or support to protect your muscles while the area is healing. Depending on severity, your therapist may recommend that you consult with another health care provider for further testing or for consideration of additional treatment such as medication. In rare cases, treatments such as cortisone injection or surgery might be needed. Your physical therapist can help you determine whether you need a referral to another health care provider.

Your physical therapist can design a specific treatment program to speed your recovery. There will very likely be exercises and other treatments that you will be expected to do at home. Your physical therapist also might use special physical therapy treatments to help relieve pain, such as manual therapy, special exercises, and ice or heat treatments or both.

For an "acute" case of tennis elbow—one that has occurred within the past few weeks— it's important to treat as early as possible. Left untreated, tennis elbow may become chronic and last for months and sometimes even years. This is especially true if treatment is focused only on relieving pain and not on correcting the muscle weakness and bad habits that might have led to your condition in the first place.

Improve Your Ability to Move

Your physical therapist may use manual therapy to enable your joints and muscles to move more freely with less pain.

Improve Your Strength

Insufficient muscle strength can lead to tennis elbow. Sometimes the weakness is in the muscles of the wrist and forearm. In many cases, the problem stems from weakness of the supporting postural, or "core," muscles. In fact, you might find that it is necessary to improve your overall level of fitness to help manage your elbow condition. Based on the evaluation, your physical therapist can determine the type and amount of exercises that are right for you.

Physical therapists prescribe several types of exercises during recovery from tennis elbow:

Early in the treatment, when the pain is most intense, your therapist may recommend passive exercises in which your wrist and elbow are moved without the use of your muscles.
As your symptoms improve, you can move the wrist and elbow actively without assistance.
As the muscles become stronger and the symptoms have lessened, you will be able to begin using weights or resistance bands to further increase your strength. The amount of weight will need to be carefully monitored to make sure you continue to progress and avoid re-injuring your muscles.

Use Your Muscles the Right Way

Your physical therapist can help you retrain your muscles so that you use them properly. For example, when you lift a heavy grocery bag, you should contract the muscles around your shoulder blade and trunk to provide support for your arm muscles. This simple movement can be easily taught to you by a physical therapist can lessen the stress to the injured muscles and help you return to your normal activities while avoiding re-injury.

Return to Your Activities

Your physical therapist will help you remain active by teaching you how to modify your daily activities to avoid pain and further injury. Sometimes it's necessary to make changes at work, on the playing field, or in the home. Your physical therapist can help you make simple modifications to your work site, your computer set-up, your kitchen devices, your sports equipment, and even your gardening tools to lessen the strain to your hand, wrist, and forearm. Your therapist will emphasize the importance of taking stretch breaks so that your muscles get frequent rest from repetitive movements and standing or sitting in the same position.

Tennis may be a contributing factor to tennis elbow for several reasons. Sometimes the problem results from over-training. In other cases, the weight of the racquet or its grip may need to be adjusted. For others, the problem may stem from improper form, poor overall fitness, or a lack of strength in the supporting or "core" muscles of the trunk and shoulder blades. A physical therapist can help analyze the source of the problem and help find a solution.

Can this Injury or Condition be Prevented?

Yes! You can help prevent tennis elbow by staying fit, using proper technique in your sport or in your job, and using equipment that is well designed and appropriate for your body type and your level of activity. Your physical therapist can show you how. If you had tennis elbow years ago, you might be at risk for re-injury if the tendons did not have time to completely heal or if your muscle strength and joint mobility were not fully restored. Returning to sports or activities before you have fully recovered might result in an elbow that has persistent pain or is easily or frequently re-injured. A physical therapist can help determine when you are ready to return to your activities and sports and can help make sure that your elbow, forearm, and wrist are strong and ready for action.

Real Life Experiences

You work as a computer graphics engineer. Yesterday, you spent the day gardening with an electric lawn trimmer. This morning you woke up with pain and a feeling of stiffness on the outside of your elbow. The pain increases the more you move your elbow, forearm, and wrist. It also hurts to use your computer mouse or to pick up your coffee cup. You immediately schedule an appointment for an evaluation with a physical therapist. A physical therapist performs a full examination of your elbow and surrounding muscles and joints and can determine whether additional tests or referral to another health care provider is necessary. In most cases of tennis elbow, the therapist will manage your care through your full recovery.

