Phit Phorum: Physical Therapy Helps Phrankie Return to Soccer

Phrankie is a 35-year-old weekend soccer player. She tries to perform weight-training exercises 3 times during the week to keep her muscles strong. On the weekends, she plays in soccer tournaments with other players her age. In 1 game on a Saturday afternoon, she was running to intercept an opposing player who had the ball. In the middle of her sprint, Phrankie felt a sharp pull and snap in the back of her lower leg, in the upper part of her calf muscle. She had to stop running immediately, and limped off the field, barely able to use her injured leg to walk. She felt immediate pain in the injured calf, which did not get better that night. When she awoke the next morning, her calf felt swollen, tight, and too painful to walk. She called her physical therapist.

Phrankie’s physical therapist examined her calf, visually and by touch. He could see and feel the swelling in the area where Phrankie said she felt the snap during the game. He tested the ankle- and knee-joint motions, and found limitations in ankle motion. He also tested the muscle strength in each of her calf muscles, and concluded that the soleus and flexor hallucis longus muscles were overstretched and mildly torn. He diagnosed a Grade 2 calf strain.

Phrankie’s physical therapist started immediate treatment to limit and reverse the swelling and pain in her calf area, and restore her ankle motion. He performed hands-on treatment called edema massage (a slow 1-direction massage) and applied electrical stimulation to help reduce the swelling and pain. He taught Phrankie some simple movements to perform each hour to help restore her ankle movement and calf flexibility. He placed half-inch heel lifts in both of her shoes to keep her injured calf from having to stretch too much while walking.

Before Phrankie left the clinic, her physical therapist applied elastic tape to the calf to help reduce the swelling. He told Phrankie she could leave it on until her next physical therapy visit. He gave Phrankie crutches, and taught her how to use them to take some weight off her injured leg and maintain her balance. However, he explained to her that she still needed to try to put as much weight as she could bear on the injured side, and to use the knee, ankle, and foot as normally as possible, so the muscles and joints would not get stiff.

Phrankie performed her home exercises as instructed, and when she returned to physical therapy 2 days later, she had gained more movement in her ankle. Her physical therapist helped her start a program of gradual strengthening exercises that used light resistance with exercise bands, which did not increase her pain.

Phrankie continued attending physical therapy for 3 weeks, increasing her strengthening program until she was able to start jogging slowly. At that point, her physical therapist allowed her to start performing slow and careful sports drills in the clinic to begin regaining her soccer technique. Phrankie and her physical therapist worked on soccer-specific activities for another week, until she could run moderately fast, at which point she joined her weekend team for practice drills, but not for a game.

Five weeks after her injury, Phrankie was able to compete in her first game, playing for a full half. Phrankie heeded her physical therapist’s advice about consistently warming up her leg and calf muscles before practices or games. The next week, she was able to play a full game.

As the tournament schedule drew to a close, Phrankie was able to celebrate her team’s championship season knowing she was safely back at the top of her form.

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