Rehab framework for the calf
Estimating prognosis
Positive:
– First time calf injury
– Not high energy mechanism eg not
running/accelerating
– If there is a disconnection between capacity
and pathology on MRI
– Good calf baseline
– Good calf strength
Negative:
– Recurrent injury
– Running or high energy mechanism
– PHx of calf, ankle or knee injury
– Older age
– Poor calf baseline profile
– Poor calf synergists both local and
upstream
Acute rehab examples (completed ~3 x day)
– Theraband plantarflexion
– aROM + isometric
– Isometric standing straight knee heel raise
– Isometric seated bent knee heel raise
– Focus on proximal synergists early – hip and knee strength
Early rehab examples:
– Body weight heel raise → Neutral position – aim for around 60bpm on metronome
– Isotonic seated calf raises in neutral position
– Body weight isometric switches → Monitor heel drop
– Smith machine isotonic standing heel raises
– Early locomotive
– Lunges
– Heel to toe walking
– Stair walking
Locomotive exercise progressions:
– Stair ascents
– Walking – start at ~90bpm on metronome
– Weight vest/waterbag
– Jogging – ~170bpm
– Lunges
– Walking lunges
– Lunge arabesque
– Lunge doubles
– Progressing to using barbell/medicine ball
Intermediate to end stage rehab examples:
– Bodyweight single leg heel raise → Progressing into dorsiflexion
– Isotonic seated calf raises → Progressing into dorsiflexion
– Smith machine isometric switches → Increase load
– Smith machine isotonic standing heel raises → Increase ROM
– Plyometrics
– Start with vertical and progress to horizontal
– Once comfortable with above progress to lateral/rotation
– Running drills → A + B walk/skip variations
– End stage locomotive
– Triple extension onto box from hinged position → Add weight with dumbbells/barbell
– Prowler progressions
Plyometric progressions
– Double leg
– 1 on 1 off
– 2 on 2 off
– Single leg