This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:

A physical therapist who is experienced in treating people with musculoskeletal problems.
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopaedics physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

Get recommendations from family and friends or from other health care providers.
When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with tennis elbow.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Shoulder Labral Tear→

September 20, 2018/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

An unstable shoulder joint can be the cause or the result of a labral tear. "Labral" refers to the ring of cartilage (glenoid labrum) that surrounds the base of the shoulder joint. Injuries to the labrum are common, can cause a great deal of pain, and may make it hard to move your arm. A labral tear can occur from a fall or from repetitive work activities or sports that require you to use your arms raised above your head. Some labral tears can be managed with physical therapy; in severe cases, surgery may be required to repair the torn labrum.

The ring of cartilage called the glenoid labrum provides extra support for the shoulder joint, helping to keep it in place. A shoulder labral tear occurs when part of this ring is disrupted, frayed, or torn. Tears may lead to shoulder pain, an unstable shoulder joint, and, in severe cases, dislocation of the shoulder. Likewise, a shoulder dislocation can result in labral tears.

When you think of the shoulder joint, picture a golf ball (the head of the upper-arm bone, or humerus) resting on a golf tee (the glenoid fossa, a shallow cavity or socket located on the shoulder blade, or scapula). The labrum provides a rim for the socket (golf tee) so that the humerus (golf ball) does not easily fall off. If the labrum is torn, it is harder for the humerus to stay in the socket. The end result is that the shoulder joint becomes unstable and prone to injury.

Because the biceps tendon attaches to the shoulder blade through the labrum, labral tears can occur when you put extra strain on the biceps muscle, such as when you throw a ball. Tears also can result from pinching or compressing the shoulder joint, when the arm is raised overhead.

There are 2 types of labral tears:

Traumatic labral tears usually occur because of a single incident, such as a shoulder dislocation or an injury from heavy lifting. People who use their arms raised over their heads—such as weight lifters, gymnasts, and construction workers—are more likely to experience traumatic labral tears. Activities where the force occurs at a distance from the shoulder, such as striking a hammer or swinging a racquet, can cause a traumatic labral tear. Falling on an outstretched arm also can cause this type of tear.

Nontraumatic labral tears most often occur because of muscle weakness or shoulder joint instability. When the muscles that stabilize the shoulder joint are weak, more stress is put on the labrum, leading to a tear. People with nontraumatic tears tend to have more "looseness" or greater mobility throughout all their joints, which might be a factor in the development of a tear.

How Does it Feel?

A shoulder labral tear may cause you to feel:

Pain over the top of your shoulder
"Popping," "clunking," or "catching" with shoulder movement, because the torn labrum has "loose ends" that are flipped or rolled within the shoulder joint during arm movement, and may even become trapped between the upper arm and shoulder blade
Shoulder weakness, often on one side
A sensation that your shoulder joint will pop out of place

How Is It Diagnosed?

Not all shoulder labral tears cause symptoms. In fact, when tears are small, many people function without any symptoms. However, healing may be difficult due to the lack of blood supply available to a torn labrum. The shoulder with a labral tear may pop or click without being painful, but if the tear progresses, it is likely to lead to pain and weakness.

If your physical therapist suspects that you have a labral tear, your physical therapist will review your health history and perform an examination that is designed to test the condition of the glenoid labrum. The tests will place your shoulder in positions that may recreate some of your symptoms, such as "popping," "clicking," or mild pain, to help your physical therapist determine whether your shoulder joint is unstable. Magnetic resonance imaging (MRI) also may be used to complete the diagnosis. Some labral tears may be difficult to diagnose with certainty without arthroscopic surgery. Your physical therapist may consult with an orthopedic surgeon if necessary.

How Can a Physical Therapist Help?

When shoulder labral tears cause minor symptoms but don’t cause shoulder instability, they usually are treated with physical therapy. Your physical therapist will educate you about positions and activities to avoid, and tailor a treatment plan for your recovery. Your treatment may include:

Manual therapy. Your physical therapist may provide gentle manual (hands-on) therapy to decrease your pain and begin to restore movement in the shoulder area.

Strengthening exercises. Improving the strength of the muscles of the shoulder will help you decrease the stresses placed on the torn labrum and allow for better healing. Your physical therapist may design rotation exercises that target the muscles of the shoulder joint, and shoulder-blade (scapular) exercises to provide stability to the shoulder joint itself.

