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This article will review the symptoms, causes, and management of calf strains. Calf strains may involve sudden or sharp pain, a popping sound, a tearing sensation, or limited functioning, or pain may only present with certain movements in milder injuries.
What is calf strain?
Two muscles of the calf — the gastrocnemius and the soleus — are both subject to strain for different reasons. Muscle strains of the gastrocnemius muscle are very common compared to soleus strains since it only crosses a single joint. The gastrocnemius helps flex the knee and flexes the foot downward (e.g. when stepping on the gas). When the knee is extended outward, it stretches the gastrocnemius, and if the ankle is flexed upward (e.g. toes toward the head) this may cause additional stretching and can tear the muscle if done quickly without prior warning or stretching.
Symptoms will likely involve pain and its severity will be dependent on the injury. Pain may be sudden or sharp, accompanied by a popping sound, tearing sensation, or limited functioning. Bruising is also possible in more severe injuries. Milder injuries, however, may only be noticed with certain movements such as standing on the tiptoes.
Treatment will depend on the severity of the strain but will likely involve rest and supportive measures. Surgery and accompanying rehabilitation are only necessary for severe injuries.
You can safely treat this condition on your own. A muscle strain can be treated with rest, ice, compression, and pain medication.
Calf strain symptoms
If you have experienced a gastrocnemius strain, you will experience pain in the lower leg and other related symptoms. This can likely be described by the following details.
- Sudden or sharp
- Accompanied by a popping sound
- A tearing sensation along the back of your lower leg
- Localized: This pain is often localized to the central portion of the calf and stretching the calf muscle can frequently cause the pain to reoccur.
- Difficulty with functioning: Mild injuries may accumulate and cause difficulty with functioning or limited functioning of the calf. You may not even know the injury has occurred until later on.
Severity of strain
Pain can be graded to determine if you have a mild, moderate, or severe injury.
- Mild injury: A mild injury only elicits pain when you flex your calf while standing (e.g. standing on “tiptoes” while on one leg) or if you give a small hop on one leg.
- Moderate injury: A moderate injury may be noticed by simple flexes of your ankle in a downward motion (e.g. pressing the gas in your car).
- Severe injury: Severe injuries, however, are usually remembered. A severe injury often leaves an individual unable to flex the calf muscle at all, either because of pain or excessive damage to the muscle.
Causes of calf strain
These strains are commonly referred to as “tennis leg” strains as they commonly occur when an individual changes direction suddenly to return a volley in tennis. They are common when an unconditioned individual engages in intense physical activity and damages the muscle fibers of the leg. Most often these are caused by sudden explosive motions in someone that is not used to them. Common examples include a sudden dash or jump or even a landing after jumping from an elevated platform. Often when a gastrocnemius is pulled or strained, a person hears an internal “pop” sound. Soon after the injury, the affected individual will often have a sudden difficulty bearing weight. If the strain is severe, bruising may occur along the back of the affected leg. This is a sign of bleeding and means that over-the-counter pain medications like NSAIDs should NOT be taken to alleviate pain.
Usually, a soleus strain causes pain when applying pressure to the Achilles tendon. Walking on the “tip-toes” can also aggravate a soleus strain. Soleus strains are caused when the ankle is flexed upward (e.g. toes toward the sky) while the knee is also flexed or bent. This is a common position for individuals that are running uphill, and the injury, while generally uncommon, is more common in long-distance runners or individuals that run very frequently. The injury tends to develop over time with frequent uphill running. Classically, a long distance runner reaching the end of a long run while running uphill may experience soleus strains as a pain in the deep middle of the calf.
Treatment options and prevention for calf strain
The primary treatment when a mild or moderate calf strain occurs is rest. Only in severe cases when the majority of the muscle is torn are other interventions, like surgery, necessary. The initial treatment in mild or moderate strains is controlling the pain and limiting any bleeding that is present. Rest means using the calves less frequently for a period of time — even halting use completely if possible.
- Bed rest or activity limits: Rest may specifically involve bed rest but more frequently involves a reduction in vigorous activities, especially those that flex or lift the ankle such as running, jumping, stopping and dashing, and ballet.
- Tall walking boot: It is possible that your physician will prescribe a “tall walking boot” that isolates the foot in a position that does not strain the calf muscle to promote healing.
If the injury is recurrent or frequent, a compression stocking or compression sock may be used to decrease the formation of a bruise within the muscle tissue. Bruising may aggravate the injury as blood is an irritant and can cause increased inflammation when is it is found outside of the heart and blood vessels. In severe cases, bruising can cause a disorder caused compartment syndrome where increased pressure threatens the viability of tissue within the calf.
Pain medication and ice
For the first two days, ice may be appropriate and useful as a means of limiting pain and swelling in the lower leg. However, after the first two days, it is often necessary to use a stronger pain control agent to control swelling. If there is no bleeding present, then non-steroidal anti-inflammatory medications (NSAIDs) can be used to control the pain. Because NSAIDs can interrupt the body’s ability to naturally stop bleeding, they must be limited in their use if any bleeding is suspected.
Stretching and heat
Stretching is important during the healing process as it reduces stiffness and limits the shortening of muscle fibers through lack of use and the extent of scarring, which can further limit your range of motion. After the earliest stages of healing, applying heat may relax muscles and allow them to stretch further. It is also recommended to stretch the opposing muscles as well by lifting the toes to the sky. Neither of these stretches should be done to the degree of causing pain. Over time the limits of stretching without causing pain will increase until the calf can be fully stretched, at which point more aggressive stretches may be necessary to further improve healing.
In instances where the muscle has been completely torn or pulled away from the bone, it is important to reconnect the muscle to restore some element of function to the lower leg. This requires emergency surgery. Even after the surgery, you will need repeated visits to your physician and at least six months to obtain a maximal potential function. The objective of the surgery will be to reattach the muscle to a point on the bone so that it might again help flex the ankle and the knee.
When to seek further consultation for calf strain
Calf strains that are recurrent may be indicative of improper care and should be evaluated by a medical professional. It is possible that you never fully healed or improper physical activity is causing a recurrent injury.
If you have recently experienced calf pain followed by a loss of sensation, evaluation is necessary to ensure that a process that threatens the viability or function of your leg is not taking place.
Questions your doctor may ask to determine calf strain
- Any fever today or during the last week?
- Is your difficulty breathing/shortness of breath constant or come-and-go?
- Has your difficulty breathing been getting better or worse?
- How severe is your calf pain?
- How severe is your shortness-of-breath?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Ezekiel Richardson is a fourth-year medical student at UPenn, currently applying into Emergency Medicine. He completed an undergraduate degree with a concentration in health disparities at Stanford University. After graduation, he spent a year working in the Maryland Department of Health as a John Gardner Public Service Fellow. Between his third and fourth year of medical school, he completed multiple publications on public health and health accessibility through the Center for Emergency Care and Policy Research Fellowship. He has participated as a teaching assistant in anatomy, histology, and doctoring ethics courses at UPenn. Outside of medical school, he enjoys cooking, volunteering, and traveling in support of his partner’s work on girls’ education in Africa.
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