Calf Strain

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Male athlete with calf pain, possibly due to a strain

A calf strain is an injury caused by damage to the muscles at the back of the lower leg. The majority of these injuries are minor tears to some of these muscle fibers. However, some calf strains can be so severe as to represent complete tearing (severing) of the calf muscles. When this happens, the affected individual will lose all or most of the function of the leg. Walking, running or even just standing up will become difficult or impossible.

Most calf strains involve damage just above the halfway point between the knee and ankle. The typical first sign of this injury is a sudden, sharp pain in this area. That pain will continue and will eventually be accompanied by tenderness and swelling of the calf area.

The appropriate treatment for mild calf strains includes resting the leg as well as applying ice. However, for the occasional severe calf strain, conservative home care may not be adequate and surgery may be indicated.

Calf strains are most commonly observed in men between the ages of 30 and 50.

Causes

The calf muscles of the lower leg run all the way down starting from the knee and connecting to the Achilles tendon just above the heel. The calf plays a key role in several athletic activities, including high speed or long distance running and bearing heavy weights. These activities demand both explosive power and endurance from the calf muscles and make calf strains more likely.

There are actually two major muscles in the calf area – the gastrocnemius and the soleus. The gastrocnemius  muscle has two heads. There is one on the medial or inner side of the knee and another on the lateral or outer side.

Either of these muscles can be damaged if one suffers a calf strain. However, the most common area of injury is the medial (inner) head of the gastrocnemius. The gastrocnemius is a biarthrodial muscle that extends over two joints – the knee and the ankle. Because of this, it tends to experience higher forces and is more vulnerable to overstretching or tearing (i.e. a strain).

The soleus muscle crosses only one joint (the ankle) and is therefore less vulnerable to strains. However, it should be noted that soleus strains do happen, albeit rarely.

Calf Strain Grades & Symptoms

As with most types of soft tissue injuries, doctors classify calf strains into 3 grades. We describe the extant of muscle damage and the accompanying symptoms below::

Grade 1

This is the mildest injury category. The calf muscle damage involves overstretching of the calf muscle but no tearing.

The patient experiences a sharp pain in the calf area at the time the injury occurs and may experience “tightness” afterwards. However, he or she may still be able to continue physical activity with mild discomfort at most.

This injury  is  referred to as a mild strain or “pull” of the calf muscle”.

Grade 2

This involves partial, but not complete, tearing of the calf muscle.

The patient will again feel a sharp pain in the calf at the time of injury and will be unable to continue physical activity. He or she will experience significant pain even from just walking. There may also be swelling in the calf area as well as mild to moderate contusions.

Grade 3

With this grade of calf strain, the patient will have suffered a complete tear (rupture) of one or more calf muscles.

There will be severe pain at the time the injury is incurred. It will most likely be felt at the point where the muscle meets the tendon, as that is where the rupturing frequently takes place. The injured individual will have to cease activities immediately. He or she will likely notice significant bruising and swelling in the calf area within hours of the onset of the injury.

Individuals experiencing these symptoms should contact a doctor (preferably one with a sports medicine background) for medical advice.

Diagnosing A Calf Strain

Diagnosing this injury is usually a straightforward process. However, the doctor will have to eliminate other causes of calf pain before concluding that a calf strain has occurred. Other possible causes of calf pain include a baker’s cyst, leg craps and blood clotting.

It is also important for the doctor to identify severe calf strains in which the muscle has been ruptured. In some (but not all) of these cases, it may be necessary to perform surgery to correct the damage.

Treatment

In general, the appropriate treatment of a calf strain depends on the severity of the strain. Almost all mild (grade I) or moderate (grade II) strains can be successfully treated by a P.R.I.C.E. protocol as described below.

Some of the strains in the most severe (grade III) category may require surgical intervention.

Conservative Home Based Treatment

The patient must be careful to Protect the calf by avoiding activities that could further aggravate his or her calf muscles. This may require keeping all body weight off the injured calf. To do this, the patient may be asked to consider using crutches or even a wheelchair.

The key to treating most grade I or II calf strains is to allow the injured muscle to Rest and recover naturally. Any activities that cause calf pain should be put on hold for the time being. The rest period should continue until the patient is once again pain free.

In addition to rest, the patient may be advised to do the following :

  • Occasional gentle calf muscle stretching, taking care not to cause any calf pain;
  • Apply Ice or a cold compress for 2-3 days after the injury has occurred. This will help to control the pain and swelling. Apply the ice or compress at intervals of 2-3 hours and for 20-30 minutes at a time. Be careful to avoid direct contact with the naked skin as this could cause skin injury;
  • Apply Compression to the calf area using a tensor bandage or a calf compression sleeve. This compression will improve blood circulation through the calf area. The enhanced supply of nutrient rich blood will help the injured muscles to recover more quickly;
  • Elevate the calf above heart level to improve the flow of blood back to the heart and (its replacement with fresh blood;
  • To further reduce swelling and inflammation, doctors may suggest using anti inflammatory medications such as Ibuprofen or Motrin;

A vital part of the treatment process will be undergoing physical therapy. The therapist will devise an exercise program to stretch and strengthen the calf muscles as the patient prepares to resume normal activities. This is an important step to reduce the risk of re-injuring the calf muscles at some future date.

Surgery

Although surgery is sometimes required to treat a calf strain, this is a relatively rare occurrence. Complete rupturing of calf muscles is relatively rare, so non invasive treatments are usually adequate.

Calf Strain Recovery Time

As with most injuries, this depends on the severity of the injury. It also depends on the patient’s compliance with recommended treatment. If the patient attempts to recommence normal activities prematurely, this could set back the healing process. The recovery period will then be longer as a result.

Having said this, for a grade I strain, most patients will be ready to resume normal activities in 7-10 days. However, for a grade 2 strain, the recovery period can be as long as 4-6 weeks. A grade 3 strain requires as much as 3 months or more before recovery is complete.

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