Stretching exercises. An imbalance in the muscles or a decrease in flexibility can result in poor posture or excessive stress within the shoulder joint. Your physical therapist may prescribe stretching exercises—such as gentle stretches of the chest (pectoralis) muscles—to improve the function of the muscles surrounding the shoulder. Your physical therapist also may introduce middle-back (thoracic) stretches to allow your body to rotate or twist to the side, so the shoulder joint doesn’t have to stretch further to perform tasks, such as swinging a racquet or golf club.

Postural exercises. Your physical therapist will assess your posture, and teach you specific exercises to ensure your shoulders are positioned properly for daily tasks. A forward-head and rounded-shoulder posture puts the shoulders at risk for injury.

Education. Education is an important part of any physical therapy treatment plan. Your physical therapist will help you understand your injury, the reasons for modifying your activities, and the importance of doing your exercises to decrease your risk of future injury.

Home-exercise program. A home-exercise program is an important companion to treatment in the physical therapy clinic. Your physical therapist will identify the stretching and strengthening exercises that will help you steadily improve your shoulder function and meet your work, home, and activity goals.

Following Surgery

In more severe cases, when conservative treatments are unable to completely relieve the symptoms of a labral tear, surgery may be required to reattach the torn labrum. Following surgery, your physical therapist will design a treatment program based on your specific needs and goals, and work with you to help you safely return to your daily activities.

A surgically repaired labrum takes 9 to 12 months to completely heal. Immediately following surgery, your physical therapist will teach you ways to avoid putting excessive stress or strain on the repaired labrum.

As the labrum heals, your physical therapist will introduce resistance and strengthening exercises, such as those listed above, to your treatment plan, to address your specific needs, and help you slowly and safely return to performing daily tasks that require force or lifting. Your physical therapist is trained to gradually introduce movements in a safe manner to allow you to return to your usual activities without re-injuring the repaired tissues.

Can this Injury or Condition be Prevented?

Forceful activities performed with the arms raised overhead may increase the likelihood of developing a labral tear. To avoid putting excessive stress on the labrum, you need to develop strength in the muscles that surround the shoulder and scapula. Your physical therapist can:

Design exercises to help you strengthen your shoulder and shoulder blade muscles
Show you how to avoid potentially harmful positions
Train you to properly control your shoulder movement and modify your activities to reduce your risk of sustaining a labral injury
Provide posture education to help you avoid placing unnecessary forces on the shoulder
Help you increase your shoulder and middle-back flexibility

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat patients who have a shoulder labral tear, but you may want to consider:

A physical therapist who is experienced in treating people with musculoskeletal problems. Some physical therapists have a practice with an orthopedic focus.
A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedics physical therapy has advanced knowledge, experience, and skills that may apply to your condition.

General tips when you're looking for a physical therapist (or any other health care provider):

Get recommendations from family and friends or from other health care providers.
When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with labral tears.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Thoracic Outlet Syndrome→

August 29, 2018/ Pro Dynamic Physical Therapy/ Travis Tanasse

Thoracic Outlet Syndrome (TOS) is a potentially painful and disabling condition of the upper extremity. It results from the compression of structures in the thoracic outlet, a space just above the first rib, and behind the clavicle (collar bone). Due to the range of signs and symptoms that can lead to a diagnosis of TOS, the incidence rates of the condition currently are unknown. Physical therapists work with individuals who have TOS to ease their symptoms and restore their upper-body function.

How Does it Feel?

Because TOS generally is classified based upon the type of structures compressed, the symptoms experienced may vary. However, more than 90% of TOS cases are thought to be neurogenic (nerve compression) in nature (categories 3 and 4 below).

Arterial TOS

Pain in the hand; rarely in shoulder or neck
Coldness or cold intolerance
Numbness and tingling

Venous TOS

Pain in the arm
Swelling in the arm
Change in arm coloration (appears bluish)
Feeling of heaviness in the arm
Numbness and tingling in fingers and hands

True Neurogenic TOS

Pain, numbness, and tingling in the hand, arm, shoulder, and often the neck
Headaches
Numbness and tingling of the arm, often waking the individual up at night
Hand clumsiness
Intolerance to cold
Hand coldness and color changes

Disputed Neurogenic TOS

Pain, numbness and tingling in the hand, arm, shoulder and often the neck
Headaches
Numbness and tingling of the arm, often waking the individual up at night
Hand clumsiness
Intolerance to cold
Hand coldness and color changes
Symptoms greater at night vs day
Tests may come back normal (hence, the term "disputed").

