Anatomy: The calf muscles are divided into three groups (muscle compartments) of powerful muscle membranes (fascias) that are partially unremitting. A forward, an exterior and a rear muscle group (which is divided into a superficial and a deep part). Each muscle group has its own blood and nerve supply.

Symptoms: With the chronic compartment syndrome, there is slowly insetting pain in the muscle after a few minutes activity. There is a sensation that the muscle is “tightened” and becomes hard, which is accompanied by discomfort. If the activity is stopped the discomfort diminishes, but returns a short period after the resumption of sports activity.

Examination: The diagnosis is made on the basis of the characteristic history and possibly with a pressure measurement in the muscle compartment (article).

Treatment: With the chronic muscle compartment syndrome the treatment comprises relief and slowly increasing training intensity, rheumatic medicine (NSAID) and massage (article). If there is scar tissue in the muscle, ultrasound guided injection of corticosteroid around the scar tissue formation can be attempted. In cases where there is a lack of progress a surgical splitting of the muscle membranes can be performed, which is usually a minor procedure with good results
(article-1) (article-2).

The rehabilitation is completely dependant on which muscle groups are affected. The sports activity can generally be slowly resumed once pain has diminished, under the principles mentioned under rehabilitation, general.

Anatomy: The calf muscles are divided into three groups (muscle compartments) of powerful muscle membranes (fascias) that are partially unremitting. A forward, an exterior and a rear muscle group (which is divided into a superficial and a deep part). Each muscle group has its own blood and nerve supply.

Symptoms: With the acute muscle compartment syndrome there is increasing pain, which is often more powerful than expected from the primary evaluation of the extent of the injury. At the same time sensory disturbances can occur in the toes.

Acute treatment: Click here.

Acute treatment: Off course compression bandage should not be applied.

Examination: The diagnosis is made on the basis of the characteristic history, increased circumference of the calf muscles, which are tight and hard and by a pressure measurement in the muscle compartment (article).

Treatment: With the acute muscle compartment syndrome the treatment in severe cases comprises acute splitting of the muscle membrane. It is imperative for the continuing function of the muscle that this operation be acute, which is, of course, only possible if the athlete seeks acute medical attention (article-1) (article) (article-3). 

Rehabilitation: The rehabilitation is completely dependant on which muscle groups are affected, the provoking cause (blow to the muscle, muscle rupture or over training) and which treatment that has been performed (relief, surgical splitting). The sports activity can generally be slowly resumed, once pain has decreased according to the principles as mentioned under rehabilitation, general.

Complications: Muscles and nerves can suffer permanent damage if the treatment is not started as soon as possible.

Special: Since there is a chance of permanent injury, the injury should be reported to your insurance agency.

Anatomy: The bones in the lower leg comprise the shin bone (tibia) and the calf bone (fibula).

Symptoms: Pain upon applying pressure (direct and indirect tenderness) and when under load (walking and running).

Acute treatment: Click here.

Examination: X-rays.

Treatment: The treatment comprises relief and bandaging. In some cases surgery is necessary depending on the type of fracture and any displacement of the fracture-surfaces.

Rehabilitation: The rehabilitation is completely dependant on the type of fracture and the treatment (relief, bandaging or surgical). Approximately six months’ rehabilitation must be expected before shin bone fractures allow resumption of maximum load, and approximately 3 months’ rehabilitation before calf bone fractures allow maximum load.
Also read rehabilitation, general.

Plastbandage: Individual plastic bandages can be manufactured for use during sports activity after bone fractures. Individual plastic bandages are particularly well-suited after a fracture of the fibula.

Complications: If progress is not smooth you should be medically re-examined to ensure that the fracture is healing according to plan. In some cases a false joint can be formed (pseudoarthrosis), requiring surgical treatment.

Anatomy: The bones of the lower leg comprise the shin bone (tibia) and the calf bone (fibula).

Symptoms: Pain upon applying pressure (direct and indirect tenderness) and applying load (walking, running).

