Combat Arts Calf Kick Injuries
Many full combat martial arts involve moves that require strong calves. Take taekwondo, for example: it involves fast spinning kicks that demand calf strength, and training these arts loads the gastrocnemius and soleus hard. Calf injury is a common issue among athletes, especially those engaged in combat sports.
Calf strains, pulls, and tears are very common in athletes, especially those involved in endurance sports — endurance coaches sometimes call a sudden calf tear a “calf heart attack” because of how abruptly it strikes and how it stops you dead. Most combat artists train for endurance as well, and the marathon matches and sparring practices can strain the calf just the same.
Causes of Calf Injury
Calf kicks are common in striking arts, and the calf is an easy target for a low, fast kick. Being kicked in the calf usually produces a deep bruise, or contusion, that leaves the leg heavy and dead rather than the muscle tear described below. The gastrocnemius tear is a different mechanism: the muscle is stretched under load, and any stretch past its threshold can tear it. Conditioning and strengthening the calf helps it tolerate both.
Source: wavebreakmedia, Standard License, via Shutterstock
Calf Injury Symptoms
Source: Cast Of Thousands, Standard License, via Shutterstock
Types of Calf Injuries
The most common calf injuries are pulls and strains, where a few muscle fibres are overstretched, and contusions from absorbing a kick. The gastrocnemius can also rupture outright, and this injury looks and feels very similar to an Achilles tendon rupture. That is why it matters to identify a gastrocnemius tear properly. The section below covers that tear; a milder strain is managed the same way, with less time off.
Related injuries
Gastrocnemius Tear
A gastrocnemius tear does not only occur only while training. The overworked muscle is susceptible to injury while simply standing up from a seated position or taking a step down the stairs. The calf muscles have a certain threshold for stretch beyond which it can tear. This threshold varies according to age, flexibility, muscle conditioning, and strength.
Source: Maridav, Standard License, via Shutterstock
Gastrocnemius Tear Symptoms
Athletes may experience a bruised calf muscle, evident by discoloration and tenderness in the area.
Gastrocnemius Tear Causes
The calf muscles or the gastrocnemius is the most overlooked muscle of the leg. When those in combat arts talk about shin conditioning, they’re only focused on the shin and not the calf. The injury takes place at the back of the knee, where the gastrocnemius begins. The muscle is injured with the knee extended and the ankle fully dorsiflexed, which stretches the gastrocnemius to its limit. It also increases the elastic tension and can far exceed the threshold at which a muscle tears.
This more the case when the muscle is eccentrically contracted. Calf kicks are very common Muay Thai and kickboxing. The gastrocnemius muscle is prone to injury as it involves three joints. These are the knee, ankle, and subtalar joint. Muscle fatigue also contributes to injuries. Failure of the muscle to relax plays an important role in developing a tear. Since they cannot relax, the fibers are vulnerable to injury during stretching.
To learn how Gastrocnemius Tear is diagnosed Click Here
Common injuries
Find out more about other injuries affecting the calf-like strains in our Common Injuries section.
Diagnosis of Gastrocnemius Tear
The diagnosis of the tears to the gastrocnemius-soleus complex is done via physical exam and imaging. Imaging is very important as it differentiates the injury from other tendinous injuries.
Calf Strains, Pulls, and Tears Are Common in Combat Athletes
Ready to Start the Healing?
Injury Specific Diagnosis
Gastrocnemius Tear
Physical Exam
The physical examination should involve checking ecchymosis and tenderness over the site of the muscle tear. The doctor might palpate a subcutaneous gap if there is a frank retraction. This may or not be visible to the naked eye.
Passive stretching of the calf and resistive plantar flexion tests are done along with an active and passive range of motion tests to the knee and ankle. Any pain on stretching the calf or resisted plantar flexion is a red flag for a calf injury.
Imaging
Imaging studies are very important for lower extremity injuries. In gastrocnemius tears, they can differentiate partial from complete ruptures. Plain films and CT plays a very limited role in muscular injuries. Ultrasound is cheaper and shows signs of disruption of the normal fibers at the myotendinous junction. It can also visualize a hematoma, and or fluid collection between the gastrocnemius and soleus muscles.
Ultrasound can differentiate partial from complete tears. It can also provide a fairly accurate size of the hematoma. Larger hematomas usually suggest a complete tear of the gastrocnemius muscle. It can determine the size of a complete rupture. This is helpful if doctors do a percutaneous aspiration of the hematoma.
