Calf Strain

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Young man holding his lower leg, with possible pain from a calf strain

A calf strain is an injury caused by stretching or tearing of part of the calf muscles at the back of your lower leg. A stretched calf muscle is also colloquially known as a “pulled” muscle.

This injury usually announces itself initially by means of a sharp pain at the back of your lower leg. In cases of severe injury, you may also experience a “popping” or snapping sound or sensation from that area. Walking may become difficult or impossible.

Most calf strains are treatable using conservative self care steps including protecting and resting your calf and applying ice and compression to the area.

Types Of Calf Strain

The calf muscles actually consist of two muscle groups – the gastrocnemius and the soleus.

The gastrocnemius is the larger of the two and lies closer to the surface of your leg (the skin). It also has two heads at the top and extends over both the knee and ankle joints. The soleus muscle is smaller and lies deeper under the skin. Either or both of these muscles may be damaged if you experience a calf strain.

Calf strains can be categorized according to their degree of severity, as follows:

First Degree (or Grade I)

This is the mildest type of strain and (fortunately) it is also the most common. Either or both of the calf muscles may experience overstretching but no tearing (either partial or complete) will be present. Any interruption to your regular sporting or other injuries will be short – about 1-3 weeks.

As we mentioned at the start, this type of calf strain is also referred to as a “pulled” muscle.

Second Degree (or Grade II)

This is a more severe injury in which either or both muscles can be partially (but not completely) torn. You will experience an interruption to normal activity of around 3-6 weeks.

Third Degree (Grade III)

This is the most severe type of calf strain but also the rarest. One or both muscles will be completely torn, usually near the junction with the Achilles tendon at the bottom of your leg. This usually produces significant pain and may require surgical correction. Expect to be out of action for several weeks or even months, depending on the severity of the muscle tear..

Causes Of A Calf Strain

The most typical cause of a calf strain is a sudden contraction of the calf muscles as preparation for a jump or sudden burst of acceleration.

The gastrocnemius muscle tends to be particularly at risk in this situation as it is a biarthrodial muscle that extends over two joints (the knee and the ankle). As a result, it can be subject to greater forces than other types of muscle. However, as we have mentioned above, the soleus muscle can also suffer damage as part of a calf strain.

The sports in which calf strains tend to be most frequently observed include basketball, soccer, tennis and others in which jumping or sudden sprints are frequently required.

Many calf strains occur at or near the medial (inner) head of the gastrocnemium muscle. When this happens, the injury is also known as “tennis leg”.

Risk Factors

Some of the risk factors that may increase your odds of experiencing this muscle injury include:

  • Extensive participation in sports involving jumping or sudden bursts of acceleration or changes in direction;
  • Failure to warm up or cool down properly before starting your physical activity. Cold muscles are generally less supple and are more likely to suffer tears or other damage when placed under pressure.
  • Engaging in physical activity in cooler conditions without clothing that will keep you warm.Even if you have warmed up properly, the lower ambient temperatures can nevertheless place your calf muscles at risk of overstretching or tearing.

Symptoms Of A Calf Strain

Symptoms of this injury commonly include the following:

  • A popping sound or sensation from the calf area at the time the injury occurs;
  • A sharp sudden pain from the same area, which continues after the onset of the injury;
  • Difficulty walking or (in the case of severe strains) even standing up. If the injury is sufficiently severe, you may find it impossible to continue your activity ;
  • Your calf may feel “tender to the touch”;
  • You may experience a loss of strength in your lower leg;
  • Bruising or contusions from the calf area.

If you experience some or all of these symptoms, you should consult a doctor, preferably one with sports medicine expertise.

Treatment

Most calf strains respond to non surgical P.R.I.C.E. based treatment, such as:

  • Protecting the calf muscle from further stress by keeping as much weight off the injured leg as possible. You can do this by sitting whenever possible instead of standing. Activities that involve running or jumping should be avoided for the time being. Wearing a walking boot can also help to protect the injured muscle fibres and allow them to recover;
  • Allowing the calf muscle to Rest and recover naturally. In addition to refraining from activities such as those that caused the strain, you can consider using crutches to keep all weight off the injured leg.
  • Applying Ice or a cold compress to the injured area to control pain and swelling. For optimal results, do this at intervals of around 2-3 hours and for periods of about 20 minutes at a time. To avoid skin injury, do not press the ice or compress directly against your naked skin. Instead, wrap it in a damp towel or other insulating material before application;
  • For further pain control, consider taking an over the counter pain medication like Tylendon. To reduce swelling as well, you can try a non steroidal anti inflammatory drug (NSAID) like Advil;
  • Applying Compression to the injured muscle fibers using a tensor bandage or by wearing a calf compression sleeve. The compression will improve blood circulation through the injured area. The enhanced supply of nutrient rich blood will help to speed healing;
  • Elevating your injured calf above heart level as much as possible. Doing so will help stale blood leave the injury site and be replaced by fresh nutrient rich blood.

Once your healing is underway, your doctor will likely refer you to a physiotherapist. An important part of your treatment will be physical therapy exercises to stretch and strengthen your calf muscles. A physiotherapist can devise an exercise program to achieve this. This program will help you regain your original knee joint range of motion and to return to normal activity with less re-injury risk.

Having said this, it is important to avoid aggressive stretching of your calf muscles at an early stage of your recovery. Any stretching activity should be very gentle and should stop if you experience any calf pain.

At the same time, you would be well advised to avoid certain activities that may aggravate the injury. These would include:

  • Heat treatments. Avoid these during the first couple of weeks of treatment. They can aggravate swelling as well as any internal bleeding that may be occurring;
  • Alcohol consumption. Refrain from this until you are once again pain free;
  • Massage treatments of the calf area should also be avoided as part of protecting the injured muscles from stress.

Surgical Treatment

Although surgical treatment may be required for some grade III strains (with complete muscle tears) these are very rare indeed. If you do have this type of calf muscle strain, your doctors can suggest the possible surgical interventions with you and help you to choose one.

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