Rehab for Very Weak Calves, Adjuncts, Screening and a Case Study

Patients whose one repetition maximum is below body weight, after rupture, a partial tear or severe tendinopathy, can train at home with double leg raises on bathroom scales, shifting from 50% to 100% of weight onto the affected side over four to six weeks, combined with holds and eccentrics. In the gym, the seated calf raise and leg press allow gradual loading from about 20 or 30 kilos up to body weight. Anti-inflammatories may help acute flare ups but probably not chronic tendinopathy, where paracetamol is likely better. A heel wedge trial in the British Journal of Sports Medicine found it effective, possibly more than exercise for some outcomes. Evidence for shock wave therapy, manual therapy and needling is mixed. Screening should cover metabolic, hormonal, rupture and inflammatory causes, with referral to a rheumatologist when needed. A case of severe insertional pain in a 105 kilo man with metabolic risk factors and a 55 kilo seated six repetition maximum improved with exercise and regular sessions with an exercise physiologist.