How Is It Diagnosed?

Diagnosis of TOS begins with a thorough health history and clinical examination.

Your physical therapist will likely check for color changes in the affected area, and gently attempt to provoke symptoms by moving the affected limb in different directions.

You also may be referred for diagnostic testing, such as a Doppler ultrasound, which can confirm arterial and venous TOS, or nerve conduction velocity testing to help confirm a true neurogenic TOS.

Your physical therapist may be the first to recognize an onset of TOS, because of its effects on your physical function. Your physical therapist may ask you:

When did you begin experiencing these symptoms, and when are they the worst?
Have you noticed any change in your symptoms when the temperature changes?
Have you noticed any significant changes in your ability to perform physical tasks that require hand movements?
Have you noticed any changes in the appearance of your arm or hand?

In addition, your physical therapist will rule out other conditions, which may mimic this disorder. Your therapist may ask you to fill out a questionnaire in order to better understand your physical state, and to screen for the presence of other conditions.

How Can a Physical Therapist Help?

Once you have received a diagnosis of TOS, your physical therapist will work with you to develop a treatment plan to help ease the discomfort, and improve your ability to perform daily activities. Most research on this condition recommends a treatment plan that involves physical therapy to help ease your symptoms and improve function.

Physical therapy treatments may include:

Manual Therapy. Manual (hands-on) therapy may be applied to manipulate or mobilize the nerves of the arm to help reduce symptoms, such as pain and numbness/tingling. Your physical therapist also may attempt to gently mobilize your first rib and/or collar bone.

Movement and Strengthening Exercises. Your physical therapist will teach you muscle-strengthening exercises to improve movement and strength in the affected area.

Education. Your physical therapist will teach you strategies that can help minimize your symptoms while performing your daily functional activities.

Activity modification and postural strategies: Your physical therapist will teach you positions and strategies to place less stress on the structures involved with TOS.

Can this Injury or Condition be Prevented?

While some cases of TOS cannot be prevented, such as those due to anatomical variations, congenital conditions, trauma, or space-occupying lesions, others may be avoidable. Understanding risk factors that could make you more likely to develop this condition is the first step in prevention.

Your physical therapist will work with you to develop strategies to help you better understand and manage your risk factors and symptoms. As with many conditions, education is key. Understanding strategies, such as methods of reducing symptoms while performing activities, can help you live a full and functional life after the onset of TOS.

Real Life Experiences

George is a 45-year-old used-car salesman who takes potential customers on test drives in a crowded city area. Recently on a test drive, his customer ran a red light and the vehicle was struck by another motorist on the passenger side, where George was sitting. George was shaken up, although the police assured him the actual collision was minor.

George was taken to the emergency room following the accident, and received an X-ray, which was negative for a fracture of his clavicle. Fearing that he may be having a heart attack, he also followed up with his primary care physician, who was able to rule that out as well.

Over the next few days, George felt pain on his right side, and numbness and tingling down his right arm. His symptoms seemed to be worse at night. He called in sick to work, fearing he could be injured further on the job. He called his physical therapist.

George's physical therapist conducted a full physical examination. During the exam, George reported that he felt very anxious about the recent event, and wasn’t sure he'd be able to trust taking customers on test drives anymore.

George's physical therapist noticed the presence of a rounded shoulder and forward-head posture, as she examined him. She was able to provoke George’s symptoms by gently placing his arm in particular positions, and gently pressing in the region of George’s first rib. She carefully checked for any other conditions that could be causing his symptoms. She told George that she suspected neurogenic TOS.

She developed a strategy for physical therapy that was best for him, consisting of activities and exercises to increase his strength, confidence, and function, while also easing his pain. She showed him postural activities to reduce compressive forces on his nerves. She also helped him with "nerve gliding" activities (encouraging his nerves to glide normally as his joints moved) to improve the function of the affected nerves.

Despite the complexity of the condition, George did well with his personalized course of physical therapy. Following several weeks of treatment and exercise, he was able to return to work without symptoms, and with a new-found confidence that he could ride in a car with customers again. With his physical therapist's ongoing help, George has returned to his normal activities of daily living.

This story highlights an individualized experience of TOS. Your case may be different. Your physical therapist will tailor a treatment program to your specific needs.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and clinical experience to treat a variety of conditions or injuries. You may want to consider:

A physical therapist who is experienced in treating people with TOS.

