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Introduction

Knee Pain

Calf tear

A pulled calf muscle is a really common sporting injury that can cause long-term problems if not effectively managed.


Other common terms for this injury include a calf muscle strain, calf tear and torn calf muscle.

Essentially, what all these terms refer to is one of the calf muscles being pulled beyond its normal elastic limit, overstretching it and damaging some or all of muscle fibers.


With a calf strain there is usually sudden, intense pain, the area may be tender to touch with swelling and bruising and walking is often difficult.

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Causes

A pulled calf muscle usually happens suddenly due to injury, but can develop gradually from overuse. A calf muscle strain most commonly affects the larger, more superficial gastrocnemius muscle but can affect the soleus muscle as well.

Common causes of a pulled calf muscle are:

  1. Overstretching: Acute calf muscle strains occur when the muscle is suddenly overstretched, usually when changing direction or accelerating e.g. sprinting or jumping.  

  2. Sudden Acceleration: Athletes participating in sports such as tennis, basketball, football, soccer or track events often suffer from calf muscle tears due to the sudden bursts of speed required when moving from a stationary position. 

  3. Repetitive Overuse: Calf muscle strains can also developed due to repetitive overuse of gastrocnemius and soleus, usually with running and jumping, especially if the muscles are weak or tight.  A calf strain is the most common cause of calf pain in runners.

Symptoms

There are three grades of calf muscle strain, depending on how much of the muscle is damaged and the location of the pain will depend on where the calf tear is.

  • Upper Calf Tear: damage near the junction between the muscle tendon and muscle belly

  • Mid Calf Tear: indicates a tear in the muscle belly and 

  • Lower Calf Tear: typically from damage to the achilles tendon 

Typical symptoms for each grade of pulled calf muscle include: 


Grade 1 Symptoms

With a grade 1 calf strain, only a few of the muscle fibres are damaged, up to approximately 10%.

Mild pain may be felt at the time of injury or may not develop until after activity has stopped.  The calf may feel tight and painful to move and it may be accompanied by cramp

Symptoms from a grade 1 pulled calf muscle usually last from a few days to a couple of weeks

Grade 2 Symptoms

With grade 2 muscle tears, more of the muscle fibres are damaged, between 10-90%, but the calf muscle is still intact 

Grade 2 pulled calf muscle injuries tend to cause a moderate, sharp pain that is usually felt at the time of injury and there may be resultant swelling and bruising in the surrounding area.  

The area will be painful when the calf muscles contract or are stretched and the region is often tender to touch.  The affected person will usually walk with a limp due to pain and weakness.  Symptoms of a grade 2 calf tear usually last 4-6 weeks

Grade 3 Symptoms

With a grade 3 there is a large tear where there is complete rupture of the calf muscle i.e. all the fibres are torn, or a complete rupture of one of the heads of gastrocnemius

When suffering from a completely torn calf muscle, pain will be severe and immediate. The person will be unable to walk on the affected leg. 

There will be considerate bruising and swelling with a grade 3 calf tear.  There may also be a bulge in the back of the calf just above where the rupture has taken place as the muscle tissue pings up into a lump.

Diagnosis

Your healthcare provider will perform a physical exam and review your symptoms. They may palpate (press) on your calf muscles to check for areas of tenderness or swelling.

Sometimes torn calf muscles look like other injuries in your lower leg, such as Achilles tendon ruptures or a burst Baker’s cyst. Calf pain that seems like muscle pain could also be a serious blood vessel problem like DVT or compartment syndrome. Your provider might require additional studies when the diagnosis is not clear.

Your healthcare provider may perform imaging exams to evaluate your calf muscles:

  • Ultrasound with Doppler: This type of ultrasound uses sound waves to create pictures of soft tissue inside your body. It also tracks the way blood flows through your body. This scan allows your provider to check for muscle tears, as well as internal bleeding and blood clots.

  • MRI: An MRI shows detailed images of the soft tissues in your body. This test can help your provider see the difference between muscle injuries and problems with your tendons and ligaments.

Non-surgical treatments

Treatment for a pulled calf muscle aims to prevent further injury, aid healing and ensure full recovery to prevent long-term problems. 

Pulled calf muscle treatment usually includes:

  • Rest: It is really important to rest for a few days after a pulled calf muscle to prevent further injury. You should avoid anything that overloads or stretches the injured calf muscle and may benefit from using crutches for a few days 

  • Ice Treatment: Regularly applying ice to a pulled calf muscle helps to reduce pain and swelling and can help speed up healing 

  • Compression: Wearing a compression support or tubigrip also help reduce swelling in the calf muscle and provides some support to help protect from further injury 

  • Elevation: Keeping the leg elevated when resting helps to stop excess fluid and blood pooling in the calf muscle which helps to reduce swelling 

  • Medication: Over-the-counter pain medication can help to reduce pain levels. Anti-inflammatories should be avoided for the first few days as they can actually slow down healing 

  • Heel Pads: Using heel lifts in your shoes helps to reduce the tension through the injured calf muscle, aiding healing and reducing the risk of further tearing

 

  • Calf Exercises: Strengthening and stretching exercises are a vital part of pulled calf muscle treatment but is really important to follow a rehab program so you know what is safe to do when 

  • Physical Therapy: A physical therapist may carry out a range of treatments including cross friction massage and ultrasound, both of which help reduce pain and inflammation and help the torn calf muscle to heal properly without a build up in scar tissue and regain full strength and flexibility

Surgery