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Calf injuries usually occur as a result of a sudden pushing off movement or from excessive over-stretching of the calf muscles as demonstrated in jumping activities or during quick changes of direction movements. They are particularly common in racket sports such as tennis or badminton which involve repeated jumping and changes of direction. Runners also suffer calf injuries and they are common in both explosive sprinting events as well as long distance (endurance) events.
Treatment includes, rest, ice and compression during the acute stage followed by a full rehabilitation program consisting of stretching and strengthening exercises.
Symptoms of a calf strain can vary significantly but usually involve a sudden sharp pain at the back of the lower leg. The calf muscle will often be tender to touch at the point of injury and swelling and bruising may appear within hours or days. Depending on how bad the calf injury is, the athlete may be able to continue exercising although he/she will often have some discomfort/tightness during or after the session. When injuries are more severe the athlete can recall when the injury occurred and or they may be unable to walk due to severe pain.
A calf muscle tear is graded from 1 to 3, with grade 3 being the most severe. A grade 1 will not normally need professional treatment whereas grade 2 or 3 injuries, depending on their severity, may require more specialist treatment and rehabilitation advice from a sports injury professional.
Grade 1 symptoms
A Grade 1 calf strain is a minor tear with up to 25% of the muscle fibres affected. The athlete may feel either a twinge of pain in the back of the lower leg or a feeling of "tightness". They may be able to carry on playing or competing without pain or with only mild discomfort in the calf. However, after exercises finishes there is likely to be "tightness" and/or aching in the calf muscles which can take up to 24 hours to develop.
Grade 2 symptoms
Symptoms of a Grade 2 strain will be more severe than a grade one, with up to 90% of the muscle fibres torn. There will be a sharp pain at the back of the lower leg and usually significant pain on walking afterwards. There is likely to be swelling in the calf muscle with mild to moderate bruising, however this may take hours or days to be visible. On strength testing the muscle, pain will be felt on resisted plantar flexion (pushing the toes and foot downwards towards the floor) against resistance. Tightness and aching may be present in the calf muscle for a week or more before subsiding.
Grade 3 symptoms
Grade 3 injuries involve 90-100% of the muscle fibres and are often referred to as "ruptures". The athlete will definitely be able to recall exactly when the injury occurred and this will be associated with severe immediate pain at the back of the lower leg. In these situations, the athlete will be unable to continue/finish exercising and will often be unable to walk due to weakness and pain. This level of injury also presents with considerable bruising and swelling although this may take hours to be visible. On strength testing, the athlete will be unable to even contract the calf muscle at all and in the case of a full rupture, a gap in the muscle can usually be felt. This is due to a deformity where the muscle is torn and the top part of the muscle may bunch up towards the top of the calf which is clearly visible.
Read more on calf strain assessment and diagnosis.
Self Help Treatment
Applying P.R.I.C.E. (Protection Rest, Ice, Compression, Elevation) is essential. Cold therapy should be applied as soon as possible to help to quickly stop any internal bleeding. cold therapy (using ice or cold pack) can be applied for 10 to 15 minutes every hour initially reducing frequency as pain and swelling goes down.
Read more about P.R.I.C.E.
It is advised to use a compression bandage, calf support or sleeve. A compression bandage can be applied immediately to help stop swelling but it should only be applied for 10 minutes at a time as restricting blood flow completely to the tissues could cause more damage, whereas the calf supports can be applied for longer.
We also advise wearing a heel pad to raise the heel and shorten the calf muscle hence taking some of the strain off the muscle. It is a good idea to put heel pads in both shoes because otherwise one leg will become longer than the other due to the raised heel thereby creating an imbalance and possibly leading to other associated injuries/pain (e.g. in the back).
For more comprehensive treatment and to minimise the risk of re-injury, Sportsinjuryclinic.net advise seeing a professional therapist (such as physiotherapist, sports therapist, osteopath or chiropractor) who can also devise a full calf strain rehabilitation program including stretching and strengthening exercises.
Read more on calf strain rehabilitation
A doctor or medical professional may prescribe anti-inflammatory medication e.g. ibuprofen which is beneficial in the first few days after the injury. Do not take ibuprofen if you have asthma and always speak to a pharmacist or doctor before taking medications. There is some evidence that anti-inflammatories can impair healing so do not take them for more than a few days at the beginning of the injury. Also, taking medication can sometimes "mask" any pain and may therefore be detrimental to the healing process.
