Calf strains: Symptoms and Management

Calf Strains: Anatomy

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:

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.

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:

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:

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:

Endrina Mangual Valladares MS3 Third year Medical Student at University of Medicine and Health Sciences (UMHS)

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