A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

General tips when you're looking for a physical therapist (or any other health care provider):

Get recommendations from family and friends or from other health care providers.

When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with TOS.

During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible. Keeping a journal highlighting when you experience pain will help the physical therapist identify the best treatment approach.

Guide to Calf Strain→

August 05, 2018/ Pro Dynamic Physical Therapy Inc./ Travis Tanasse

What is a Calf Strain?

The “calf muscle” consists of 9 different muscles. The gastrocnemius, soleus, and plantaris muscles attach onto the heel bone, and work together to produce the downward motion of the foot. The other 6 muscles cause knee, toe, and foot movements in different directions; these muscles are the popliteus, flexor digitorum longus, flexor hallucis longus, tibialis posterior, and the fibularis (or peroneal) longus and brevis. They extend from the lower leg bones around the sides of the ankle and attach to various parts of the foot and toes. Injuries to these 6 muscles are sometimes wrongly attributed to the first 3 muscles mentioned here, as the pain is felt in similar areas of the calf.

A calf strain is caused by overstretching or tearing any of the 9 muscles of the calf. Calf strains can occur suddenly or slowly over time, and activities, such as walking, climbing stairs, or running can be painful, difficult, or impossible.

A muscle strain is graded according to the amount of muscle damage that has occurred:

Grade 1. A mild or partial stretch or tearing of a few muscle fibers. The muscle is tender and painful, but maintains its normal strength. Use of the leg is not impaired, and walking is normal.
Grade 2. A moderate stretch or tearing of a greater percentage of the muscle fibers. A snapping or pulling sensation may occur at the time of the injury and after the injury. There is more tenderness and pain, noticeable loss of strength, and sometimes bruising. Use of the leg is visibly impaired, and limping when walking is common.
Grade 3. A severe tear of the muscle fibers, sometimes a complete muscle tear. A “popping” sound may be heard or felt when the injury occurs. Bruising is apparent, and sometimes a “dent” in the muscle where it is torn is visible beneath the skin. Use of the leg is extremely difficult, and putting weight on the leg is very painful.

When muscles are strained or torn, muscle fibers and other cells are disrupted and bleeding occurs, which causes bruising. Within a few hours of the injury, swelling can occur, causing the injured area to expand and feel tight and stiff.

After a severe calf strain, bruising may also be seen around the ankle or foot, as gravity pulls the escaped blood toward the lower part of the leg.

How Does it Feel?

If you strain your calf muscles, you may feel:

Sharp pain or weakness in the back of the lower leg. The pain can quickly resolve, or can persist.
A throbbing pain at rest with sharp stabs of pain occurring when you try to stand or walk.
A feeling of tightness or weakness in the calf area.
Spasms (a gripping or severe tightening feeling in the calf muscle).
Sharp pain in the back of the lower leg, when trying to stretch or move the ankle or knee.
A “pop” or hear a “pop” sound at the time of injury (with a Grade 3 calf strain).

Signs and Symptoms

With a calf strain, you may experience:

A snap or pull felt or heard at the time of injury (with a Grade 1 and 2 calf strain). A "pop" may be felt or heard at the time of injury of a Grade 3 calf strain.
Pain and weakness in the calf area.
Swelling in the area.
Tightness in the area.
Bruising.
Weakness in the calf when trying to walk, climb stairs, or stand.
Limping when walking.
Difficulty performing daily activities that require standing and walking.
An inability to run or jump on the affected leg.

How Is It Diagnosed?

If you see your physical therapist first, your physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will ask you:

What were you doing when you first felt pain?
Where did you feel the pain?
Did you hear or feel a "pop" when it occurred?
Did you receive a direct hit to your calf area?
Did you see severe swelling in the first 2 to 3 hours following the injury?
Do you feel pain when moving your ankle or knee, standing, or walking?

Your physical therapist will perform special tests to help determine whether you have a calf strain, such as:

Watch how you walk, and see if you can bear weight on the injured leg.
Test the different calf muscles for weakness.
Look for swelling or bruising.
Gently feel parts of the muscle to determine the specific location of the injury (palpation).

Your physical therapist may use additional tests to assess possible damage to specific muscles of the lower leg.

In certain cases, your physical therapist may collaborate with an orthopedist or other health care provider. The orthopedist may order further tests, such as an x-ray or magnetic resonance imaging (MRI), to confirm the diagnosis and to rule out other potential damage. These tests, however, are not commonly required for a calf strain.

