What’s really going on inside
A calf strain is an injury characterised by tearing of one or more of the calf muscles and typically causes pain in the back of the lower leg.
The calf comprises of 2 major muscles one of which originates from above the knee joint (gastrocnemius) the other from below the knee joint (soleus). Both insert into the heel bone via the Achilles tendon. The muscle’s main roles are plantar flexion (pointing your toes) and to assist in bending the knee.
Calf strains range from grade 1 to grade 3, majority are grade 2
Grade 1 (mild) – a small number of muscle fibres are torn resulting in some pain, but allowing full function
Grade 2 (moderate) – a significant number of muscle fibres are torn with moderate loss of function
Grade 3 (severe)– all muscle fibres are ruptured resulting in major loss of function
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, when jumping or when lunging forward. 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). The most common place to incur this injury is at the muscular tendinous junction (MTJ) of the Gastrocnemius; roughly halfway between the knee and the heel.
What you might be feeling
A sudden sharp pain or pulling sensation in the calf muscle can be felt at the time of injury. In minor strains, pain may be minimal allowing for continued activity. In more severe cases, patients may experience severe pain, muscle spasm, weakness, and the inability to continue activity. A severe calf strain may result in the inability to walk without a limp or weight bear correctly on the affected leg. Swelling, tenderness and bruising may also be present. In cases of a grade 3 tear a visible deformity in the muscle may be evident.
- Keeping calf muscles strong so they can absorb the energy of sudden physical stress
- Dynamic stretching of calf muscles before physical activity, i.e. calf rises.
- Practicing proper technique for exercise and sporting activities
- Undertaking fitness programs to develop strength, balance, coordination and flexibility
- Gradually increasing the intensity and duration of training
- Allowing adequate recovery time between workouts and or training sessions.
- Wearing correctly fitted footwear.
- Always checking the sporting environment for hazards.
- Drinking plenty of water before, during and after physical activity
Acute Management Advice
The immediate treatment of any soft tissue injury is the RICER protocol – rest, ice, compression, elevation and referral to a medical professional. RICE should be followed for the initial 48–72 hours post injury. The aim is to reduce the bleeding and damage to the muscle tissue. The leg should be rested in an elevated position with an ice pack applied for 20 minutes every two hours (never apply ice directly to the skin to avoid ice burn). A correctly sized compression bandage can also be applied to help limit bleeding and swelling in the injured area.
The No HARM protocol should also be applied which includes no heat, alcohol, running or activity, and no massage. This will help ensure decreased bleeding and swelling in the injured area.
How a physio can help
As pain decreases, gentle exercise and stretching can usually begin in addition to treatment recommended by a medical professional. Rehabilitation should be conducted under the supervision of a professional due to the risk of injury recurrence. Recovery can often be a slow process.