Pulled up with a painful calf after a run or a sports match? Felt a “popping” or “pulling” feeling as you went to take off or change direction? Finding it hard to walk the following day or raise up onto your toes? Suffering from a cramping feeling in your lower leg?
You may be suffering from a calf strain!
What is a calf strain? How do you grad the severity of a calf strain? Signs and symptoms of a calf strain? Differential diagnosis for a calf strain? Immediate management of a calf strain? When to see a physio after a calf strain? How long until you return to sport after a calf strain? This article will answer all these questions and more!
What is a calf strain?
A calf strain occurs when fibers, which make up the muscle belly of the calf, become damaged or torn. This is most commonly due to a forceful contraction of the muscle during acceleration from a stationary position or change of direction but can also be caused by a high velocity stretching mechanism i.e. falling with your foot in a flexed position.
The most common muscle that is usually torn is the gastrocnemius muscle, which is a bi-articular muscle (meaning that it has the ability to move two joints). When the gastrocnemius muscle is torn the pain will typically be in the upper ½ of the calf. There is another muscle in the calf called the Soleus, which will typically present as pain and cramping in the lower ½ of the calf region.
When you sustain a muscle tear the is a classification system used to grade the significance of the injury. The grading system is outlined below.
Grading severity of a muscle strain
Grade I: The most minor and most common type of muscle tear. Usually you feel a sharp pain during an activity/sport in the muscle region. There is little or no loss of strength and only less than 10% of fiber destruction.
Grade II: A moderate injury with pain and pulling felt during an explosive or halting movement. This is coupled with moderate loss of power and some range of motion loss. Usually there will be enough pain to no longer continue the activity/sport. There is between 10 -50% fiber disruption associated with Grade II muscle strains.
Grade III: A severe injury which results in the complete rupture of the muscle. This is often felt via a similar mechanism as a Grade II injury but will involve significantly more severe pain, bruising, loss of strength and flexibility. Whilst usually a rare injury for the general population, Grade III injuries are more common for individuals competing in high intensity armature or professional sporting codes.
Signs and symptoms of a calf strain
Below are the common signs and symptoms that may indicate you have suffered from a calf strain:
- Calf pain
- Cramping or pulling feeling
- Painful walking and running
- Weakness on heel raise
- Unable to hop or pain with hopping
If you believe you have a calf injury or strain book an appointment with your physiotherapist.
Differential diagnosis for a calf strain
Sometimes when you have pain in your calf it may not mean you have a calf strain. There are other conditions that may present similar to a calf strain and may also need urgent medical review. These include:
- Deep vein thrombosis
- Neural referral from the lumber spine
- Medial tibial stress syndrome
- Compartment syndrome
- Achillies tendinopathy
It is important that if you are experiencing calf pain, particularly without a significant ‘event’ or mechanism you see a medical practitioner or allied health professional as soon as possible to rule out the above conditions.
Could your calf pain be Deep Vein Thrombosis (DVT)?
It is important when you have a calf pain to rule out deep vein thrombosis or DVT. If you meet any of the below risk factors you should always consult with your GP or physiotherapist immediately to rule out DVT:
- Recent air travel or surgery
- High blood pressure
- Overweight or obese
- On the oral contraceptive pill
- Over the age of 60 years old
- No clear event or mechanism of injury
- Swelling of the calf or ankle
- Cramping sensations
If your medical practitioner suspects a DVT they will refer you for a Doppler Ultrasound to rule out this condition.
Immediate management of a calf strain
When dealing with a soft tissue/muscular injury, the immediate treatment should always follow the POLICE principle for tissue healing:
- Protection – avoiding aggravating activities such as running/sport
- Optimal- choosing only appropriate activities, avoiding those that aggravate
- Loading – Using low load exercises to stimulate healing and maintain muscle strength
- Ice – icing for 10 minutes intervals in the first 72 hours (prolonged use of ice is not recommended)
- Compression – to provide some element of immobilisation and reduce swelling and bruising
- Elevation – will reduce swelling by increasing venous return
Also the No Harm protocol should be used during the initial days post injury:
This means avoiding:
It is also advised to avoid Non-steroidal Anti-Inflammatories (NSAIDS) as they dampen the body’s initial healing response and may increase the size of any hematoma’s that have formed.
When should you see a physiotherapist for a calf strain?
As soon as possible!
Gaining quality advice on how to be manage your injury starts from day 1. Book in to see your physiotherapist as soon as possible to improve your recovery time and reduce re-occurrence in the future.
What should you expect when you see a physiotherapist?
Your physiotherapist will perform a thorough assessment and commence initial treatment which will involve:
- Preliminary diagnosis for severity using the grade system (Grade I-III)
- Initial management of swelling and pain using heel raises and crutches if necessary
- Advice and education on prognosis and approximate prognosis of healing time
- Gentle ROM exercises and possibly commencing isometric exercise is appropriate
How long until I can get back to sport after a calf strain?
This will depend on the severity of your injury and the type of sport you do. It may be slightly longer if you play a jumping or sprinting sport.
Generally speaking the expected time frames are:
- Grade I Calf Strain = 1-2 weeks
- Grade II Calf Strain = 3-6 weeks
- Grade III Calf Strain= 6- 12 +weeks
What will my recovery look like for a calf strain?
Goal: Return to pain free walking
- Reduce pain by offloading the calf muscle
- Gentle ankle range of motion exercises to Restore flexibility
- Gait retraining
- Commence gentle calf strengthening using low load isometric exercises (sustained contractions)
- Avoid stretches in this phase
Goal: Able pain free single leg Calf raise or Jog
- Double leg calf strengthening focusing on isometric exercises initially
- Progressing to eccentric and concentric movements
- Progressing to single leg calf strengthening
- Commence flexibility program
Goal: Return to pain free running and change of direction (COD)
- Progressive resisted concentric strengthening
- Commence dynamic flexibility program
- Commence plyometric (jumping and COD) program
- Return to training/specific sports related skills i.e. kicking ball in soccer
Goal: Return to sport and successful prevention from re-injury
- Maintenance of flexibility and strengthening programs
- Maintenance of plyometric exercises throughout pre-season- off season
- Education and correct management of training volume/load
Your Physiotherapist will appropriately guide you through each stage and will work with you to appropriately get you back to sport.