The Orthopaedic Clinic

Calf Strain


Overview Diagnosis
  Treatment Options

Overview

A calf strain can be caused by:

  • stretching the calf muscles beyond the amount of tension or stress that they can withstand
  • suddenly putting stress on the calf muscles when they are not ready for the stress
  • using the calf muscles too much on a certain day
  • a blow to the calf muscles

    Risk factors that increase your chances of straining your calf include:
  • sports that require bursts of speed, such as: running, hurdles, basketball, soccer, football, or rugby
  • fatigue
  • tight calf muscles
  • overexertion
  • cold weather

    Diagnosis

    Symptoms of a calf strain include:

  • pain and tenderness in the calf
  • stiffness in the calf muscles
  • weakness of the calf muscles
  • bruising on the calf (if blood vessels are broken)
  • popping sensation as the muscle tears (possibly)

    The doctor will ask about your symptoms and medical history, your recent physical activity, and how the injury occurred. The doctor will also examine your calf for:

  • tenderness and/or bruising directly over the calf muscles
  • pain when contracting the calf muscles, particularly against resistance
  • muscle strains are graded according to their severity:

    Grade 1
  • stretching with some microtearing of muscle fibers
  • recovery can be complete in about 2 weeks

    Grade 2
  • partial tearing of muscle fibers
  • recovery can take up to 1-2 months

    Grade 3
  • complete tearing (rupture) of muscle fibers
  • recovery can take more than 3 months
  • surgery may be needed to repair the torn muscle fibers (very rare)

    For a severe calf strain, you may have a magnetic resonance imaging (MRI) scan to see if the tearing requires surgical repair. Professional athletes sometimes have MRI scans to help predict the length of their recovery period.

    Treatment Options

    Treatment depends on the severity of the strain. Treatment usually includes:

  • rest
    Do not do activities that cause pain, such as running, jumping, and weightlifting using the lower leg muscles. If normal walking hurts, shorten your stride. Do not play sports until the pain is gone.

  • cold
    Apply ice or a cold pack to the calf area for 15 to 20 minutes, four times a day for several days after the injury. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.

  • pain relief medications
    Take aspirin, ibuprofen (Advil, Motrin), or acetaminophen (Tylenol) to help relieve pain. If you still have tenderness in the calf while taking these drugs, do not return to physical activity. Check with your doctor.

  • compression
    Wear an elastic compression bandage (e.g. Ace bandage) around your lower leg to prevent additional swelling. Wrap from the toes up the leg so as to not cause swelling below the wrapping. Be careful not to wrap the bandage too tightly.

  • elevation
    Keep your leg higher than your heart as much as possible for the first 24 hours to minimize swelling.

  • heat
    Use heat only when you are returning to physical activity. Then use it before stretching or getting ready to play sports.

  • stretching
    When the acute pain is gone, start gentle stretching as recommended by a health care professional. Stay within pain limits. Hold each stretch for about 10 seconds and repeat six times.

  • strengthening
    Begin strengthening exercises for your calf muscles as recommended by a health care professional.

    Prevention
    To reduce the chance that you will strain a calf muscle:
  • Keep your calf muscles strong so they can absorb the energy of sudden physical stress.
  • After a short warm-up period, stretch out your calf muscles before physical activity.
  • Learn the proper technique for exercise and sporting activities. This will decrease stress on all your muscles, including your calf muscles.

    How can I prevent a calf strain?
    Stretching your calf muscles before doing your activities best prevents a calf strain. If you have tight calf muscles, it is a good idea to stretch these twice a day whether or not you are doing any sports activities that day.
    To reduce the chance that you will strain a calf muscle:

  • Keep your calf muscles strong so they can absorb the energy of sudden physical stress.
  • After a short warm-up period, stretch out your calf muscles before physical activity (especially in cold weather).
  • Learn the proper technique for exercise and sporting activities. This will decrease stress on all your muscles, including your calf muscles.
  • Know when your body has had enough. Fatigue puts you at risk for a strain.
  • Cool down properly by stretching after exercise

    Improving Sports Performance
    The key to improving sports performance after a calf strain is a proper rehabilitation program and adhering to some of those same principles after the injury is gone.