How Can a Physical Therapist Help?

Your physical therapist will design a specific treatment program to speed your recovery, including exercises and treatments that you can do at home to help you return to your normal lifestyle and activities.

The First 24 to 48 Hours

Your physical therapist may advise you to:

Rest the area by avoiding walking or any activity that causes pain. Crutches or a brace may be recommended to reduce further strain on the muscles when walking.
Apply ice packs to the area for 15 to 20 minutes every 2 hours.
Compress the area with an elastic bandage wrap.
Insert heel lift pads into both of your shoes.
Consult with another health care provider for further services, such as medication or diagnostic tests.

Treatment Plan

Your physical therapist will provide treatments to:

Reduce Pain. Your physical therapist can use different types of treatments and technologies to control and reduce your pain, including ice, heat, ultrasound, electricity, taping, exercises, heel lifts, and hands-on therapy, such as massage.

Improve Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the knee and ankle. These might begin with "passive" motions that the physical therapist performs for you to gently move your knee and ankle, and progress to active exercises and stretches that you perform yourself to increase muscle flexibility.

Improve Strength. Certain exercises will benefit healing at each stage of recovery; your physical therapist will choose the appropriate exercises, and teach you how to safely and steadily restore your strength and agility. These may include using cuff weights, stretchy bands, weight-lifting equipment, and cardio exercise equipment, such as treadmills or stationary bicycles.

Speed Recovery Time. Your physical therapist is trained and experienced in choosing the right treatments and exercises to help you safely heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.

Return to Activities. Your physical therapist will collaborate with you to decide on your recovery goals, including your return to work or sport, and will design your treatment program to help you reach those goals in the safest, fastest, and most effective way possible. Your physical therapist will apply hands-on therapy, such as massage, and teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.

Prevent Future Reinjury. Your physical therapist can recommend a home-exercise program to strengthen and stretch the muscles around your ankle and knee to help prevent future reinjury of your calf. These may include strength and flexibility exercises for the calf, toe, knee, and ankle muscles.

If Surgery Is Necessary

Surgery is rarely necessary in the case of calf strain, but if a calf muscle fully tears and requires surgical repair, your physical therapist will help you minimize pain, restore motion and strength, and return to normal activities in the safest and speediest manner possible after surgery.

Can this Injury or Condition be Prevented?

Calf strains can be prevented by:

Increasing the intensity of any activity or sport gradually, not suddenly. Avoid pushing yourself too hard, too fast, too soon.
Always warming up before starting a sport or heavy physical activity.
Following a consistent strength and flexibility/stretching exercise program to maintain good physical conditioning, even in a sport's off-season.
Wearing shoes that are in good condition and fit well.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat calf strains. However, you may want to consider:

A physical therapist who is experienced in treating people with calf strains.
A physical therapist whose practice focus is in orthopedics or sports rehabilitation.
A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in sports physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

General tips when you're looking for a physical therapist (or any other health care provider):

Get recommendations from family and friends or from other health care providers.
When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have calf strains.
During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and describe what makes your symptoms worse.

Authored by Andrea Avruskin, PT, DPT. Reviewed by the MoveForwardPT.com editorial board.

Blog

Signs and Symptoms

How Is It Diagnosed?

How Can a Physical Therapist Help?

The First 24 to 48 Hours

Improve Your Ability to Move

Improve Your Strength

Use Your Muscles the Right Way

Return to Your Activities

Can this Injury or Condition be Prevented?

Real Life Experiences

What Kind of Physical Therapist Do I Need?

Further Reading

How Does it Feel?

How Is It Diagnosed?

How Can a Physical Therapist Help?

Following Surgery

Can this Injury or Condition be Prevented?

Further Reading

How Does it Feel?

How Is It Diagnosed?

How Can a Physical Therapist Help?

Can this Injury or Condition be Prevented?

Real Life Experiences

What Kind of Physical Therapist Do I Need?

Further Reading

What is a Calf Strain?

How Does it Feel?

Signs and Symptoms

How Is It Diagnosed?

How Can a Physical Therapist Help?

The First 24 to 48 Hours

Treatment Plan

If Surgery Is Necessary

Can this Injury or Condition be Prevented?

What Kind of Physical Therapist Do I Need?

Pro Dynamic Physical Therapy Inc.