What is a Calf Strain Injury?
A calf muscle injury is common in sports. Calf injuries are sometimes known as a ‘pulled calf’. The term ‘pulled muscle’ comes from the description of how the injury takes place. Usually the calf muscle is forcibly stretched beyond its limits and the muscle tissue becomes torn. A tear in the calf muscle is referred to as a calf strain and depending on its severity it is classified as a first, second or third degree strain:
- A first degree strain is damage to a few muscle fibres
- A second degree strain is damage to a more extensive number of muscle fibres
- A third degree strain is a complete rupture of the muscle itself.
The calf muscle group consists of the gastrocnemius, soleus and plantaris muscles, situated at the back of the lower leg. The function of the calf muscles is to pull up on the heel bone during the ‘push-off’ phase of walking and running.
Signs & Symptoms of Calf Muscle Strain
With a grade one calf strain the signs may not be present until after the activity is over. There may be a sensation of cramp or tightness and a slight feeling of pain when the muscles are stretched or contracted.
With a grade two calf strain there is immediate pain which is more severe than the pain of a grade one injury. It is confirmed by pain on stretch and contraction of the muscle. A grade two calf strain is usually sore to touch, may have some slight bruising and can be painful to walk on, especially when trying to push up on to the toes.
A grade three calf strain is a very serious injury. There is an immediate burning or stabbing pain and the athlete is unable to walk without pain. The muscle is completely torn and there may be a large lump of muscle tissue above a depression where the tear is. After a few days with grade two and three injuries a large bruise will appear below the injury site caused by the bleeding within the tissues.
Calf Muscle Strain Treatment
Resting may be the common sense approach, but it is one that is often ignored by competitive athletes. This is unwise, since it does not take much to turn a grade one calf muscle strain into a grade two, or a grade two calf strain into a grade three. As a general rule, grade one calf strains should be rested from sporting activity for about 3 weeks and grade two injuries for about 4 to 6 weeks. In the case of a complete rupture, the calf muscle will have to be repaired surgically and the rehabilitation afterwards will take about 3 months.
The immediate treatment of a calf muscle injury consists of the RICE protocol – rest, ice, compression and elevation (never apply ice directly to the skin). This is aimed at reducing the bleeding and secondary tissue damage within the calf muscle. The calf should be rested in an elevated position with an ice pack applied for twenty minutes every two hours, if practical. A compression bandage should be applied to limit bleeding and swelling in the tissues. Anti inflammatory medication prescribed by a doctor or topical anti-inflammatory gel can be effective in relieving pain. A calf support may also be effective in reducing swelling and pain after injury and again when returning to activity.
After the early stages have been spent resting, more active rehabilitation can be started. Gentle resistance exercises using resistance bands and stretching are important as they help to align the scar tissue which forms during the healing process. By aligning the scar tissue along the normal lines of stress the tensile strength of the healing calf muscle is enhanced.
At first gentle resistance is provided by a therapist, but as the muscle gets stronger then resistance bands can provide more of a challenge. The sets and repetitions are gradually increased and eventually core strengthening can be started.
Core strength and stability exercises can improve muscle function across the trunk and pelvis and this can reduce the risk of calf muscle injury. Core strength exercises using a swiss ball and resistance bands are ideal. Once core strength and calf strength are improved, then a return to functional activity is possible. With a grade one calf strain gentle jogging can usually be initiated between seven and nine days after injury and straight line sprinting is usually started after 3 weeks. Many people find that a calf support provides reassurance during this active rehabilitation.
Calf Muscle Strain Prevention
What you can do
- Wear shock absorbing insoles to reduce stress on the calf muscles
- Perform warm up exercises prior to sporting activity
- Perform cool down exercises following sporting activity
- Practise stretching exercises to maintain muscle length
- Sip sports drinks to maintain carbohydrates & fluids
Warm up prior to matches and training is thought to decrease muscle stretch injuries because the muscle is more extensible when the tissue temperature has been increased by one or two degrees. A good warm up should last at least 20 minutes – starting gently and finishing at full pace activity. Practising sport specific activities helps tune coordination and prepare mentally for competition.
Recovery after training sessions and matches can be enhanced by performing a cool down. This is thought to help muscles get rid of waste products. This is also the ideal time to do stretching exercises.
Maintaining good muscle strength and flexibility may help prevent muscle strains. Muscle strength allows a player to carry out match activities in a controlled manner and decreases the uncoordinated movements which can lead to injury. Tight muscles are associated with strains. Stretching is therefore practised to maintain muscle length and prevent injury.
Diet can have an affect on muscle injuries. If a player’s diet is high in carbohydrate in the 48 hours before a match there will be an adequate supply of the energy that is necessary for muscle contractions. However, if the muscles become short of fuel, fatigue can set in during training or matches. This fatigue can predispose a player to injury. Carbohydrate and fluids can be replenished during training and matches by taking regular sips of a sports drink . Shock absorbing insoles and calf guards can reduce stress on the calf muscles and help to prevent calf muscle injuries.