Examination: X-ray. Since many stress fractures are not visible early in the course, x-ray examination can be repeated after a few weeks, if stress fractures are still suspected. Scintigraphy, MRI and ultrasound scans can often diagnose stress fractures far earlier than x-rays (Ultrasonic image) (Photo). It is crucial for the result of the treatment that the diagnosis is made as early as possible (article).

Treatment: The treatment primarily comprises relief and possibly bandaging. Only in special cases is surgery necessary. It is imperative that there are good shock-absorbing soles in the shoes (article).

Rehabilitation: The rehabilitation is completely dependant on the type of fracture and the treatment (relief or surgical).
Also read rehabilitation, general.

Complications: If progress is not smooth, you should be medically re-evaluated to ensure that the fracture is healing according to plan. In some cases a false joint is formed (pseudoarthrosis), which requires surgical treatment.

Special: Shock absorbing shoes or inlays will reduce the load.

Anatomy: The calf muscle (M Gastrocnemicus) is comprised of two muscle heads which gather in a wide tendinous ligament and continue in to the Achilles tendon. Another of the larger calf muscles (M Soleus) is attached to the front side of the Achilles tendon and thus forms a part of the Achilles tendon. It is these muscles that are most frequently subjected to ruptures and bleeding. On the lower leg there are many other muscles, where bleeding is relatively rare.

Symptoms: Pain and swelling in the muscle. In some cases a hard, tender accumulation can be felt (accumulated bleeding in the muscle). In other cases a bluish discoloration of the subcutis (the bleeding has penetrated the muscle membrane and spread into the subcutis). The pain is aggravated upon activation and stretching of the muscle.

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness and no discomfort when walking normally, medical examination is not necessarily required. The severity of the tenderness is, however, not always a measure of the extent of the injury. In case of more pronounced pain medical examination is required to ensure the diagnosis and treatment. A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the
diagnosis an ultrasound scan can be performed for ensuring the diagnosis
(Ultrasonic image) (article). The larger the bleeding, as evaluated by ultrasound, the longer the healing process.

Treatment: The treatment primarily consists of relief, as with muscle rupture in the calf. In cases of large accumulated bleeding the blood accumulation can be drained under ultrasound guidance. Some recommend treatment with rheumatic medicine (NSAID) and advise caution with massage to reduce the risk of myositis ossificans (formation of bony bars within the muscle).

Complications: If the course does not progress smoothly, you should be medically re-examined to ensure that the diagnosis is correct, and that complications to muscle ruptures have not arisen.

Anatomy: The calf muscle (M Gastrocnemicus) is comprised of two muscle heads which gather in a wide tendinous ligament and continue in to the Achilles tendon. Another of the larger calf muscles (M Soleus) is attached to the front side of the Achilles tendon and thus forms a part of the Achilles tendon. It is these muscles that are most frequently subjected to ruptures. On the lower leg there are many other muscles, where ruptures are relatively rare.

Symptoms: In light cases a local tenderness is felt after being subject to load (“sprained muscle”, “imminent pulled muscle”). In severe cases sudden shooting pains are felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst case a sudden snap is felt rendering the muscle unusable (“total muscle rupture”). With muscle injuries the following three symptoms are characteristic: pain upon applying pressure, stretching and activation of the calf muscle against resistance. With total ruptures a defect can often be seen and felt in the muscle, and above and below the rupture a swelling can be felt (the contracted muscle belly and bleeding). The most frequent place for ruptures on the lower leg is in the inner (medial) part of the calf muscle on the transition between the muscle belly and the tendon part of the muscle (“Tennis leg”).

Acute treatment: Click here.

Examination: In light cases (“sprained muscle”) with only minimal tenderness and no discomfort when walking normally, medical examination is not necessarily required. The severity of the tenderness is however, not always a measure of the extent of the injury. In cases of more pronounced tenderness or pain, medical examination is required to ensure the diagnosis and treatment. A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the diagnosis an ultrasound scan can be performed to ensure the diagnosis (article) (Ultrasonic image).

Treatment: The treatment of the vast majority of muscle injuries today involves relief and rehabilitation (article). In some cases with total ruptures, surgery can be considered.

Complications: If the course does not progress smoothly, you should be medically re-examined to ensure that the diagnosis is correct, and that complications to muscle ruptures have not arisen.