UNDERSTANDING CALF MUSCLE STRAIN

UNDERSTANDING CALF MUSCLE STRAIN

PHYSIO SUDHIR BHARRDWAJ

BPTh, CSPT(SPORTS), MTFI(SPINE), MSc-YOGA (Therapy),

MPT-SPORTS, DCPOT

CHIRANJIV PHYSIO & WELLNESS CLINIC, PALAM VIHAR, GURUGRAM

+91-9650383603

The lower leg is a vital biomechanical element during locomotion, especially during movements that need explosive power and endurance.

The calf complex is an essential component during locomotive activities and weight-bearing and injuries to this area impacts various activities of daily living (ADL’s) in general populations such as walking, running, standing, driving, cycling etc.

A strain refers to an injured muscle or tendon. Tendons are the cords of tissue that connect muscles to bones. A strain occurs when the fibers of the muscle or tendon partially or completely tear.

In this article, we discuss the symptoms of a pulled calf muscle and explain how doctors & therapists treat it. We also provide a list of useful stretches that people can use to aid recovery.

Calf muscle strain injuries (CMSI) occur commonly in activities involve high-speed running or increased volumes of running load, acceleration and deceleration as well as during fatiguing conditions of performance.

Calf strain is a common muscle injury and it is very important to understand that if not managed appropriately there is the risk of Re-injury and Prolonged Recovery.

The calf muscle, on the posterior aspect of the lower leg, is composed of three muscles: gastrocnemius, soleus and plantaris,These muscles come together as the Achilles tendon and all three muscles insert into the calcaneus bone. 

  

  

A pulled or strained calf muscle affects the muscles and tendons in the back of the lower leg.

A person may feel pain in the:

• gastrocnemius muscle
• soleus muscle
• plantaris muscle
• Achilles tendon

The symptoms of a pulled calf muscle vary depending on the severity of the injury. Mild muscle strain can cause pain that feels similar to post-workout soreness.

A severe strain can cause intense, even debilitating, pain that can make walking difficult or impossible until the muscle heals.

Other symptoms of a strained calf muscle include:

• Swelling                                          redness
• muscle cramps or spasms                decreased mobility

Causes

People may pull a muscle in their calf if they:

• do not warm up before exercising
• participate in strenuous sporting activities
• do not wear proper footwear while running
• regularly wear shoes with high heels

This condition frequently occurs in the middle-aged, poorly conditioned and/or physically active patient.

Thus, weakness of the calf muscles or improper strengthen muscles are the cause behind strains.

Further, it may be the cause of heal pain, achillis tendinitis also.

Hence, to strengthen the calf muscles along with other leg muscles (Hamstring & Quadriceps Group) is the fundamental and permanent solution to prevent leg muscle strains and complications of ankle joint as well. 

A pulled calf muscle can be diagnosed by carrying out a physical examination, during which we can check for swelling, bruising, and redness. Any recent changes to regular physical activity routine also describes the injuries.

Muscle injuries fall into three broad categories or “grades” based on the severity of a person’s symptoms and the extent of the muscle damage.

• Grade 1 (mild): Grade 1 injuries cause minimal muscle damage, although there may be a sharp pain at the time of the injury. This type of injury carries a low risk of long term complications.
• Grade 2 (moderate): Grade 2 injuries cause moderate muscle damage, and people with this category of muscle injury may have difficulty walking. They will often experience a sharp pain that worsens when they flex or extend their foot.
• Grade 3 (severe): A grade 3 injury is a complete tear of the muscle, and it can cause significant bruising and swelling in the calf.

PRIMARY TREATMENT

In general, someone with a pulled or strained calf muscle should rest to prevent further damage to the muscle. As inflammation should be subsided to control the pain. 

depending on the severity of the injury the NSAID can be taken by patient to improve inflammation.