Electrotherapy such as ultrasound may be applied. This transmits high frequency sound waves into the tissues, which in the early stages can help with pain relief and to reduce swelling. In the later stages of rehabilitation, the ultrasound waves cause a micro massaging effect which can help stimulate blood flow into the muscle.
Sports massage of calf muscles can be applied after the initial acute phase has finished (Warning: do not massage in the first 5 days post injury as this may increase bleeding in the area). The benefits of massage are stimulating blood flow, micro-stretching the muscle and releasing areas of spasm (removing muscle knots) in the muscle. The other major benefit of massage in the latter stages of a calf strain recovery is to soften the newly formed scar tissue and help to align the newly laid fibres in order to encourage more effective muscle healing and prevent re-injury. Finally, a skilled masseur may also be able to identify areas of the muscle that are at risk of injury so regular massage can be beneficial even when fully fit.
If you seek a sports injury professional's opinion, he/she will carry out a full assessment of your injury and hopefully make an accurate diagnosis. Then, if required, they will then treat the injury and prescribe and progress a full calf strain rehabilitation program consisting of a number of stretching and strengthening exercises.
Once the initial healing of the muscle has taken place it is essential that the calf muscles are fully strengthened in order to reduce the likelihood that the injury will reoccur or have an adverse effect on future performances.
Read more on calf strain rehabilitation
View calf strain rehab expert interviews.
The calf muscle group consists of two muscles - the Gastrocnemius muscle which is the big muscle at the back of the lower leg and the Soleus muscle which is a smaller muscle lower down in the leg and lies underneath the gastrocnemius.
Gastrocnemius (the larger of the two muscles) originates from the thigh bone (femur) above the knee joint and inserts into the heel bone via the achilles tendon. When the muscle contracts it assists the hamstrings in bending (flexing) the knee but its main function/action is to plantarflex (point toes/foot downwards towards the floor) of the ankle. The is the same movement as standing up onto your tip-toes before you start walking, running or jumping. Gastrocnemius is the powerful muscle of the calf that produces propulsion during dynamic movement such as sprinting and jumping. A medial gastrocnemius muscle injury is often referred to as "Tennis Leg".
The Soleus muscle originates below the knee joint from the tibia and fibula (shin bones) and also inserts (like gastrocnemius) into to the back of the heel via the Achilles tendon. When the soleus muscle contracts it also plantar flexes the foot, but unlike gastrocnemius has no effect on bending the knee. If the soleus muscle is damaged as opposed to the gastrocnemius, the pain is usually lower down the leg but is not painful when attempting to bend the knee (unlike gastrocnemius). The soleus muscle is the main calf muscle that fascilitates running for long periods (endurance activities).
Either of these two muscles can be injured but the usually the injury occurs at the junction where the muscle meets the Achilles tendon called the "musculotendinous junction".
Calf Muscle Injury Prevention
If the calf muscles are particularly tight then they may be more susceptible to strains. Gradual overuse can cause tension in the muscles which in turn causes tight knots. Shortened muscles are also susceptible to injury and this is most commonly seen in women who wear high heels a lot of the time. Over a period of time the calf muscles adapt and shorten due to the excessively raised heel and then when running shoes or flat shoes are worn, the calf muscles are stretched excessively and are at more risk of injury. Another linked factor in calf injuries is that wearing high heels can weaken the calf muscles thereby also increasing the risk of injury,
Regular stretching of the calf muscles, particularly after training is important. Getting a regular deep tissue massage can also help stretch the muscles and identify any potential at risk areas before they develop into an injury.
If you know that you have a particularly tight calf muscles then you may consider wearing a night splint to gradually stretch the muscles over a prolonged period of time. The splint is worn in bed and helps prevent the natural shortening of the muscles which can occur over night. It should be noted that in addition to stretching the muscle it is important to combine this with performing strengthening exercises otherwise the muscle may become long and weak and also prone to injury.
Similar / related injuries
Deep vein thrombosis - or DVT is a blood clot in a vein. Symptoms consist of a constant pain usually in the calf muscle at the back of the leg. It is very important this is not diagnosed as a calf strain as serious injury or worse could occur!
Posterior deep compartment syndrome - will cause deep aching pain in the lower leg which comes on during a run, goes away with rest only to return when training resumes.
Lateral compartment syndrome - similar symptoms to a posterior compartment syndrome only more likely towards the outside of the lower leg.
Cramp - is an involuntary contraction of the muscle which can not only be very painful but may also cause muscle damage in severe cases.