Calf muscle strain – stop it becoming a tear!

A calf muscle strain is a mild injury, often without any damage or tear. It affects either or both of the calf muscles, Soleus and Gastrocnemius. It can feel like tightness, aching or a pulling sensation.

A “strain” is not a medical classification but refers to mild muscle injuries. It is roughly equivalent to a Grade 1 or low Grade 2 muscle injury. (There are three grades of muscle injury, Grade 3 being the most severe).

This image shows a Soleus strain, grade 1
MRI image shows a Soleus muscle strain, grade 1 (without structural damage), highlighted by the green arrow

Calf muscle strains are most common after a running activity, including football, basketball or running itself. It can present as a sudden stabbing pain although it’s more commonly felt as a gradually worsening tightness.

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TIPS FOR FIXING A CALF MUSCLE STRAIN QUICKLY

  • The most commonly injured muscle in the calf is the Soleus
    • The Soleus muscle is the deeper (closer to the bone) of the two calf muscles
    • It’s function is to brace the ankle (hold it rigid) on landing
    • This bracing action protects the ankle joint and allows the Achilles tendon can store elastic energy
  • Calf circumference measurements can be useful to track swelling and bleeding in this injury
    • Measure the calf muscle while relaxed and lying prone (on your stomach)
    • Find the largest measurement with a cloth tape measure
    • Compare sides:
      • Differences of <1cm are unlikely to be relevant
      • If the injured side is larger by 1cm or more, this may indicate an accumulation of swelling or bleeding. This may indicate a Calf muscle tear instead of a strain
  • Add a heel wedge (like this example) to your regular shoes or wearing shoes with a medium (5-8cm) broad heel
    • This is helpful in the early weeks as it reduces the stretch and pressure on the muscle
    • However a narrow heel or unstable shoe can cause the muscle to become more active. This would have the opposite effect
    • Select a shoe with a broad stable heel, such as a wedge or block heel
  • Massage can be helpful at managing symptoms during rehab
    • It can be helpful in the early phase in relieving muscle soreness and aching
    • As rehab progresses, massage can be used to relieve the feeling of tightness and fatigue
    • Massage should be gentle in the early phase and can gradually increase in pressure over the weeks
    • Massage shouldn’t be used if a tear is suspected or with an increased calf circumference (see point above)
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AVOID THESE MISTAKES WHEN TREATING YOUR CALF STRAIN

  • Calf raises (aka Heel raises) a common calf muscle exercise, are rather ineffective for rehab of calf muscle injuries
    • The main role of the most commonly injured muscle is to brace the ankle, not push you up on your toes
    • Movement is too slow to train the muscle for rapid propulsion
    • The loading is insufficient to adequately rehab a calf strain
  • Stretching a recently torn muscle is counterproductive
    • Stretching may overload the healing tissue and delay recovery
    • It doesn’t offer any benefits for muscle length or tissue tolerance
  • Strength exercises alone are insufficient to prepare for a return to running sports
    • The calf muscles rapidly generate forces up to 8x body weight
    • They need both heavier loads and faster movements to be ready for running
    • Following on from strength training, a full return to play program should incorporate aspects of calf function including sprinting and slowing down quickly

WHAT ELSE COULD IT BE?

As a calf muscle strain can come on gradually and without an obvious cause, it’s important to consider other diagnoses that have a similar presentation.

  • If it’s a deep constant ache, it could be a Tibial Stress Fracture
    • Consider this to be more likely if the ache is present without weight on the leg and it lasts for >24 hours after exercise
  • When there’s a concurrent knee injury with knee swelling, you may have a ruptured Baker’s Cyst
    • This injury can present as an increasing ache in the calf without obvious cause
    • On calf circumference measurement (see point above in Tips), the calf will be significantly larger on the affected side
  • If it’s a vague pain that extends further up the leg, it may be Sciatica
    • Sciatica doesn’t have to cover the whole leg and may just present with calf pain
    • However, if your calf pain begins to extend above the knee or below the ankle, suspect the Sciatic nerve as a potential cause
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