The following treatments may provide “symptomatic” relief for people with a mild sprain:

• Ice therapy. People can use a cold compress to reduce inflammation and relieve muscle pain during the first 2 days, when they should apply a cold compress to the calf for 20 minutes up to eight times a day. After this time, hot packs can help ease muscle soreness and stiffness.
• Wraps and bandages. Wrapping the injured calf in an elastic bandage or compression sock can help prevent swelling and inflammation.
• Elevation of the injured leg. People can rest their leg on a pillow or a rolled-up blanket or towel. Doing this will help decrease swelling.
• Over-the-counter (OTC) pain relievers. People can take a pain reliever, such as ibuprofen, to relieve pain and reduce inflammation.
• ULTRASONIC THERAPY. UST local application just after the icing is most effective in muscle strain. UST application without prior icing have poor evidence of recovery. The dosage can be 0.8 wt/cm2, PULSE MODE, 3min.

Depending on the severity of the injury, a pulled calf muscle can take several weeks or months to heal.

 A doctor may recommend surgery to treat a severely strained or torn calf muscle but it is rare.

Muscle injuries can damage nearby blood vessels, which may cause localized bleeding under the skin. (BRUISE)

Blood cells that collect in muscle tissue can form a hematoma or a blood clot. A doctor can use a minimally invasive procedure called aspiration to treat a hematoma. It can be managed by ICING.

Primary treatment must be followed by rehabilitation to prevent further complications and reoccurrence of the same.

REHABILITATION & LONG TERM TREATMENT

As discussed earlier to mange pain is a symptomatic treatment only, patient should be educated to get proper rehabilitation of muscle strains which will prevent further complications and reoccurrence of the same.

The Rehabilitation treats the cause behind the injuries, which has been explained earlier. Weakness of the calf muscles or improper strengthen muscles are the cause behind strains.

strengthen the calf muscles along with other leg muscles (Hamstring & Quadriceps Group) is the fundamental and permanent solution to prevent leg muscle strains and complications of ankle joint as well. 

Some activities, such as walking, running, or playing team sports, can further damage a pulled calf muscle. People should rest and avoid strenuous activity while their calf muscle heals.

Then after, the rehabilitation can be divided into two exercise protocol.

First is STRETCHING EXERCISES which should be followed by STRENGTHENING EXERCISES.

Stretches

However, it is possible to use gentle stretches and physical therapy to maintain mobility and stabilize the knee and ankle joints while they heal. As

“Everything is Connected & Everything Matters.”

Helpful stretches include

                                       Standing wall stretch

                                    

1.   Stand in front of a wall and place both hands firmly against the wall at shoulder level.

2.   Step the unaffected leg toward the wall while keeping the injured leg straight.

3.   Bend the front knee so that the hips and chest move toward the wall. Gently deepen the bend to produce a light stretch in the back leg.

4.   Hold this position for 15–30 seconds and release.

Standing toe-raise stretch

1.   Find a wall, countertop, or chair to hold on to for balance.

2.   Place a book on the floor.

3.   Place the balls of the feet on top of the book and keep the heels on the floor.

4.   Carefully lean forward while keeping the knees straight.

5.   For a deeper stretch, try using a thicker book.

                                     Standing heel-raise

                                

1.   Stand facing a wall, countertop, or chair back to hold on to for balance.

2.   Lift the body up on the balls of the feet.

3.   Hold this position for 3–5 seconds and then lower the heels to the ground.

4.   For an extra stretch, try doing the heel raise while standing on a block or heavy book.

                                         Foot flexion

                             

1.   Sit on the floor with both legs straight in front of the body.

2.   Reach forward and wrap a resistance band, pair of tights, or other rolled up cloth around the feet.

3.   Keeping the legs straight, gently flex the foot backward while keeping the heel on the floor.

4.   Try to pull the toes toward the body to deepen the stretch.

5.   Hold the stretch for 3–5 seconds.

Recovery

Most people who have a pulled calf muscle will not need surgery. Resting the injured leg and keeping it elevated can help speed up the recovery process.

People should wait until their calf muscle heals completely before resuming their regular physical activities. Most of the patients stop their physiotherapy just after improving the pain, which is harmful and increases the chance of reoccurrence and secondary complications.

Using a muscle before it heals & incomplete rehabilitation can result in the initial injury taking longer to heal. In some cases, it can even cause a second injury.

Summary

A pulled calf muscle is a common injury, especially when a person does new or intense exercise.

In most cases, people can treat a pulled calf muscle at home with rest, cold and hot packs, and elevation.

If the injury is severe or pain does not improve over time, it is best to see a doctor for diagnosis and treatment.