Calf strains are athletic injuries that often garner little attention from researches and lecturers in the realm of orthopedics. They are, however, common injuries that can keep you on the shelf and unable to participate in your favorite sports and activities for extended periods of time. Maybe you’ve been playing tennis or basketball and felt a sudden pain in the back of your lower leg that causes you to pull up limping. As a competitive athlete, you try to push through the pain hoping it subsides but you soon realize that the more you push yourself the worse the pain becomes. This happens because you’ve stretched the muscle beyond its limits which results in tearing of the fibers of the muscle itself. Depending on the degree of the tearing of these fibers it may heal quickly or can nag at you for weeks or even months. Calf strains come are graded based on their severity. The most common system grades them on a scale of 1-3 as listed below.
- Grade I (mild) Relatively few fibers are torn. Often this degree of tearing is not felt until the next morning upon waking up and stepping out of bed. You will notice that it doesn’t cause much discomfort until the muscle is stretched to its end-point when stretching or during activity. Usually there is little swelling or bruising and it tends to heal within days or a week or two depending on the individual. A short period of rest followed by a gradual build up to regular activities is usually necessary for recovery.
- Grade 2 (moderate) Many fibers are torn which often results in swelling and/or bruising to the posterior lower leg. You will often feel immediate pain when pointing your toes down to the ground (plantarflexion) and when pointing your toes back towards your upper body (dorsiflexion). Often, a decrease in plantarflexion is also noted during the examination. Patients often describe tightness and tenderness to touch in this area as well. Patients can also usually pin-point the moment they noticed the injury, unlike with first degree strains. With this degree of injury, you will find it difficult to run, jump, or even walk extended distances without discomfort. A moderate period of rest of 2-4 weeks depending on the individual is often necessary for healing to occur. Treatment may also involve a brief period of immobilization in a walking boot to protect the muscle from further injury. We also often use physical therapy as a resource which results in a quicker return to your normal activity level. NSAID’s can be used to alleviate pain when necessary.
- Grade 3 (severe) Between 90-100 per cent of the muscle fibers are torn. We often use the term rupture to describe this injury. Pain is felt immediately and substantial bruising and swelling are noted during physical exam. In some cases, an abnormal appearance of the calf muscle is observed with a visible or palpable deficit in the muscle where the tear is located. With this degree of injury, you will find it very difficult to put weight down on the injured side without experiencing major discomfort. Often an MRI is ordered to evaluate the extent of the tear and to check for tendon involvement. Treatment may involve surgery depending on the location and the extent of the ruptured tissue. Immobilization in a cast or a boot with no weight bearing allowed for 3-6 weeks is often the appropriate treatment for a grade 3 strain. Physical therapy will be necessary for a speedier return to activities but plan on at least 8-12 weeks before your back to your usual self again.
Your foot and ankle specialist or orthopedist will perform a thorough history and physical examination to determine the appropriate treatment for you. Our goal, as always, is to help our patients heal these injuries quickly and completely so they can get back to participating in the activities they enjoy.
1.In which sports do calf strains most commonly occur?
A.Any sport that involves rapid acceleration which requires pushing off a plantarflexed foot with a lot of force. i.e., tennis, basketball, football and soccer, for example. These injuries can also occur due to overuse, so sports that involve running for long distances at a time can lend themselves to these injuries.
2.If I have had a calf strain before does that make me more likely to experience another?
A.Studies have shown that those patients who have had calf strains in the past are slightly more likely to suffer another calf strain or injury than someone who has never had one. The reason for this is because those torn fibers can heal back into normal position but the healed tissue is structurally different (scar tissue) than the tissue seen in uninjured muscles.
3.What can I do to avoid a calf strain?
A. As with many soft tissue injuries of the foot and ankle you can reduce your changes of suffering a calf strain by proper warm and stretching prior to and after physical activity. I think people often forget to cool down and stretch after athletic activity but more and more research is suggesting that it is just as important for avoiding injury.