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!
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.
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.
Below are the common signs and symptoms that may indicate you have suffered from a calf strain:
If you believe you have a calf injury or strain book an appointment with your physiotherapist.
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:
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.
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:
If your medical practitioner suspects a DVT they will refer you for a Doppler Ultrasound to rule out this condition.
When dealing with a soft tissue/muscular injury, the immediate treatment should always follow the POLICE principle for tissue healing:
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.
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.
Your physiotherapist will perform a thorough assessment and commence initial treatment which will involve:
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:
Goal: Return to pain free walking
Goal: Able pain free single leg Calf raise or Jog
Goal: Return to pain free running and change of direction (COD)
Goal: Return to sport and successful prevention from re-injury
Your Physiotherapist will appropriately guide you through each stage and will work with you to appropriately get you back to sport.