What is a calf strain?
A calf strain, commonly known as tennis leg involves a tear or partial tearing of one or more of the calf muscles causing pain in the back of the lower leg. The Calf muscles are made up of the gastrocnemius and plantaris muscles which originate just above the back of the knee and the soleus muscle which originates just below the back of the knee. The plantaris has a short muscle belly of around 6 cm after which it turns into a tendon that runs down the inside of the lower leg between the soleus and gastrocnemius muscle. The long plantaris tendon then attaches to the heel (the calcaneus) below the Achilles tendon. Both the gastrocnemius and soleus muscles overlap and run down the back of the leg down to the foot and attach onto the heel via the Achilles tendon. The calf muscles are responsible for plantar flexing the foot (pointing the foot downwards) and the gastrocnemius contributes to flexing the knee. Tennis leg typically involves tearing of the plantaris muscle or the medial head of the gastrocnemius muscle.
What is a muscle strain?
A muscle strain commonly known as a pulled muscle is a medical term used when a muscle or tendon has been injured by a sudden powerful contraction or from overuse resulting in small tears within the muscle fibres or tendon itself. Each muscle is made up of thousands of small fibres that have a powerful elastic property that allows it to stretch and be flexible yet strong. The muscle fibres are in what we class the muscle belly and they all converge to one point and are connected to the bone by a very strong tendon which looks similar to a cord or piece of string. General muscle pain is derived from the disruption of the small muscle fibres either through mild injury like repetitive movements, tightness or inflammation. A muscle strain results from sudden or excessive tension being placed through the muscle fibres causing small tears. Milder injuries to the muscles tendons are covered under the condition tendonitis. Muscle strains are graded by their severity
Grade I- This is where only a small number of muscle fibres are torn resulting in pain and discomfort but not affecting the muscle function or movement.
Grade II- This is a partial tear where a substantial number of muscle fibres are torn resulting in slight loss of muscle function and movement.
Grade III- This is a complete tear where all the muscle fibres are ruptured resulting in a complete loss of muscle function and movement.
Strain injuries are commonly confused with sprains. The injury is very similar but a sprain affects the ligaments not the muscle or tendon.
Why and when does a calf strain happen?
Calf strain or tennis leg is a common injury and effects people of all ages in particular those between the ages of 35-50. It is normally seen in individuals who partake in a lot of athletic sports in particular tennis and sprint running that both involve repetitive or forceful plantar flexion of the ankle and foot.
Calf strains commonly occur due to a sudden contraction of the calf muscle. This frequently occurs when attempting to accelerate from a stationary position, when jumping or when lunging forwards whilst playing tennis, badminton or squash, hence the descriptive term ‘tennis leg’. Calf strains are also commonly seen in running sports such as football and athletics. Occasionally they occur due to gradual wear and tear associated with overuse. This may be due to activities such as repetitive jumping, distance running or walking excessively (especially up hills or on uneven surfaces) without adequate stretching or warming up.
What does a calf strain feel like?
A calf strain or tennis leg begins as a sudden sharp burning pain, initially concentrated along the inside of the calf muscle or behind the knee. In some cases a tearing or snapping noise is heard during the injury. In most instances a calf strain will mean that the player or runner is unable to continue. The tear or rupture will be accompanied by severe swelling and bruising that will be incredibly tender to touch. In cases of rupture there will possibly be an inability to move the ankle. Pain levels will be aggravated by any foot movements making weight bearing and walking excruciating and impossible in a rupture case with specific weakness when trying to stand on tip toes. In partial tear cases patients can still fully use their lower leg with stiffness and a feeling of discomfort on weight bearing, resulting in a mild limp. Once healing has started the severe pain will be replaced with dull aches and discomfort felt on plantar flexion of the foot or when the calf muscles are stressed. Stiffness and dull aches are normally experienced during the night and most intense early in the mornings.
Due to the similar presentation of symptoms a calf strain can sometimes be confused with deep vein thrombosis (DVT). A DVT causes intense calf pain, swelling, redness and warmth caused by a blood clot and is a medical emergency. The presence of a DVT is increased if you have recently incurred any prolonged bed rest, say after surgery or after long haul flights. If you are concerned you may have a DVT then please seek immediate medical attention.
How long does a calf strain or tear take to heal?
A mild calf strain can recover relatively fast, normally between 1-3 weeks. The healing time varies dramatically depending on the severity of the strain, with most calf muscle tears healing time ranges from 1-2 months and in some cases as long as 3 months. However complete calf muscle tears take much longer to heal and almost always need surgical intervention. Post-surgery a cast will be applied and the patient may be immobilised for up to two months followed by up to 6 months’ worth of physical rehabilitation, a recovery to the original muscles strength can take up to a year.
How is a calf strain diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. No X-rays or further investigation should be needed to confirm the diagnosis however occasionally an ultrasound or MRI will be used to evaluate the extent of the tear or rupture.
What treatment options are available for a calf strain?
Your GP will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. Initially you will be advised to follow the R.I.C.E protocol. The R.I.C.E protocol involves Resting your leg, try not to walk about on it too much and most importantly to avoid all aggravating movements. Ice by applying a covered ice pack to the area, this may significantly hasten the healing process by reducing the pain and swelling. Make sure the ice pack is covered to prevent any ice burn and for best results use the icepack regularly for 10-15 minutes with intervals of 30 minutes. Compression, try and keep the elastic bandage on during the day to limit the swelling and make sure to take it off at night. Elevation, keep your foot raised on cushions or a stool to help limit the swelling.
Your doctor or therapist will evaluate the extent of the tear or rupture. If the strain is mild then you may just be instructed to rest and avoid any aggravating movements for a couple of weeks. In cases where weight bearing is painful crutches may be provided. Once it is no longer painful, you should try to gradually return to full weight bearing using calf muscle stretches to help. Stretches should be avoided if they aggravate pain levels. Once you are weight bearing pain free then you should focus on strengthening the calf muscles which will have atrophied and weakened after the injury and rest. Your therapist or rehabilitation trainer will be able to provide you with the correct exercises, which will be mild and may involve resistance bands. Once the affected calf muscle is as strong as the other side then you can reintroduce any activities or sports that were previously painful.
Using sports or athletic tape whilst training can also help to prevent further strains and help relieve any discomfort and pain once a strain has occurred. The calf muscles can be taped individually or can be taped as a unit connecting the knee and supporting the Achilles tendon. Many sports therapists, physiotherapists, chiropractors and osteopaths can apply sports tape but you can also buy pre-cut strips and use the many online videos to help you apply them correctly (see our products section below).
If the calf muscle is partially torn then a cast or splint will be applied and you will be ordered to rest for as long as the healing process takes. In cases of a complete muscle rupture, surgery is almost always necessary and is the best form of treatment to return the muscle back to original function and strength. The surgery will stitch the muscle back together, after this a cast will be applied and you will be instructed to rest for 2 months at which point you will be referred through to a physiotherapist who will provide you with strengthening exercises for the lower limb muscles this can take over 4 months. Full strength recovery is not guaranteed and can occasionally take well over 6 months to achieve. A good rehabilitation program can aid the healing process and prevent reoccurring injury.
Once into the later phase of recovery many people find massage therapy helpful to loosen the affected muscles, manipulative therapies such as physiotherapy, chiropractic and osteopathy are thought to help through mobilisation treatment of the ankle and knee working to reduce any stiffness levels and return the joint back to its normal movement.