    The single most important aspect of improving performance is stretching before and after you step onto the field, court, ice, or golf course.

    Benefits derived from stretching include:

  • increased physical efficiency and performance
  • decreased risk of injury
  • increased blood supply and nutrients to joint structures
  • increased coordination
  • improved muscular balance and postural awareness
  • reduced stress
  • enhanced enjoyment

    Rehabilitation for a calf strain usually depends on the severity of the strain, but usually includes:
  • Rest
    Do not do activities that cause pain, such as running, jumping, and weightlifting using the lower leg muscles. If normal walking hurts, shorten your stride. Do not play sports until the pain is gone.

  • Cold
    Apply ice or a cold pack to the calf area for 15 to 20 minutes, 4 times a day for several days after the injury. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.

  • Pain Relief Medications
    Take aspirin, ibuprofen, or acetaminophen to help relieve pain. If you still have tenderness in the calf while taking these drugs, refrain from physical activity, and consult your doctor.

  • Compression
    Wear an elastic compression bandage (e.g., Ace bandage) around your lower leg to prevent additional swelling. Wrap from the toes up the leg so as to not cause swelling below the wrapping. Be careful not to wrap the bandage too tightly.

  • Elevation
    Keep your leg higher than your heart as much as possible for the first 24 hours to minimize swelling.

  • Heat
    Use heat only when you are returning to physical activity. Then use it before stretching or getting ready to play sports.

  • Stretching
    When the acute pain is gone, start gentle stretching as recommended by a health care professional. Stay within pain limits. Hold each stretch for about 10 seconds and repeat 6 times.

  • Strengthening
    Begin strengthening exercises for your calf muscles as recommended by a health care professional.
    The major objectives of rehabilitation from a calf strain are to improve the elasticity of the calf muscle and to gradually increase pain-free range of motion. Exercises to achieve these goals include:

  • Passive stretching
    Keeping your legs straight, stretch the calf gradually by gently pulling your foot and toes up. Hold for 10 seconds and repeat 5 to 10 times.

  • Active stretching
    Pull your foot and toes up (using the muscles in the front of your leg) to stretch the calf muscle. Hold for 10 seconds and repeat 5 to 10 times.

  • Progressive strengthening exercises
    For light resistance exercise of the calf muscle, hook a band under your toes and gently point your foot downward against resistance and then allow it to come up again. Do 10 repetitions, rest, and repeat 5 to 10 times.

    When can I return to my sport or activity?
    The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon, you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your calf strain recovers, not by how many days or weeks it has been since your injury occurred.

    You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
  • You have full range of motion in the injured leg compared to the uninjured leg.
  • You have full strength of the injured leg compared to the uninjured leg.
  • You can jog straight ahead without pain or limping.
  • You can sprint straight ahead without pain or limping.
  • You can do 45-degree cuts, first at half-speed, then at full-speed.
  • You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
  • You can do 90-degree cuts, first at half-speed, then at full-speed.
  • You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
  • You can jump on both legs without pain and you can jump on the injured leg without pain.

    How long will the effects of the injury last?
    Calf strains are graded according to their severity. In some cases, an athlete can return to competition in 2 weeks. In severe cases, where surgery is necessary, recovery can take up to 3 months. The grades are as follows:

  • Grade 1
    Stretching with some micro tearing of muscle fibers.
    Recovery can be complete in about 2 weeks.

  • Grade 2
    Partial tearing of muscle fibers.
    Recovery can take 1-2 months.

  • Grade 3
    Complete tearing (rupture) of muscle fibers.
    Recovery can take more than 3 months.
    Surgery may be needed to repair the torn muscle fibers. This is very rare.
    For a severe calf strain, you may have an MRI scan (pdf file) to see if the tearing requires surgical repair. Professional athletes sometimes have MRI scans to help predict the length of their recovery period.



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