Calf Strain

What it feels like

Pain may be sudden or sharp. You may hear a popping sound, notice a tearing sensation, or feel like you can’t move it in the same way.  If the injury is more severe, you may also have bruising. If it is a mild strain, you may notice it only when doing certain movements, like trying to jump or raise up on your toes. Main symptoms

• Sudden or sharp pain in the lower leg
• Popping sound
• Tearing sensation along the back of your lower leg
• Pain is often in the center of the calf and is felt when the calf muscle is stretched.
• You may have trouble moving your lower leg. Sometimes you do not notice it right after you have injured it.
• If the injury is severe, you may not be able to move your lower leg.

Mild injury

If the injury is mild, you will only feel pain when you flex your calf while standing (like when going on tiptoes) or if  doing a small hop on one leg.

Moderate injury

If you notice pain when your ankle is flexed and downward—like when pressing down on the gas in your car—then the strain is probably moderate.

Severe injury

If the strain is severe, you will know it as soon as it happens. Often, you will not be able to flex the calf muscle at all, either because of the pain or excessive damage to the muscle.

Causes of calf strain

Gastrocnemius strains

A strain of the gastrocnemius muscle is commonly referred to as “tennis leg” strain as it often happens when you suddenly change direction, like when returning a volley in tennis. Athletes like soccer players and runners are also more likely to strain their calf muscle.

This type of calf strain is also more likely to happen when you suddenly start doing intense physical activity and are not in shape.  Damage to the muscle fibers of the leg are often caused by sudden explosive motions that you are not used to doing.  This can be a sudden dash or jump or even when landing after jumping from an elevated platform.

Often when a gastrocnemius is pulled or strained, you will hear an internal “pop” sound. Soon after the injury, you may realize that it is difficult to stand on the leg.  If the strain is severe, you may also have bruising along the back of the affected leg.

Soleus strains

Usually, if the injury is to the soleus muscle you will have pain when there is pressure on the  Achilles tendon. You can also tell if you have a soleus strain if you feel pain when walking on your tiptoes.

Soleus strains are caused by the ankle being flexed upward— toes toward the sky—while the knee is also flexed or bent. This is a common position when running uphill. And while a strain to the soleus muscle happens less often than a gastrocnemius strain,  long-distance runners or anyone who runs frequently is more likely to get it.

A soleus strain often develops over time from regularly running uphill. A typical scenario is that a person is going uphill at the end of a long run and suddenly has a pain in the deep middle of the calf.

Treatment options and prevention of calf strain

Treatment is based on the severity of the strain. Usually, you can treat a calf strain yourself with rest, ice, and pain relievers. Bruising is a sign of bleeding, and it means you should not take OTC anti-inflammatory medication (NSAIDs) like ibuprofen (Advil, Motrin) for the pain. Surgery is only needed when the injury is extremely severe.

Rest

The main treatment for a mild or moderate calf strain is rest. In severe cases, where the majority of the muscle is torn, you will probably need surgery.

When treating mild or moderate strains, the goal is to control pain and bleeding, if there is any.  Rest means limiting doing any activity that uses the calves for a period of time—and possibly stopping doing any activity if possible.

• Bed rest or limiting activity: While rest can mean actually staying in bed all the time, it generally means you reduce or stop doing vigorous activities, especially those that flex or lift the ankle like running, jumping, and ballet.
• Tall walking boot: Your doctor may prescribe a “tall walking boot” to help with healing. The boot keeps the foot in a position that does not strain the calf muscle.

Compression stockings

If you keep getting calf strains, you may need a compression stocking or compression sock to help stop bruising of the muscle tissue. Bruising can make the injury worse because it can sometimes increase inflammation. In severe cases, bruising can cause compartment syndrome where increased pressure damages tissue within the calf.

Pain medication and ice

For the first two days, ice can be used to help decrease pain and swelling in the lower leg. But after the first two days, you will probably need OTC medication for the pain and swelling.

If there isn’t any bleeding, then OTC anti-inflammatory medication (NSAIDs) like ibuprofen (Advil, Motrin) can be taken to control the pain. But because NSAIDs can interfere with the body’s ability to stop bleeding, if you think there is bleeding you may want to talk to your doctor about limiting their use or trying a different pain reliever like acetaminophen (Tylenol).

Stretching and heat

Stretching is an important part of the healing process. It helps reduce stiffness and stop the shortening of muscle fibers from lack of use and scarring, which can further limit your range of motion.

After the earliest stages of healing, applying heat can relax muscles and allow them to stretch even more.  It is also recommended to stretch the opposing muscles as well by lifting the toes so they point up to the sky. Stop doing any stretches if you feel any pain.

Over time, you should be able to stretch further without feeling any pain until the calf can be fully stretched. When you reach this stage, you may be given some more challenging stretches to help the healing process even more.

Surgery

If the muscle has been completely torn or pulled away from the bone, it is important to reconnect the muscle to restore some function to the lower leg. This requires emergency surgery.

The surgery reattaches the muscle to the bone so that you are able to flex the ankle and the knee. After the surgery, you will need to see your doctor regularly for at least six months to help with recovery.