(Also known as Calf Strain, Calf Tear, Torn Calf Muscle, Strained Calf Muscle, Pulled Calf, Gastrocnemius Tear, Torn Gastrocnemius)
What is a calf strain?
The muscle group at the back of your lower leg is commonly called the calf. The calf comprises of two major muscles one of which originates from above the knee joint (gastrocnemius) the other of which originates from below the knee joint (soleus). Both of these muscles insert into the heel bone via the Achilles tendon.
During contraction of the calf, tension is placed through the calf muscle. When this tension is excessive due to too much repetition or high force, the calf muscle can be torn. This is known as a calf strain. Tears to the calf muscle can range from a small partial tear whereby there is minimal pain and minimal loss of function, to a complete rupture which may require surgical reconstruction.
Causes of a calf strain
Calf strains commonly occur due to a sudden contraction of the calf muscle. This frequently occurs when a patient attempts to accelerate from a stationary position or when lunging forwards such as while playing tennis, badminton or squash. Calf strains are also commonly seen in running sports such as football and athletics. Occasionally they occur due to gradual wear and tear associated with overuse. This may be due to activities such as repetitive jumping, distance running or walking excessively (especially up hills or on uneven surfaces).
Signs and symptoms of a calf strain
Patients with this condition usually feel a sudden sharp pain or pulling sensation in the calf muscle at the time of injury. Pain may increase during activities such as walking (especially uphill), going up and down stairs, running, jumping, hopping, or standing on tip toe. It is also common for patients to experience pain or stiffness after these activities with rest especially upon waking in the morning. Swelling, tenderness and bruising are often present in the inner belly of the calf muscle.
Diagnosis of a calf strain
A thorough subjective and objective examination from a physician is usually sufficient to diagnose a calf strain. Further investigations such as an MRI scan or Ultrasound may be required, in rare cases, to confirm diagnosis.
Treatment for a calf strain
Most patients with this condition heal well with an appropriate physical therapy program. The success rate of treatment is largely dictated by patient compliance. One of the key components of treatment is that the patient rests sufficiently from any activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
RICE in the initial phase of injury (first 72 hours) will greatly assist in improving recovery time in patients with a strained calf. This involves rest from aggravating activities, regular icing, the use of a compression bandage, and keeping the lower leg elevated. Anti-inflammatory medication may also help to reduce inflammation, pain and swelling. The use of crutches or a heel raise when walking may be necessary to protect the calf muscle from further damage and to hasten the healing process.
A graduated flexibility and strength program guided by a physiotherapist is essential to recondition the muscle and reduce the likelihood of injury recurrence. Careful assessment by the physical therapist to determine which factors have contributed to the development of the injury, with subsequent correction of these factors is also important to ensure an optimal outcome.
For those patients who wish to return to running, a graduated return to running program is essential in the final stages of rehabilitation to recondition the muscle for running in a safe and effective manner.
Prognosis of a calf strain
With appropriate management, patients with minor calf strains can usually recover in one to three weeks. With larger tears, recovery may take four to six weeks or longer depending on the severity. In cases of a complete rupture of the calf muscle surgery may be required with intensive rehabilitation to follow. Return to sport or activity may then take 6 months or longer.
Contributing factors to the development of a calf strain
There are several factors which can predispose patients to developing a calf strain. These need to be assessed and corrected with direction from a physical therapist. Some of these factors include:
Physiotherapy for a calf strain
- poor calf flexibility
- inappropriate training
- poor biomechanics or foot posture
- inadequate warm up
- ankle joint stiffness
- calf weakness
- inadequate rehabilitation following a previous calf strain
Physical therapy for patients with a calf strain is vital to hasten the healing process, ensure an optimal outcome and minimize the likelihood of recurrence. Treatment may comprise:
Other intervention for a calf strain
- soft tissue massage
- electrotherapy (e.g. ultrasound)
- anti-inflammatory advice
- joint mobilization
- ice or heat treatment
- exercises to improve strength, flexibility or balance
- activity modification advice
- biomechanical correction
- a gradual return to activity program
In the event of a complete rupture of the calf muscle surgery if often indicated. It is vital that all patients with a potential calf muscle complete rupture seek physical therapy or medical assessment as soon as possible to determine if the muscle is completely ruptured. This is vital as delayed treatment may result in a poor outcome due to shortening of the torn calf muscle. The patient's doctor or physical therapist may then refer on to an orthopedic specialist if it is warranted clinically.
Surgical repair of the ruptured calf muscle is generally considered the most appropriate form of management for active individuals seeking the highest level of function. This often involves a period of immobilization in a plaster cast for one to two months following surgery and a rehabilitation period of three to six months involving extensive physical therapy.
Conservative management of ruptured calf muscles may be appropriate for older individuals. This involves immobilizing the calf in a shortened position in a cast for approximately four weeks. The calf is then gradually stretched and strengthened over time.