When we opened Niseko Physio in 2006, I had no idea that calf muscle strains were so common in skiers. Soon after we opened, we had a gaggle of middle-aged Aussie skiers waddle up our wonky staircase in ‘The Brick’ and into our clinic with the now familiar calf muscle gait. Their hip is kept in external rotation, with the toes on their injured leg pointed out to 10 o’clock/2 o’clock with the foot raised from the hip as they avoided end-of-range knee extension and toe-off with every step.
The history became quite familiar; usually, a big-calved middle-aged male skier, whose ski tips dug into the powder and body rolled forward over the front of their skis. During the split second, the knees were straight; the gastrocnemius would give. I soon realised that although they were debilitated while walking, they could function at quite a high level, provided they kept their knees bent. Even jumping from side to side. We came up with the saying that these people could ‘ski before they can walk’. We found that many of them could return to skiing in about three days despite reverting to Calfgait above as soon as they removed their ski boots.
Over the years, we refined our management to fine art, procuring the exact products to assist people in returning to skiing and, more importantly, fully recovering from their injury and preventing DVT on their return trip home.
So what do we do for the gastrocnemius tears?
Firstly, the assessment should include the three staples for muscle tear assessment:
- Palpation to check tear length and depth
- Stretching – and do in bent knee and straight knee
- Manual Muscle testing – contracting the muscle, again in bent knee v straight knee
Invariable, the tear is in the gastrocnemius as it is asked to work maximally and unexpectedly, then overstretched while the skier goes ‘over the tips’. However, the soleus, which usually does all the work while skiing, is left uninjured. We spend a long time training patients to function with different tasks without straightening their knees, using our Game Ready Ice and compression machine, and providing heel raisers, a compression sleeve, and flight socks for the journey home. We also counsel on DVT prevention techniques before, during, and after the flight home and encourage people not to fly for five days post-injury. This season, we offer electric calf compression pumps and the Geko muscle stimulation for higher-risk DVT patients.
We also talk at length with our patients about their risk profile and goals – short and long-term and balance these with the extent of the injury and other variables. And, of course, we educate them on the risk of increasing the tear if they have a similar fall again. For some patients, skiing again on the trip is a high priority. Hundreds of our patients can ski very well soon after a gastrocnemius strain without a problem. Other patients are OK not to ski again on their trip.
As physiotherapists, we should try to help our patients achieve their goals where possible. I love nothing more than returning someone safely to running or another sport they love after they’ve been told they’ll never be able to do it again. Leave the black-and-white, dream-crushing advice to the old-school doctors.
Be sure to seek the right advice if you strain your calf skiing!
