Overview

Calf Strains are common injuries, particularly in active populations, with research indicating they can contribute up to 13% of injuries in football. They are also notorious for having a high recurrence rate, with up to 31% of calf strains presenting as recurrent injuries. Calf strains often occur due to sudden overstretching or forceful mechanisms placed on the calf complex, leading to a strain, tear, or rupture of the muscle fibers or tendon. They are more common in males, with the medial (inside) head of the gastrocnemius being the most common site of injury. 

 

Anatomy 

The calf complex consists of 2 main muscles; the gastrocnemius and soleus. The gastrocnemius has 2 heads (medial and lateral) that lie superficial (closer to the skin) and are responsible for the powerful movements of the calf in actions like sprinting and jumping. The soleus lies deeper and is composed of more type 1 muscle fibers, meaning it contributes to slower, endurance based movements like long distance running. Along with these 2 main muscles, there are also several smaller muscles that are part of the calf and lower shank complex including the tibialis posterior, peroneals and the muscles of the foot. The 2 calf muscles attach into the Achilles tendon, which connects the muscle complex to the heel. The Achilles tendon can also be a common site of injury, with the predominant injury being Achilles tendinopathy. This blog will focus more so on calf muscle strains, but for more information on Achilles tendon pain, check out our blog here!

Common Causes 

Calf strains are commonly caused by 1 of 3 mechanisms:

  • 1. Overstretching.
    This often involves a quick mechanism where rapid stretch is applied to the calf complex, causing an excessive stretch through the muscle fibers. E.g. Slipping over or your foot dropping off the edge of a step. 
  • 2. Forceful Mechanism.
    We most commonly see this mechanism in active individuals, whether it is from recreational running or playing sport. This will often occur when quickly pushing off your foot, creating a large force impulse through the calf, such as when jumping up off one leg. 
  • 3. Overuse.
    This is more typical of a lower grade calf injury, and can often be described as a cramping sensation that slowly increases during repetitive high impact activities such as running. 

 

Diagnosis 

The mechanism of injury will give us a good insight into the potential muscle involvement, severity and expected recovery time of a calf strain. Once a calf strain is suspected, it is vital to identify the location of the strain and which muscle (or muscles) are involved. This will be determined through palpation and your description of pain. From here, identifying the grade of the strain is the next step. Functional testing such as calf raises, pogo jumps and knee to wall tests are used with force dynamometry testing to determine strength discrepancies in key positions, assess muscle length and gauge pain. This will indicate the severity of muscle damage and guide our rehabilitation protocols.

Grades of Injury

The follow is a guideline for the typical symptoms and return to play (RTP) timelines for the grades of muscle strain:

  • Grade 1: tightness and mild pain, usually able to continue with activity (may get sore after). 2-3 week RTP
  • Grade 2: sharp pain at time of injury, moderate pain, unable to continue activity, difficulty walking. 4-8 week RTP
  • Grade 3: severe pain and popping sensation at time of injury (often at MTJ), unable to continue, bruising and swelling, painful walking. Can take months to RTP pending on activity
  • Complete calf rupture: severe pain, unable to walk, separation and fluid between calf muscles. May require surgery

 

Management 

The management for calf strains will differ significantly pending on the grade of injury. Our management will start with targeted exercises which will be tailored to the strength testing results and any muscle imbalances identified. For higher grade strains, this may involve calf raise isometric holds, however for lower grade strains, these exercises can be progressed to more dynamic calf raises. 

In the acute phases, soft tissue massage and dry needling (for lower grades) can be used to help alleviate tightness in surrounding tissue structures and provide some temporary pain relief. Taping can also be used to ensure no further irritation to the muscle occurs during day to day activities. Depending on what you are currently doing in terms of physical activity, it may be advisable to modify or reduce training loads. Commonly, running based activities and sports will need to be reduced to avoid worsening the muscle strain. 

As symptoms and strength improves, rehab will progress through more challenging strength exercises to reduce any residual strength imbalances and then move into plyometric (jumping) exercises. We often implement plyometric exercises in conjunction with returning to running drills in our on field rehab running sessions, however this process will depend significantly on the severity of injury and the activity you are returning to.