Calf Strain

What Is A Calf Strain?

The calf is a group of muscles that point the feet and toes and support the arches of the foot. When you walk, the calf and Achilles act as a spring, absorbing force and helping you roll over your toes.  When we move forward quickly, these muscles contract allowing the toe off action.

The 2 largest muscles are called the gastrocnemius and the soleus. These muscles both go on to form the Achilles tendon which attaches on to the heel bone. A calf strain is when one or more of these muscles are torn and they become painful and inflamed.

What does it feel like?

The typical presentation of calf strain is an acute sudden onset of pain when running or jumping. There is a greater risk of injury if the muscles have not been warmed up properly. Initially weight-bearing is extremely painful and there may be swelling and even bruising visible in the calf. Because there are different degrees of tear it is important to get a correct diagnosis. The diagnosis is classified into one of the following:

1. Grade 1 – Sharp pain at the time of injury but usually able to continue with the activity, minimal loss of strength and range of movement. Some spasm and swelling. Mild localized pain and tenderness. 10 % damage to the muscle
2. Grade 2 – Sharp pain and unable to continue with activity, clear loss of strength and range of movement .10 – 50% damage to the muscle
3. Grade 3 – Immediate severe pain and disability. Complete loss of muscle function. Palpable defect or mass. Possible positive Thompson’s test. Over 50% tear to the muscle.

Complications of calf strains

In some cases the Achilles tendon may completely rupture. When this happens, people often report a loud snapping noise at the time of the injury – even if they are not the one whose achilles is rupturing! Surprisingly this injury may be less painful than a calf strain. And people may be able to stand. A very easy and accurate test for this is Thompson test. Kneel on a chair with the feet hanging off and squeeze the belly of the calf. A moving foot suggests the tendon is still intact, and if it does not then there is a complete rupture.

If you suspect you have a ruptured achilles tendon keep your weight off the affected side. seek medical advice immediately. Immediate surgical repair – ie surgery within days – has much better outcomes.

What should I do for my calf strain?

For the first 3 – 5 days after the injury, regardless of what type of strain you have you should follow the RICE guidelines (Rest, Ice, Compression, Elevation):

1. Rest – Avoid any weight bearing on the affected side to reduce further damage, use crutches if possible and put a wedge under the heel of the affected side. To keep the foot pointed down and avoid further injury.
2. Ice – Use an Ice Pack (frozen peas/ice cubes or other wrapped in a towel is fine). Put the ice pack over the painful area for 10 minutes every 2 hours during the day. It will help with pain.
3. Compression – Put a compression support or bandage on the calf, to get the correct tension you should just be able to fit two fingers inside the support.
4. Elevation – Keep the foot above the level of the heart when sitting. Avoid any massage or heat at this stage due to risk of haemorrhaging (bleeding) in the muscle.

What happens next?

Once the swelling and pain has started to subside, then it is advisable to start rehabilitation. Initially, I’ll need to diagnose what grade of strain you have and which muscles are affected. To do this, I’ll take a detailed case history of how the pain started and how it is progressing. I’ll then do tests to stress the soleus and gastrocnemius muscles individually to identify which one is causing the pain. I’ll press in and around the calf to isolate where the pain is and to feel for any masses or thickening in the muscle.

It is possible to strain both muscles in the calf but this does not necessarily mean the prognosis will be worse. Occasionally, ultrasound and MRI scans may be required to assist with diagnosis if the pain is severe and persistent.

How is a calf strain treated?

Once a diagnosis has been made then I’ll create a suitable stretching, strength and conditioning program. Other techniques may include massage and lymph drainage techniques to reduce the swelling and passive movement techniques to increase mobility and reduce the scar tissue formation.

Assessment of surrounding joints including knee, ankle, foot and hip may be carried out as well. This may pick up predisposing causes for the calf strain or secondary injuries from the strain. For example tightness in the ankle joint may increase tension in the calf muscles, which in turn leaves them less flexile and susceptible to injury.

How long will it take for my calf to get better?

Typically the recovery times for each grade of strain is approximately:

1. One – 7 – 10 days
2. Two  – 4 – 8 weeks
3. Three  – Up to 3 – 4 months

The prognosis for most calf strains is very good. However care must be taken to gradually re-introduce sport again as going back too soon can cause setbacks.  There is also a small risk that if this happens a return to your previous level of fitness and activity may not be possible due to scar tissue causing weakness.

If you have calf pain it’s important to get it assessed. Calf pain with swelling, warmth to the touch, or redness, get your calf assessed immediately at Accident and Emergency as the calf is a common spot for a potentially life threatening blood clot to form.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697334/
https://www.researchgate.net/publication/264008315_British_athletics_muscle_injury_classification_A_new_grading_system
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655731/