Yipee ki yay. I'm Bob Schrupp physical therapist, Brad Heineck physical therapist
Together we are the most famous physical therapists on the internet, well in our opinion, of course Bob
So we're gonna discuss calf pain today. You must know this if you're having calf pain, is it a muscle strain?
Is it a clot or is it, we even have another thing it possibly could be
Compartment syndrome
We're gonna go over some of the possible signs of each and hopefully help you discern
But at some point you may have to go into the doctor to actually get this figured out
Yeah, you'll have to see a professional, particularly
For blood clot, but we're gonna go over some things that they're gonna look for and how they look for it as well.
So we're gonna start out with a muscle strain though, but even before that Bob
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Okay, so when you have calf pain very common
the most common cause, most likely cause is
Straining a muscle, a strain or slight tear, right
And the activity is usually you know what happened
Maybe you're out playing softball and you took off running from first base and you felt that sharp pain
You're jump roping, maybe running longer distances, very common in tennis players. Sure
Sometimes you could have a muscle strain and you don't really know where it came from
But you know, it may be going up the stairs aggressively when you weren't thinking about it, and it's creeped up on you
So one way or another the location, I'm gonna show my leg today Bob. All right, go ahead. The location is in
Typically the muscle belly, although if it's a tendon, you know
It may be lower down in here or right in the tendon itself. Then you might have a tendonitis, right
So that's a bit different then, but it does tend to be right in the middle here basically, that's where
The gastroc this bump here and the soleus muscle here oftentimes right on that borderline
Sometimes in a little deeper it does vary, it's
Often times point tender if you're pushing the muscle, if you can find the spot
It'll actually hurt, it might be the size of a quarter a little bigger than that, it's like oh there's the spot
That's pretty typical
When you stretch it or dorsiflex often times that may irritate it particularly if you go a little more aggressively
And you know actually and I know you're gonna mention some of the treatments Brad
but one of the treatments too is actually to wear
A little heel wedge for a while, sure, and that takes some of the stress off the cap
So you take like a half-inch heel wedge, put it in your shoe, which you can get by
Dr. Scholl's or something like that, sure you can get them at the store, and it'll take some of the stress off
the calf while it's healing, right if you do that, you should put one under each foot
otherwise, you'll have one leg essentially shorter than the other but if you do that also, you should notice that
It immediately feels better and it's a short-term thing
You're not gonna wear these in your feet because you don't want the heels to tighten up
other treatments for a muscle strain
You're gonna use cold packs initially when it's tender and sore 24 to 48 hours generally
You can do some gentle stretching, you know, you just injured it. You don't want to stretch it aggressively and re-injure it
So maybe some gentle range of motion and stretching initially particularly, ibuprofen if you want to do some anti-inflammatory
Over-the-counter
And then you know after it's starting to heal you may get into some soft tissue work either some cross friction mobilization
or the six inch roller where you're going to work on that, we don't have time to get into these treatments
We have a whole video on this. So if you type in Bob and Brad and put in calf injury
I mean it'll pop up and, I think we've even got more than one video. I do think we do. Yes, same people though. Yeah.
Go ahead
Typically a calf strain is going to heal within you know, two weeks is probably getting you know, pretty good
it may go up to six weeks depending on how aggressive you are if you you know go out and
Run or do something to irritate it, they tend to respond well
I mean, and two weeks is probably if it's a new injury and you do the cross fiber
Right away six weeks might be more for a chronic problem. Sure. So yeah, but it should heal
I mean, oh, yeah. So now the next one we're gonna go to is Compartment Syndrome
This is a more of a rare event, right
But you know, it's not like it never happens. Right, right
It's out there and you know, you can Google it and look it up
I was just talking to a podiatrist who works with this and she actually does surgery on it
Last week and had a chance to talk to her about it, but you have actually four compartments in your calf and each compartment has
Muscles in it and when you exercise those compartments start to fill up with blood because the muscles need the blood
But the blood doesn't exit the way it's supposed to, in Compartment Syndrome. Normally it does exit, right precisely
so what happens is blood's going in because you exercise, the blood's not going out for whatever reason and the
compartment starts to fill up and gets too much pressure get too much lactic acid in there pain starts and
typical symptoms are once you start an activity
within a short time you get a real sharp pain but then when you stop
The pressure goes down and it feels better
You do your activity again sharp pain stop
If it's serious
You'll see some swelling you may have numbness tingling down your foot because the nerve and the blood flow is being
Compromised, right. So if you're getting those kind of symptoms
neurological symptoms
Then you know, you got to go in. I think you're gonna see this quite often in runners
I mean this type you might see it as an a runner or biker because you're using the calf a lot. Sure
You know when I was running when I was younger I'd get a little numbness there
Yeah, and I think it was just a mild form of Compartment Syndrome
Another time you get Compartment Syndrome is after trauma. If the leg gets broken or a crushed syndrome where the leg got smushed
That can irritate and start the blood flow problems, which can lead to
Compartment Syndrome, so the compartments are made out of fascia and the muscles are inside the fascia
They form again kind of a tube almost right around the muscle and again, they can only expand so much
So the muscles expand from the blood flow.
