Calf pain is a common complaint, especially for those who are active. Often the culprit is a calf strain, an injury to the muscles in the lower back leg. This blog will delve into the anatomy of the calf complex, how strains occur, and the different stages of recovery. We'll also explore how a Sports Therapist or Physiotherapist can help you get back on your feet.

Common Causes of Calf Strains

Calf strains occur when the muscle fibers are overstretched or torn by the demand on them outweighing their capacity. This can happen due to:

• Previous Injury: 38% of calf injuries occur again. This may be due to incomplete rehabilitation, returning too soon or failure to address underline factors

• Sudden increases in activity: Starting a new exercise routine or pushing yourself too hard too soon can put stress on the calf muscles.

• Hamstring or Quadricep Weakness: The calf muscles work in unison with the rest of the leg, contracting at different points throughout the gait cycle, each has a specific role to play. Weakness in one muscle will potentially cause compensation and overload in another.

• Improper warm-up: Preparing your brain and body for what is to come enables the nervous system to effectively recruit muscle fibres for the job. A warm-up can also improve activation of other muscle groups and range of motion in key joints.

• Sudden changes in footwear: Knowing the specification of your training shoes is really important. Read more about this here. Suddenly changing from a high to low heel drop can cause an increase in calf load. Learn more about what to look for in your trainer specification.

• Gait Pattern: Some common gait patterns are associated with calf strains. These include overstriding and a cross over gait.

Signs and Symptoms of a Calf Strain

The severity of a calf strain can vary depending on the extent of the tear. Here's what to look out for:

• Pain: This is the most common symptom, ranging from a dull ache to a sharp, stabbing pain. Often an injury that is sharp or described as a ‘ping’ will be the gastrocnemius, whereas the Soleus is often described as progressively ‘tightening’.

• Tenderness: The calf muscle will be tender to the touch, especially at the site of the injury.

• Swelling: There may be some swelling in the calf, particularly with more severe strains.

• Bruising: In some cases, bruising may appear on the calf.

• Weakness: Difficulty pushing off the ground or flexing the foot upwards.

Grades of Calf Strains and Recovery Timelines

Calf strains are typically graded based on the severity of the tear:

• Grade 1 (Mild): Microscopic tears in the muscle fibers. Pain is mild and walking is possible with minimal discomfort. Recovery: 1-2 weeks.

• Grade 2 (Moderate): More significant tears in the muscle fibers. Walking may be difficult and there will be noticeable pain and weakness. Recovery: 4-6 weeks.

• Grade 3 (Severe): Complete muscle tear. Significant pain, swelling, and bruising. Walking is often impossible. Recovery: 8-12 weeks, possibly requiring physical therapy.

Important Note: These are general timelines. It's crucial to consult with a healthcare professional for a proper diagnosis and personalized recovery plan.

• Neural stretch: Sit with your leg extended and the other leg bent. Loop a towel around your foot and gently pull back to stretch your calf. This can also be done in the lying position with a raised straight leg. Aim to only pull the foot/toes towards you for a few seconds. Nerves can be quite reactive.

• Hopping, bounding & jumping. If your goal is to return to activity the muscle needs exposure to this type of stimulus. Start by doing a hop & hold on the spot. Progress to jumping up onto a small step & down. These exercises then progress to double leg repeated jumps.

References

Dixon JB. Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Current reviews in musculoskeletal medicine. 2009 Jun 1;2(2):74-7.

Wikimedia Commons contributors, "File:1123 Muscles of the Leg that Move the Foot and Toes b.png," Wikimedia Commons, the free media repository, https://commons.wikimedia.org/w/index.php?title=File:1123_Muscles_of_the_Leg_that_Move_the_Foot_and_Toes_b.png&oldid=276846515 (accessed July 25, 2018).

Hamner SR, Seth A, Delp SL. Muscle contributions to propulsion and support during running. J Biomech. 2010 Oct 19;43(14):2709-16. doi: 10.1016/j.jbiomech.2010.06.025. Epub 2010 Aug 9. PMID: 20691972; PMCID: PMC2973845.