What is a calf strain and how can it happen?
A strain refers to an injured muscle or tendon that has partially or completely torn. A calf injury is most often caused during sports where you need to push off with your foot quickly for a sudden burst of speed. The sudden movement can stretch the muscle beyond its normal limits. This can happen suddenly or over time. Various sports such as rugby, football, tennis, baseball, soccer, dancing and even simple running are impacted by calf muscle strain injuries. Calf strains are common muscle injuries that if not managed appropriately can result in re-injury and prolonged recovery.
The calf muscles:
The "calf" refers to the muscles on the posterior aspect of the lower leg. It is composed of three muscles: the gastrocnemius, the soleus and the plantaris.
• Gastrocnemius muscle: Main function is plantar flexion of the ankle joint in conjunction with the soleus and the plantaris which provides the propelling force seen when walking. It also helps provide flexion at the knee joint. The gastrocnemius muscle is more susceptible to injury as it is a extends over both the knee and the ankle.
• Soleus muscle: Main function is stabilizing the tibia on the calcaneus limiting forward sway while helping the gastrocnemius with plantar flexion.
• Plantaris muscle: Acts with the gastrocnemius and the soleus as both a flexor of the knee and a plantar-flexor of the ankle.
These muscles come together to form the achilles tendon and all three muscles insert into the calcaneus.
How can a calf strain present?
Patients may feel pain depending on which muscle has being strained:
- Gastrocnemius strain: Can present as a sudden sharp pain or tearing sensation at the back of the lower leg. Patients often report an audible or palpable "pop" in the medial aspect of the posterior calf and tenderness to touch at the point of injury. Swelling and bruising may appear within hours or days of the injury. During examination stretching of the muscle and resisted plantarflexion will reproduce pain.
- Soleus strain: Tend to be less dramatic in clinical presentation and more subacute when compared to injuries of the gastrocnemius. This injury causes pain when activating the calf muscle. On examination stretching the Achilles tendon, walking on tip-toe or applying pressure at the calf muscle aggravates pain.
- Plantaris strain: Injury to the plantaris muscle can present with similar clinical features as those of the gastrocnemius and soleus muscle. Depending on the extent of the injury, the individual may be able to continue exercising although they will have some discomfort and/or tightness during or after activity.
Typical symptoms for all strains are stiffness, discoloration and bruising around the strained muscle.
Grading of strains:
Muscle strains are graded from I to III, with grade III being the most severe.
- Grade I: Partial stretch or tearing of a few muscle fibers. The muscle is mildly tender and painful, but maintains its normal strength. Leg use is not limited, and walking is normal. Average time to return to sports activities is 10 - 12 days.
- Grade II: Moderate stretch or tearing of muscle fibers. The muscle is tender with pain and loss of strength. Sometimes bruising will occur. Leg use is limited and limping when walking is common. Average time to return to sports activities is 16 - 21 days.
- Grade III: Severe tear of the muscle fibers. This can include a complete muscle tear. Bruising and swelling develops within hours of injury. Sometimes a "dent" is noticeable beneath the skin where the muscle is torn. Leg use is extremely difficult and putting weight on the leg is very painful. On examination a positive Thomson's test may reveal an Achilles tendon rupture. Average time to return to sports activities is up to 6 months if the injury requires surgery.
At the physician's office:
A doctor can diagnose a pulled calf muscle by carrying out a physical examination, during which they will check for swelling, bruising, and redness. They may also ask the person to describe any recent changes to their regular physical activity routine.
Many doctors use Ultrasound imaging to determine the extent of damage and X-rays to asses for fractures or calcifications. They may also use imaging techniques such as MRIs to gather soft tissue detail and assess the severity of the injury.
What is the treatment?
Treatment depends on the severity of the muscle strain. The following treatments may provide symptom relief:
- Ice and heat therapy: People can use a cold compress to reduce inflammation and relieve muscle pain during the first 2 days. After 2 or 3 days, you can try alternating cold with heat. (Do not go to sleep with a heating pad on your skin.)
- Wraps and bandages: Wrapping the injured calf in an elastic bandage or compression sock can help prevent swelling and inflammation.
- Elevation of the injured leg: Try to keep it above the level of your heart. This will help reduce swelling.
- Over-the-counter (OTC) pain relievers: People can take a pain reliever, such as ibuprofen or naproxen to relieve pain and reduce inflammation.
- Physical Therapy/Exercise: Some patients respond well to certain exercises.The goals of physical therapy are to improve strength, function, and stability.
- Surgery: Most calf strains will not require surgery and tend to recover well with physical therapy.
Physical Therapy Exercises:
Physical therapists treat people with calf strains by reducing pain, restoring muscle strength, restoring muscle flexibility, and increasing recovery speed. Some exercises that aim to strength these muscles are:
- Chair stretches: Sitting in a stable chair, bend and straighten the knee of your affected leg.
- Wall stretches: Face a wall and put your arms out so your hands are firmly against the wall at shoulder level. Straighten your affected leg with your heel pressed firmly into the ground. Then step your other leg forward so it’s at a 90-degree angle. Repeat the process as often as you feel comfortable throughout the day.
- Floor stretches: Sit on the floor with your affected leg straight. Flex your foot and set your heel firmly into the floor. Gently press your toes towards you for 5 seconds in this position.
- Standing stretches. Grip the back of a sturdy chair and lift yourself on the balls of your feet for 5 seconds. Patient can repeat this exercise up to twice a day.
What is the recovery and prognosis?
Recovery and prognosis will depend on the extent of the injury. In the less severe cases it usually takes up to three days for a pulled calf muscle to start feeling better. In the most severe cases that don't require surgery a full recovery may take up to six weeks. In the case that the injury requires surgery the recovery period may extend up to six months to a full year. Most people who have a pulled calf muscle will not need surgery.
Promt treatment is important for your overall recovery. While it may be difficult to rest your affected leg for a few days, moving around too soon can make the muscle strain worse. There’s also a risk for a recurring calf muscle strain within one to two weeks of the initial injury. Allowing yourself enough recovery time is critical to your calf muscle treatment.
Once you’ve had a pulled calf muscle, you’re at much greater risk for getting another strain of this type in the future. You can help prevent muscle strains and pulled calf muscles by:
- Warming up for at least five minutes before exercise
- Stretching your legs before exercising
- Cooling down for five minutes after you work out
- Stretching your muscles again for five minutes after you’ve cooled down
Author
Endrina Mangual Valladares MS3
Third year Medical Student at University of Medicine and Health Sciences (UMHS)
