Calf Muscle Injury
Article by John Miller
What is a Calf Muscle Injury?
How to Care for a Calf Muscle Injury
Pain that occurs in the calf muscle on the lower part of the leg often is the result of a pulled or torn calf muscle.
A calf strain is similar to an Achilles tendon tear or rupture, but occurs higher up in the back of the leg. A sign of a calf strain is similar to that of an Achilles tendon rupture. You may think you've just been hit in the leg and potentially hear a "pop." There is sudden pain at the back of the calf. Then you’ll experience pain, swelling or bruising in the calf muscle, and you’ll have difficulty walking properly or standing on your toes.
Calf injuries usually occur during acceleration or changes in direction. However, we have known people to tear their calf by simply walking across the road.
Calf strains may be minor or very severe. Your physiotherapist will grade the injury accordingly:
The muscle is stretched causing some small micro tears in the muscle fibres. Recovery takes approximately 2 to 4 weeks if you do all the right things.
There is partial tearing of muscle fibres. Full recovery takes approximately 4 to 8 weeks with good rehabilitation.
This is the most severe calf strain with a complete tearing or rupture of muscle fibres in the lower leg. Full recovery can take 3-4 months and, in some instances, surgery may be needed.
How to Treat a Calf Muscle Injury
Calf tears are one of the most common problems that we see at PhysioWorks and it is unfortunately an injury that often recurs if you return to sport too quickly – especially if a thorough rehabilitation program is not completed.
Researchers have concluded that there are essentially 6 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence – these are:
Phase 1 - Early Injury Protection: Pain Reduction & Anti-inflammatory Phase
As with most soft tissue injuries the initial treatment is RICE - Rest, Ice, Compression and Elevation.
Your calf muscle is a large powerful group of muscles that can produce sufficient force to run, jump and hop. In the early phase you’ll be unable to walk without a limp, so your calf needs some rest from weight-bearing loads. You may need to be non or partial-weight-bearing, when crutches or a wedged achilles walking boot may be the best treatment.
Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.
Anti-inflammatory medication (if tolerated) and natural substances eg arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication.
As you improve a compressive bandage, supportive taping or an elastic calf support will help to both support the injured soft tissue and keep the blood from pooling in your foot.
Keep your foot elevated above your heart (where possible) to allow for gravity to help drain your calf and lower leg swelling.
Phase 2: Regain Full Range of Motion
If you protect your injured calf appropriately the torn muscle will successfully reattach. Mature scar formation takes at least six weeks. During this time period you should be aiming to optimally remould your scar tissue to prevent a scar that will re-tear in the future.
It is important to lengthen and orientate your healing scar tissue via massage, muscle stretches and neurodynamic mobilisations. Signs that your have full soft tissue extensibility includes being able to walk without a limp and able to perform calf stretches with a similar end of range stretch feeling.
Phase 3: Restore Concentric Muscle Strength
Calf strength and power should be gradually progressed from non-weight bear to partial and then full weight bear and resistance loaded exercises. You may also require strengthening for other leg, gluteal and lower core muscles depending on your assessment findings.
Phase 4: Restore Eccentric Muscle Strength
Calf muscles work in two directions. They push you up (concentric) and control you down (eccentric). Most calf muscle tears occur during the controlled lengthening phase. Your physiotherapist will guide you on an eccentric calf strengthening program when your injury healing allows.
Phase 5: Restore High Speed, Power, Proprioception & Agility
Most calf injuries occur during high speed activities, which place enormous forces on your body (contractile and non-contractile). In order to prevent a recurrence as you return to sport, your physiotherapist will guide you with exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.
Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepares you for light sport-specific training.
Phase 6: Return to Sport
Depending on the demands of your chosen sport, you will require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.
Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimised your chance of future injury.
There is no specific time frame for when to progress from each stage to the next. Your injury rehabilitation status will be determined by many factors during your physiotherapist’s clinical assessment.
You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.
It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration.
For more specific advice about your calf injury, please contact your PhysioWorks physiotherapist.
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