What is a calf strain?
The calves are a group of muscles at the back of the lower leg. There are two main muscles in this group, gastrocnemius and soleus. These muscles insert into the Achilles tendon, one of the strongest tendons in the human body. Injury can occur in either muscle or the tendon. Strains can range from mild to very severe and in extreme case even rupture of the Achilles tendon. They are commonly caused by excessive forces during explosive contraction, eccentric control loading or when your calf muscles fatigue.
What causes a calf strain?
Calf strains often occur following a rapid eccentric load (think rapid change of direction/landing with a straight leg and pushing off) the muscle can overstretch whilst having maximal contractile force causing the muscle to ‘tear’. Calf tears often occur during sports such as tennis, netball, squash with hard playing surfaces, or in contrast team sports that require endurance and power such as football codes where the muscle is enduring great stress under fatigue. People often can experience calf pain and tightness prior to the actual injury.
The most common calf muscle that is torn is your medial gastrocnemius, in the mid-belly. Tears at the Achilles musculotendinous junction second most likely. However, you can tear any of your other calf muscles; particularly lateral gastrocnemius or solues.
As with most injuries, accurate diagnosis is vitally important. Pain in the calf muscles can be from direct cause as discussed, i.e. a gastrocnemius strain, however it can also be from an indirect cause like knee, ankle, lower back and even a DVT (Deep Vein Thrombosis). Correct diagnosis, treatment and adequate rehabilitation will improve healing time and aim to prevent any future recurrence.
Imaging, such as an MRI or ultrasound, can help identify the severity of a calf injury but they are often unnecessary and rarely required.
There are common risk factors in most calf strains. They are :
- Athletes aged between 35-50.
- Lack of warm up and/or conditioning.
- The semi-active athlete or ‘Weekend Warrior’.
- Playing sports on hard surfaces or were fatigue is a factor as discussed above.
What are the symptoms of a calf strain?
- A calf strain usually has a sudden onset – often caused from running or jumping
- Can feel pain of a moderate discomfort to a severe pain
- Some people feel a ‘pop’ or a ‘pull’ with an odd sensation of release or cramp
- Pain located in the back of the lower leg, above the ankle and below the knee
- Difficulty/pain on walking particularly lifting the heel of the ground
- Definite tenderness around site of pain/injury
- May have some swelling or bruising
How is a calf strain diagnosed?
It is important to rule out other differential diagnoses such as deep vein thrombosis, tendon ruptures, radiculopathy from the lumbars and chronic compartment syndrome.
A calf strain generally ;
- starts with a sudden onset.
- moderate to severe pain.
- pain located in the back of the lower leg.
- occasionally a popping sensation immediately preceding the pain.
- difficulty to walk or putting pressure through foot.
- marked tenderness around the site of pain.
- may have visible swelling and bruising
Diagnosis will often be made via palpation, noting any muscle damage, swelling and tenderness. ROM and strength testing can help differentiate the grade of the injury
– Grade 1 calf strain (1-3 weeks).
With a grade 1 strain, there will be tightness in the back of the lower limb and may cause a minor limp. Awareness of calf discomfort and an inability to run or push off with any power or speed. Will commonly be mild pain and inflammation, may get some minor bruising. Pointing your toe or lifting your heel from the ground are likely to induce pain.
– Grade 2 calf strain (4-8 weeks).
With a grade 2 strain the limp will be much more noticeable and pain with walking will be present, with feeling of twinges or cramping feelings with activity. Inflammation will be increased and bruising may pool around the ankle
– Grade 3 calf strain (6 – 12 weeks).
A grade 3 calf strain is a severe injury involving a complete tear to half or all of the calf muscle. Crutches or even a moon boot may be required to enable walking due to severe pain and weakness. Immediate swelling and bruising will be present within 24 hours.
Calf strain treatment
- If you suspect you’ve torn your calf the first thing you should do is initiate the P.E.A.C.E. & R.I.C.E. principle, this can help speed up the healing process, weight bear as tolerated. If severe you may need to use some crutches.
- Recent studies have shown that the use of an ankle brace or a CAM boot that holds the ankle in dorsiflexion (think pulling the front of your foot up towards the head) has shown an increased rate of healing.
- Come in and see one of our excellent Osteopaths for assessment of strength and range of motion, this can indicate whether a scan is necessary, or whether rehab can start straight away.
How can an Osteopath help?
- Our dedicated osteopaths will assess severity of the injury and do some hands on therapy to relieve surrounding tension and improve range of motion.
- Over the course of the next couple of visits motion and strength will be improved with specific exercises and return to sport training advice to get you back on track.
- With this combination your osteopath will be able to aid in relieving muscle tension and pain.
- Strengthen your calf.
- Improve nociceptive abilities and balance.
- Improving speed and agility.
- Give you the best chance to avoid re-injury.
- If thought to be secondary to poor biomechanics of the foot and ankle, our new heat moldable orthotics may be warranted.
Dr. Cameron Bayliss
B Hlth Sc, B App Sc (Osteopathy)