Ultrasound can pick up a deep vein thrombosis in the presence of a tear without any visible signs on imaging. Doctors even use the ultrasound to follow up during recovery if the muscle is healing well.
Magnetic resonance imaging (MRI) is the best imaging tool for soft tissue imaging. On MRI, the rupture or discontinuity of the muscle fibers is easily visible. Any retraction of the torn muscle fibers is also visible. MRI differentiates between gastrocnemius and Achilles tendon injury. It can assess surrounding connective tissues as well.
Using imaging the injury is staged. Grade 1 Injury (Mild): those in combat arts might be able to continue activity with pain, and only a small proportion of the muscle fibres is disrupted on MRI. Grade 2 Injury (Moderate): a partial tear. Walking is painful and limited rather than impossible, and there is weakness on ankle dorsiflexion and plantar flexion. On MRI the muscle shows edema or hemorrhage with a clear but incomplete disruption of the fibres. Grade 3 Injury (Severe): the calf has a defect or deformity, and walking is usually not possible. On MRI there is complete disruption of the muscle, with retraction and extensive hemorrhage or edema.
Lab Tests
Blood tests are not used to diagnose the injury. However, certain markers of inflammation can be done which suggests muscle inflammation. These include CRP, CK, and ESR.
To learn how Gastrocnemius Tear is treated Click Here
Common Diagnoses
Find out more calf strains are diagnosed through our Common Diagnoses section.
Calf Injury Treatment
The treatment of gastrocnemius tears depends on the type of tear and the presence of any associated injury. Recovery ranges from a couple of weeks for a mild strain to several months for a complete tear, so ask for a timeline based on the grade of your own injury rather than an average. Physical therapy is essential to make a full comeback to combat sports.
Injury Specific Treatment
Gastrocnemius Tear
Emergency Treatment
The first treatment is providing symptomatic relief. Rest, do not bear weight, apply ice, wrap the calf with a compression bandage that is snug but never tight, and elevate the leg. This will reduce swelling and pain. Never put a tourniquet on a torn calf: the muscle bleeds into itself rather than out through the skin, and a tourniquet only traps blood in the leg and drives the pressure inside it up. Two things need urgent assessment rather than home care. A calf that becomes increasingly tight, very painful, or numb can mean compartment syndrome, which is a surgical emergency. A calf that is swollen, warm, and painful can be a deep vein thrombosis, a clot that needs same-day medical assessment.
Medical Treatment
Medications are prescribed to reduce pain and muscle spasm. Early gentle movement is necessary to prevent contractures. Some doctors avoid the usual non-selective NSAID’s in the first 24 to 72 hours because their antiplatelet effect can increase bleeding into the muscle. A COX-2 selective NSAID such as celecoxib is one alternative, and acetaminophen or paracetamol is another. Opioid painkillers are prescription-only, are used sparingly and briefly if at all, and are not something to take on your own: they carry dependence risks and can mask a leg that is getting worse.
Physical therapy is instrumental to promote functional recovery. It must begin with gentle stretching. This can lengthen the intramuscular scar and prevent any contractures. After several weeks, strengthening exercises, heel raising, and proprioceptive exercises are added to the rehab protocol.
Core muscle strengthening and general reconditioning are gradually introduced as tolerated. After the pain subsides, the fighter can be allowed to walk and bear weight.
In cases of complete tears, weight-bearing is limited. Doctors may advise a cast or orthosis. Any dorsiflexion stretching or exercises, weight-bearing must begin only after the fighter is pain-free.
Most combats artists will do well with medical treatment. Surgical repairing of the muscle tear is necessary very rarely. The procedure is challenging in itself as suture through muscle tissue is difficult and it can lead to fibrosis and contractures.
Home Treatment
Return to play is a clinical decision rather than an MRI one: pain-free full range of motion, calf strength that matches the other side, and passing functional tests such as repeated single-leg heel raises and running. Scans often still look abnormal in athletes who are ready to train. To reduce the risk of these injuries, warm up properly and build eccentric calf strength and training load gradually — the evidence that static stretching before training prevents muscle injuries is unclear. Calf conditioning is very important to prevent these tears.
Common Treatments
Read how various therapies are used to treat common injuries of the calf in our Common Treatments section.
