I decided to write this piece after recently straining my own calf in the middle of a pickleball game. In my case, I was doing some light footwork to position myself properly on the court, when I suddenly experienced a sensation as though somebody had hit me in the back of the lower leg. It felt so much like I’d been whacked with an object that I actually turned around to see who had done it!
Most players who experience a calf strain will tell you a story very similar to this one, and that feeling of being hit may or not be accompanied by a pop. Depending on the severity of the injury, the player may be able to walk afterwards with a little bit of pain, or they may not be able to walk at all. Following the injury, there is often a good amount of inflammation around the calf, in addition to quite a bit of muscle guarding and tightness.
I should mention that calf strains can vary from small overstretching injuries to 100% tears. This information is meant to serve as an educational resource, but nothing is as valuable as seeing a healthcare provider in person. Especially if the injury seems nasty, check in with your healthcare provider sooner than later. After all, it’s good to make sure that what you have is ‘just’ a strain and not something more serious.
The Early Phases - Do’s and Don’ts
Over the past few days, I’ve received a wealth of commentary from a ton of people (all well intentioned people, most of which aren’t aware that I’m a physical therapist). Some of the advice has been sound, some harmless, and some….rather strange or potentially harmful. I imagine that most people with visible injuries get bombarded with well-intentioned recommendations, so I wanted to go over some of the more common things that players are advised to do after a new calf strain.
Compression (Do): Swelling in the calf region can be a tricky thing to deal with, and often takes a while to go away. This is largely influenced by the fact that people spend most of their daytime hours either standing or sitting - this means that our blood vessels have to work against gravity in order to get rid of all of that extra fluid. Compression, whether it’s achieved with a calf sleeve, ACE bandages, or some other method, provides a little extra support to your blood vessels to help them do their job a little easier. This additional support also tends to help immensely with pain. A calf sleeve may also prove helpful once you’re well enough to start hitting the pickleball courts again. Though it isn’t needed long term, a little extra protection is helpful in the beginning, and players often report that it makes them feel more confident to move around on the affected leg as well.
Massage (Don’t): After a calf strain, the muscle typically becomes very knotted and tight. This can contribute to difficulty walking and increased pain, so many people think that a good massage will help to accelerate the healing. In fact, after a calf strain, you’re already likely dealing with quite a bit of swelling in your lower leg. Early tissue massage, though it may sound logical, can actually stimulate a further increase in blood flow and swelling. Additionally, given that massage right after a calf strain is likely to elicit quite a bit of pain, you may stimulate surrounding tissues to tighten even more as a protective mechanism.
Later down the road, once the injury is no longer new, massage is typically fine. It may be utilized as a later stage activity in conjunction with exercises in order to ensure proper tissue extensibility, function, and optimal healing. The timing is crucial.
Ice (Do): Honestly, there is a lot of disagreement out there regarding whether or not ice actually helps with actual injury healing. Ice decreases the rush of blood (and therefore essential clean-up cells) to the injured area, so some people theorize that it could slow down healing to some extent. Other healthcare providers are still big proponents of using ice to reduce things such as motion loss and difficulty with putting weight on the limb. Perhaps someday we’ll see general ice-related recommendations change, but at this point most sources still recommend it.
Ultimately, I think it’s also important to acknowledge that the effects of ice are temporary, that using it can create a considerable reduction in pain for a while.
Resume Pickleball with a Limp (Don’t!): I’ve seen so many people go back out on the courts when it’s clear that they’re still injured. I 100% have the pickleball bug too, guys, believe me. But it just isn’t worth it. Being able to resume walking normally is one of the earlier milestones of healing, and you’re just setting yourself up for a re-injury (which is usually worse than the initial one) if you resume play too soon. Additionally, the swelling and pain should be gone.
Gentle Motion Exercises (Do): Motion exercises have two major benefits after a calf strain. First, the pumping effect created by the tightening and relaxing of our leg muscles actually helps quite a bit with reducing swelling. Secondly, it’s pretty common for people to experience a loss of ankle motion following a calf strain (mostly in the letting-your-foot-off-a-gas-pedal motion). Even though they’re about as exciting as watching paint dry, gentle exercises such as ankle pumps and ankle circles can help with this substantially.
Motion exercises are especially good to do when you’re about to get up and walk. Just that little bit of a warmup and flexibility gain can make the initial footsteps a lot less painful and awkward.
Aggressive Stretching (Don’t): Many people believe in the notion of ‘no pain no gain,’ but this really doesn’t apply in the early stages following a calf strain. It’s important to respect the fact that calf strains are often an overstretching injury - by stretching aggressively, you risk causing further injury to the area, and may also be triggering the surrounding musculature to reflexively tighten even more. A bit of discomfort with movement after a new injury is typical, but if you’re pushing things to the point that you’re making yourself howl in pain, you’re likely doing much more harm than good.
Elevate (Do): Similar to compression, elevating your leg can be quite helpful for reducing swelling. Ideally, you want your calf to be above the level of your heart.
Apply Heat (Don’t): During the early stages of healing, your body is already creating inflammation as part of the healing process. Though inflammation is not the enemy, applying heat to the injured area will further increase blood flow and swelling, and this can lead to higher pain levels and more difficulty with moving around.
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Once a player makes it out of the early stage of injury, they’re well on the road to recovery. Depending on each person’s specific injury severity and needs, treatment plans may differ from one person to the next. But ultimately, players should be able to walk, put their weight on the affected leg, and replicate pickleball specific movements without pain or an increase in swelling before they get out there and play a real game.
I’m a big proponent of doing dinking games and drills as an initial return to play transition, just because you’ll be moving around a little less aggressively.
Unlike myself, I hope that you never find yourself needing to use the above advice on calf strains. However, injuries happen, and nobody is immune. It doesn’t always take ‘doing something stupid’ or even large or aggressive movements to get hurt.
Happy pickleballing my friends, and I hope to be back out there on the courts soon!
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Here at Serendipity Physical Therapy and Wellness, I’m well versed in working with pickleball players to treat issues such as calf injuries. I also provide wellness services to help players improve their game, provide guidance on injury prevention, and reduce aches and pains that can impact performance.
If you’re new, you can check out more of my advice and content here: https://www.serendipityptw.com/blog.
If there is anything I can help you with, or you have questions, please give me a call at (239) 232-8155, or send me an email at Contact@SerendipityPTW.com. I would love to see how I can help get you moving at your best!
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