It's compromising on the blood and the nerves. That fascia's tough it's not
As far as treatment on this
Particularly if it's serious, it's a simple surgery
The podiatrist Maggie she said it's simple once they
Prepare everything it's 15 minutes
They go in it's an incision. They open up the compartment, releases a pressure
It actually has to heal up and it's all soft tissue. I wouldn't recommend doing it yourself
Don't take the little butcher knife, well, that's what I say if this is so simple, maybe we do it
Yeah, but she said probably not. No. Yeah and finally the most
The last but not least and probably the most serious and probably the second most common
I'd say wouldn't you? Sure. Yeah, I mean I've seen probably five cases of this
okay, and what we're talking about is a DVT or a blood clot, deep vein thrombosis
Professional term, right the layperson calls it a blood clot and
That can happen here often times, it's a little closer to the knee
You can get these blood clots throughout the body or anywhere, but this is a common location for them
The worry is that the blood clot could dislodge and go up into your lungs. So I mean, there was a reporter years ago
Remember we discussed this before, it was during the Iraq war. Oh right. Mhm
He actually was killed because he was driving around in the tanks so long
Then he was inactive and he developed a blood clot and it went up to his lungs and killed him. Right so far it's causes and his
Reason that he got the blood clot was because he was sitting still for so long for hours at a time
Right, and that's why you know, the concern is on airplanes
That's why we tell you when you're on an airplane to go ahead and do ankle pumps because you're sitting still
And I think there's something to do with the air pressure to, isn't it on airplanes
You know that I'm not sure but as far as the simple thing is getting some exercise you get these muscles working
Keep the circulation moving
You're more at risk after surgery, obviously
Surgery or maybe an injury that things are healing down here
If you have a lot of swelling in your leg for whatever reason a little more concerned about it
If you've suddenly become more sedentary for a reason and maybe because of an injury or something, then you could be more at risk
Normally you're active, right, you broke a leg or whatever and you're sitting around for days on end because of the injury
But waiting for it to heal that's always a concern as far as symptoms
and this is what I do, you know in the clinic
You know, I'll squeeze I'll feel for temperature
Tenderness, when you squeeze an area that's got a deep vein thrombosis it's pretty tender, yes it is
And then we've stretched the ankle. There's a test called the Homan sign
We're not going to go through it in detail
but you palpate, you stretch the muscle you check for temperature and the thing is if
It's positive in the clinic
Chances of it being a false positive are pretty high. Yeah, in other words 50% of the time
It may be a positive Homan's sign saying, oh it looks like a deep vein thrombosis
And you take it in and do the confirmation test
which is an ultrasound which is done in you know in the hospital
Or where they have an ultrasound and that's gonna tell you for sure
So I don't recommend you try to diagnose yourself with either Compartment Syndrome or blood clot
You need a professional to do it. Yeah, that's been my experience
I probably have had 10 people sent in to check to see whether or not they've had a blood clot and it's been five
Or six that did. So it goes along with the study that right about 50%
And you know quite often, you know
what I'll do to is like I'll squeeze this side and I'll squeeze the other side and compare and if they both hurt like
Yeah, they're always tender to me, you know
Usually we take a lot of things into consideration, right
And that's why it's something you need to work with
Day after day year after year to really get a good feel for both Compartment Syndrome and a blood clot or DVT
So I hope this helps you understand a little bit about calf pain and some of the more common
Reasons for it and then you know what to do about it
Yeah, watch our other video if you do need help with that calf strain, so thanks everybody for watching.