LEG PAIN - Calf Strain

A calf strain is a tear to one or both of the muscles at the back of the lower leg, usually the gastrocnemius muscle in the middle at the junction between the muscle and tendon. We explain a tear of the calf muscles as well as treatment and rehabilitation to return you back to full fitness.

Symptoms

Symptoms of a calf muscle strain can vary significantly but in general include a sudden sharp pain at the back of the lower leg. The calf muscle will be tender to touch at the point of injury and swelling and bruising may appear. Depending on how bad the calf injury is the athlete may be able to continue in some discomfort or they may be unable to walk in severe pain.

Calf strain explained

The calf muscles consist of the gastrocnemius muscle which is the big muscle at the back of the lower leg and the soleus muscle which is a smaller muscle lower down in the leg and under the gastrocnemius. 

Gastrocnemius is the larger of the two muscles which attaches above the knee joint and inserts into the heel bone via the achilles tendon. The Soleus attaches below the knee joint and then also to the heel via the achilles. Either of these two muscles can be strained. 

Both muscles act to plantar flex the ankle or point the foot away from the body as in standing up on tip toes. A calf strain usually occurs at the muscular tendinous junction where the muscles meet the achilles tendon. If the Soleus muscle is damaged there may be pain lower in the leg and also pain when you contract the muscle against resistance with the knee bent.

Calf injuries usually occur through a sudden pushing off force or an over-stretching of the calf muscles such as in jumping or changing direction quickly.

How bad is my calf strain?

A calf muscle tear is graded from 1 to 3, with grade 3 being the most severe.

Grade 1 symptoms

Grade 1 calf strain is a minor tear with up to 10% of the muscle fibers effected. The athlete will feel a twinge of pain in the back of the lower leg. They may be able to carry on playing or competing in mild discomfort. There is likely to be tightness and aching in the calf muscles two to five days after injury.

Grade 2 symptoms

Symptoms of a grade 2 strain will be more severe than a grade one with up to 90% of the muscle fibers torn. A sharp pain at the back of the lower leg will be felt with significant pain walking. There is likely to be swelling in the calf muscle with mild to moderate bruising. Pain will be felt on resisted plantar flexion or pushing the foot downwards against resistance. There may be tightness and aching in the calf muscle for a week or more.

Grade 3 symptoms

There will be severe immediate pain at the back of the lower leg. The athlete will be unable to continue and unable to walk. There will be considerable bruising and swelling appearing and the athlete will be unable to even contract the calf muscle. In the case of a full rupture, often there is deformity where the muscle can be seen to be bunched up towards the top of the calf. A grade three is a near, or complete rupture of the muscle.

See calf strain assessment and diagnosis for more detailed information.

Treatment

What can the athlete do?

Applying R.I.C.E. (Rest, Ice, Compression, Elevation) is essential. Cold therapy should be applied as soon as possible to help to quickly stop any internal bleeding. Ice can be applied for 10 to 15 minutes every hour initially reducing frequency as pain and swelling goes down.

Use a compression bandage, calf support or sleeve. A compression bandage can be applied immediately to help stop swelling but it should only be applied for 10 minutes at a time as restricting blood flow completely to the tissues could cause more damage.

Wear a heel pad to raise the heel and shorten the calf muscle hence taking some of the strain off it. It is a good idea to put heel pads in both shoes or one leg will be longer than the other creating an imbalance and possibly leading to other injuries including back injuries.

See a sports injury professional who can advise on a full calf strain rehabilitation program with stretching and strengthening exercises.

Professional calf strain treatment

A doctor or medical professional may prescribe anti-inflammatory medication e.g. ibuprofen which is beneficial in the first few days after the injury. Do not take ibuprofen if you have asthma.

Use electrotherapy such as ultrasound therapy. In the early stages this can help with pain relief and to reduce swelling. In the later stages of rehabilitation a micro massage effect can help stimulate blood flow in the muscle.

Use sports massage techniques for calf muscles after the initial acute phase. Sports massage can help by stimulating blood flow, stretching the muscle and loosening any tight knots, lumps and bumps in the muscle. Scar tissues is softened and new fibers aligned which will aid the healing process and help prevent re-injury.

Prescribe a full calf strain rehabilitation program with calf stretching and strengthening exercises.

Once the initial healing has taken place it is essential the lower leg is fully strengthened in order to reduce the likelihood that the injury will reoccur or have an adverse effect on future performances. For more detailed information on calf strain rehabilitation see our calf strain rehab page.

Source: http://www.sportsinjuryclinic.net/sport-injuries/ankle-achilles-shin-pain/calf-strain