This article is going to look at the basics of a calf strain, from the anatomy right through to the rehab.
If you have ever had a calf strain or know someone who has, this article is ideal to get the knowhow on how to manage it properly.
Calf Strain Basics
A calf strain typically refers to an injury to the muscle group which sits on the back of your shin. The calf muscle actually consists of 2 different muscles which are the gastrocnemius and the soleus.
Gastrocnemius – this is the visible 2 headed muscle of the calf that you can see.
Soleus – band like muscle which sits below the gastrocnemius.
The calf’s main function is to plantar flex the foot (pointing it downwards) and secondary function is to assist knee flexion.
The gastroc works when the knee is straight and the soleus works when the knee is bent. The calf muscle is important for walking, running, skipping and jumping movements.
The calf muscle leads in to the achilles tendon which attaches to the foot and this acts as the attachment which makes the foot point downwards. The achilles tendon helps to generate force and tension and then transfers power to the calf muscle to complete the movement.
What is a Calf Strain?
A muscle strain is commonly known or defined as the overstretching or tearing of the muscle fibres which leads to damage, dysfunction and pain.
A calf strain is a common injury within sports which include running and jumping which causes repetitive use of the calf muscles at high speed and force which can lead to injury if an athlete is tired, underprepared or is performing outside their fitness levels.
Injury can quite often occur within this muscle because of:
- Overuse and repetitive use of the calf can cause injury
- Increased force or over contraction outside of its normal limits causing strain and damage to the muscle fibres.
- Exercising while fatigued can also increase the risk of injury – lack of sleep is a big indicator for injury. A high percentage of injuries actually occur when insufficient sleep is had the previous night.
Calf strains can involve the muscle and the tendons dependent on location of the injury. If a muscle only strain occurs then this injury should resolve in a much quicker timeframe than if an achilles tendon tissue is involved as well. This makes the injury much more complex and lengthens the recovery time. Achilles injuries often require surgery if there is a rupture or can be immobilised for long periods in a moon boot.
When suffering a calf strain, pain can be reported instantly – for example a runner starting to sprint and a sharp pain develop in their calf.
Others may not feel any pain at the time and develop their symptoms after their activity or sometimes the day after. Typical symptoms of a strain are commonly reported as:
- Pain with movement and to touch
- Swelling / Bruising
- Difficulty with maintaining a normal walking pattern.
- Loss of power in the muscle
The level of symptoms experienced will depend on the severity of the injury suffered. Calf strains are typically graded as follows:
- Grade 1: Mild – low pain levels – minimal disruption to function – minimal muscle fibre disruption
- Grade 2: Moderate – medium pain – some loss of function and potential disruption to muscle fibres
- Grade 3: Severe – high pain levels and major loss of normal function – likely disruption to muscle fibres.
Grade 1 injuries of the calf are easy to manage and will not have many major visible symptoms – likely soreness and some minor dysfunction reported which should resolve within 1-2 weeks.
Grade 2 injuries can typically take between 2-6 weeks – these can display some swelling and potentially bruising as this indicates more tissue damage has occurred.
Grade 3 injuries can show notable defects such as disrupted fibres – this means there could have been a major tearing of the muscle or tendon resulting in a shortening of the muscle. The appearance of the calf may change with this type of injury and loss of function will be major.
The first stage of the injury is known as the acute/inflammatory stage when the injured location has an inflammatory response leaking blood and chemicals required to deal with the injury to facilitate the healing process. After the first 72 hours the repair phase begins with the muscle trying to rebuild itself and strengthen – what you do with the muscle in terms of treatment and rehab can determine how well you progress.
Treatment of the injury can begin immediately after onset – the quicker you begin the acute management of the injury the better effect it can have on the end result. A delay in the management of the injury can lengthen your recovery time.
If you do delay managing your injury correctly it could also result in greater dysfunction and pain.
A major factor with reducing the severity of the injury which has been sustained is the ability to control the bleed within the tissue and the development of swelling at the injury site.
Once the tissues have been overstretched or torn – they will start to bleed and the more you can control this with acute treatment then the less severe the symptoms will be in the coming days – effectively improving your recovery time.
There is a simple way in which you can now manage calf and muscular injuries.
It comes in the form of PEACE & LOVE a new update from previous acronyms such as PRICE and POLICE.
Protection – of the calf from further injury, this may mean removing yourself from the activity which injured it or providing the limb with the support it requires to help reduce any further damage occurring. Reducing activity levels for the next 72 hours is advised whilst the body delivers the necessary action to aid the healing process.
Elevation – of the injured limb is necessary to avoid a build-up of swelling within the limb as this can then hinder your recovery. Increased amounts of swelling can make the area more painful, inhibit movement and power.
Elevate the limb above hip/heart height. This allows for more effective drainage of swelling with the use of gravity. Elevate the limb anytime you are off the feet – a perfect time and easy way to do this is in bed at night with the use of pillows while you sleep. The best time to elevate is within the first 48 hours of the injury occurring – if excess swelling continues after this period then continue with the previous principles until it is controlled or reduced.
Avoid anti-inflammatories – use of NSAID’s can actually delay healing and this goes for ice as well. This is now due to a change in recent evidence, previous ice and anti-inflammatory were advised but they can now potentially slow and delay healing.
Compression – use of an elasticated bandage or sports support helps to provide comfort to the injured area but also acts as an aid to assisting the reduction of swelling. Movement may also feel easier when the limb is supported with compression.
Elastic Velcro wraps are a great tool that can be bought easily and cheaply online and they offer the most practical way to aid your injury with compression. Wrap the bandage below, above and through the injury. Be aware of the amount of compression you apply to the injury, it should not be so tight that it causes pain or significant changes in skin colour – if this happens, loosen the bandage. Use compression during your waking hours and remove for sleep.
Education – your body knows best – try and avoid any passive treatment and do what feels best for your body, use pain as your guide.
Load – again – use your symptoms as a guide to gently restoring load back to your injured calf. If you need guidance with this seek the help of a physiotherapist to guide your rehab.
Optimism – remain confident and do not get caught in a spiral of doom, injuries often take prolonged periods of time to heal – trust the process and allow your body to heal.
Vascularisation – choose an exercise, movement or any treatments which are pain free and allow the repairing muscle to become supplied with fresh blood which promotes healing. Do not go for deep tissue work as this can disturb the healing and harm the recovery.
Exercise – start to return to regular exercise, load, technique and proprioception by using graded rehab – again if you need help – see a physiotherapist.
Passive treatments from a therapist could include:
- Massage – this has to be done at the right time and with the right intensity. If massage is too tough then it can delay healing and make the injury worse.
- Shockwave – mechanically generated shockwaves help to accelerate soft tissue healing by 40% by improving the healing response and generating circulation to the injured area.
- Acupuncture / Dry Needling – needle based therapies can help to stimulate healing and reduce pain.