While most of us know that the calf is located in the back of the lower leg below the knee, many don’t realize that the calf is actually made up of 9 separate muscles, any of which can be injured individually or together. Calf strains are very well-known to runners, gymnasts, dancers, soccer and basketball players. They can occur during hi-speed motions (e.g., running and jumping), or from any type of forceful or uncoordinated movement. As we age, so too does our vulnerability to calf strains with less forceful movements. The goal of Physical Therapy in treating individuals with calf strains is to reduce pain, restore flexibility and muscle strength, and increase recovery speed.
SO WHAT EXACTLY IS A CALF STRAIN?
We often think of the calf as being synonymous with the gastroc (gastrocnemius muscle), when in actuality there are 8 other muscles making up the calf complex. The gastroc, soleus, and plantaris muscles all attach onto the heel bone (calcaneus) and work together to produce the downward motion of the foot (think stepping on the gas while driving, or raising up on your tippy toes in standing). The other 6 muscles are responsible for knee, foot, and toe movements in different directions. Injuries to any of these “other” 6 muscles are sometimes wrongly attributed to the first 3 muscles mentioned above, as the pain is felt in similar areas of the calf.
A calf strain is caused by overstitching or tearing of any of the 9 muscles of the calf. Calf strains can occur suddenly or gradually over a period of time, and normal everyday activities such as running, walking, or going up or down steps can be extremely difficult, very painful, or downright impossible. A muscle strain is graded according to the amount of muscle damage that has occurred:
Grade 1–A mild or partial stretch or tearing of a few muscle fibers. The muscle is sore, but maintains its normal strength. Use of the leg is not generally impaired, and walking is normal.
Grade 2–A moderate stretch or tearing of a greater percentage of the muscle fibers. A pulling sensation or snapping may occur at the time of the injury and after the injury. Bruising may be noticeable, there is a noticeable loss of strength, and much more pain and tenderness. Limping is very common when walking as use of the leg is visibly impaired.
Grade 3–A severe, or sometimes complete, tear of the muscle(s). Oftentimes a “pop” could be heard or felt at the time of injury. Bruising is very noticeable, and there is sometimes a “dent” in the muscle where it was torn that is visible beneath the skin. Weight bearing is extremely painful and difficult.
Muscle fibers and other cells are disrupted when muscles are strained or torn, causing bleeding to occur which, in turn, causes the bruising. Within hours after the injury swelling generally occurs, causing the injured area to expand and feel stiff and tight. After a severe calf strain bruising may also be seen around the ankle and foot, due to gravity pulling the escaped blood toward the lower part of the leg.
WHAT DOES A CALF STRAIN FEEL LIKE?
If you strain your calf muscles, you may experience:
Sharp, “stabbing” pain or weakness in the back of the lower leg. The pain may persist, or can resolve fairly quickly.
Throbbing at rest, or sharp, “stabbing” pain when attempting to stand, walk, or climb stairs.
Sharp, “stabbing” pain in the calf when trying to stretch or move the ankle or knee.
A feeling of weakness or tightness in the calf area.
Feeling or hearing a “pop” at the time of injury (occurs with a Grade 3 calf strain).
An inability to run or jump on the affected leg.
Bruising in the calf area.
Limping when walking.
DO I NEED TO SEE MY DOCTOR FIRST?
No, you do not need to see a doctor first! Your Physical Therapist can conduct a thorough and comprehensive evaluation that includes a medical history, and will ask questions such as:
How did the injury occur? What were you doing when you first felt the pain?
Did you receive a direct hit to your calf?
Did you feel a “snap” or “pop” when the injury occurred?
Did you experience swelling within the first 2 to 3 hours after the injury?
Is it painful to move your knee or ankle? Is is painful to stand or walk?
Your Physical Therapist will also perform objective diagnostic tests such as:
Testing for mobility or strength deficits
Looking for swelling and/or bruising
Palpate (feel) parts of the muscle to determine specific location of the injury
Assess gait (walking) to see if you can bear weight on the injured leg.
In severe strains, your Physical Therapist may collaborate with an orthopaedist or other health care provider. They may, in turn, order further diagnostic tests such as an X-ray or MRI to confirm the diagnosis and to rule out other potential damage. However, these tests are not commonly required for a calf strain.
HOW CAN PHYSICAL THERAPY HELP?
The goal of Physical Therapy is to design a specific treatment program to speed your recovery, including a home exercise program and treatments you can do on your own to help your return to your normal activities. Within the first 24 to 48 hours your Physical Therapist may recommend:
Using ice on the affected area for 15 minutes every 2 hours
Use an elastic wrap for compression
Rest the area by avoiding walking or any activity causing pain. Crutches or a brace may be recommended to further decrease strain on the muscles when walking.
Insert heel lift pads into both shoes.
Your Physical Therapist will provide treatments to:
Decrease Pain–Use of ice/heat, taping, heel lifts, exercise, and manual (hands-on) therapy .
Increase Mobility–Specific activities and treatments will be utilized to help restore normal movement in the knee and ankle. This may include passive range of motion (the Physical Therapist moves your knee and ankle) and progress to active stretches that you perform yourself to increase muscle flexibility.
Increase Strength–Exercises will be added at each phase of recovery, and may include cuff weights, weight lifting equipment, and cardio exercise equipment, such as treadmills, ellipticals, and stationary bicycles.
Speed Recovery Time–Your Physical Therapist is an expert in function and movement, and will choose the right treatments and exercises to help you heal safely, return to your prior level of function, and reach your goals faster than you are likely to do on your own.
Return to Activities–Your Physical Therapist should perform manual therapy as well as instruct you in exercises, work re-training activities, and sport specific techniques and drills to help you achieve your goals in the safest, fastest, and most effective way possible.
Prevent Future Re-injury–A home exercise program will be given to stretch and strengthen the muscles around your knee and ankle to help prevent future re-injury of your calf. These would most likely include flexibility and strengthening exercises for the muscles of the knee, calf, ankle, and toes.
CAN A CALF STRAIN BE PREVENTED?
Here are several ways in which we can be proactive in helping to prevent a calf strain:
Always warming up before starting a sport or heavy physical activity.
Following a consistent strength and flexibility exercise program to maintain good physical conditioning.
Gradually (not suddenly) increasing the intensity of any activity or sport. Avoid pushing yourself to hard, too fast, too soon.
Wearing proper footwear that are in good condition, fit well, and match the purpose of your exercise or activity (not sure? Ask your Physical Therapist).
If you or anyone you know is experiencing pain in the calf and thinks it could be a calf strain, don’t wait to take action. Call my office at once at (302)691-9055 or visit my website at www.wildermanpt.com to schedule your FREE 30 minute consultation to see how Physical Therapy can help you. Don’t wait–schedule now!