Pulled Calf Muscle
aka Calf Strain

A pulled calf muscle is a really common sporting injury that can cause long-term problems if not effectively managed. Other common terms for the condition include a calf muscle strain or torn calf muscle. 

Essentially, what all these terms refer to is when the calf muscles are pulled beyond their normal elastic limit, overstretching them and damaging some or all of muscle fibres.  With a calf strain there is usually sudden, intense pain, the area may be painful to touch with swelling and bruising and walking is often difficult.  There are three grades of calf muscle strain, depending on how much of the muscle is damaged. 

Here we will look at what muscles make up the calf complex, how they are injured, what the best treatment options are and how to prevent pulled calf muscles happening to you.

Background

Calf anatomy - gastrocnemius and soleus

The calf is made up of two muscles, gastrocnemius and soleus.  The deep soleus muscle arises from just below the knee joint. The gastrocnemius muscle sits over the top of the soleus muscle and arises from just above the knee.  Both muscles join together around the mid-calf level to form the Achilles tendon which attaches the calf to the foot at the back of the heel. 

The calf muscles work together to pull the foot downwards into plantarflexion.  They play an important role when the foot is pushing off the ground when walking, running and jumping and help to stabilise the ankle.

Causes of Calf Muscle Strain

A pulled calf muscle most commonly 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.

Frank Lampard suffered from a pulled calf muscle in 2012

Acute calf muscle strains occur when the muscle is suddenly overstretched, usually when changing direction or accelerating e.g. sprinting or jumping.  Athletes participating in sports such as tennis, basketball, football or track events are commonly affected by calf muscle strain due to the sudden bursts of speed required when moving from a stationary position.

Calf muscle strains can also developed due to repetitive overuse of the calf muscles usually with running and jumping, especially if the muscles are weak or tight.  Pulled calf muscles are the most common cause of calf pain in runners.

Calf Strain Symptoms

There are three grades of calf muscle strain:

Grade 1: This is when torn calf muscle affects only a few of the muscle fibres (up to approximately 10%)
Symptoms:
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 usually last from a few days to a couple of weeks.

Ruptured Gastrocnemius. Copyright  HarryGouvas

Grade 2: More fibres are damaged but the muscle is still intact (10-90% of the muscle fibres)
Symptoms: With a grade 2 pulled calf muscle, a moderate, sharp pain is usually felt at the time of injury and there may be resultant swelling and bruising.  It 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 usually last 4-6 weeks.

Grade 3: Complete rupture of the muscle i.e. all the fibres are torn.
Symptoms: 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.  There may also be a bulge in the calf just above where the rupture has taken place as the muscle tissue pings up into a lump.

Treatment Options

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

1) Rest

The most important treatment for a pulled calf muscle is rest.  It sounds simple, but it is vital to rest to allow the muscles to heal and to prevent the injury getting worse.  Returning to activity too soon can turn a grade 1 torn calf muscle into a grade 2 or a grade 2 to a grade 3. 

You will probably need to rest for 2-3 weeks with a grade 1 calf muscle strain.  Avoid any activities that cause pain and do not stretch the muscle.  You should not return to sport until you are pain free.  Stretching should be avoided until you can plantarflex your foot against resistance without pain e.g. pushing up onto your tiptoes.  Do not return to sport until you have been given the all clear by your doctor or physical therapist

2) Ice

Icing a pulled calf muscle helps to reduce bleeding and swelling

Ice should be applied to a torn calf muscle as quickly as possible.  Either use a specially designed ice pack or wrap ice cubes in a towel and place them over the affected area for 10 minutes.  Leave 2 hours between applications.  To find out more about how to use ice safely and effectively, visit the ice treatment section.

3) Compression

Tubigrip compression bandage can be used to reduce pain and swelling and provide some support to a calf muscle strain

Wearing a compression bandage such a tubigrip or a specially designed calf wrap will help to reduce swelling and provide some support to the pulled calf muscle.  The compression helps to limit swelling by reducing blood flow.  Tubigrip should not be worn at night. 

To find out more about how tubigrip works and what size is right for you, visit the tubigrip compression bandage section

4) Elevation

Keep the injured calf elevated above the level of the heart to help reduce swelling.  Ensure that the back of the knee is supported when in this position to prevent knee pain.

5) Medication

Your doctor may advise medication to help reduce the pain and inflammation associated with a torn calf muscle.  Over the counter medication such as paracetamol/acetaminophen or ibuprofen/Advil is usually sufficient.  Always consult your doctor before taking any medication.

6) Crutches

You may need to use crutches for a few days to keep the weight off your leg and prevent further damage to the strained calf muscle.  These should be provided by a health care profession to ensure they are the right height and so they can teach you how to safely move around and go up and down stairs.

7) Heel Pad

Wearing a heel pad in your shoe helps to raise the heel and therefore decrease the tension through the calf muscle.  It is best to wear a pad in both shoes otherwise you will end up with one leg slightly longer than the other which can lead to back problems.

8) Exercises

Calf Exercises should only be started once you have been given the go-ahead from your doctor or physical therapist following a pulled calf muscle.  Approved use by www.HEP2go.com

Once the pain from your pulled calf muscle is settling, you can start gentle movement and strengthening exercises.  These should be carried out under the guidance of your doctor or physical therapist.  Any exercises that cause pain should be stopped immediately. When appropriate, resistance exercises e.g. using theraband are important as they help the fibres to align properly as they heal and prevent the build-up of scar tissue.

 It is important to continue rehab even once the symptoms have gone to ensure you regain full strength and flexibility in your calf muscles or you run the risk of suffering from further pulled calf muscles in the future.

9) Sports Massage

A sports massage, carried out by a fully trained professional can aid healing of a pulled calf muscle by improving blood flow, stretching the muscle and preventing the build-up of scar tissue.

10) Ultrasound

You physical therapist may also use ultrasound to help promote healing after a torn calf muscle.  It is thought that Ultrasound can help to improve blood flow to the area and breakdown any cross-fibres that have formed in the muscle allowing the collagen fibres to heal in the correct alignment to ensure good strength and flexibility in the muscle.

Preventing Calf Strains

Whether you have suffered from a pulled calf muscle in the past or not, prevention is better than cure.  By ensuring that your muscles are warmed up before commencing exercise, you reduce your risk of suffering from a calf muscle strain. 

You also want to make sure you calf muscles are strong and flexible so that they can cope with strain you put them through:
1)  Strengthening Exercises: exercises to improve the strength and endurance of the calf muscles will reduce the chance of injury
2)  Stretching Exercises: regularly stretching your calf muscles, especially before and after exercise reduces the strain on the muscle and improves flexibility.

To find out how to effectively strengthen and stretch your calf muscles, visit the calf workout section on our sister site, foot-pain-explored.com

What Else Could It Be?

A pulled calf muscle is the most common cause of calf pain, but there are other, potential life threatening causes of calf pain.  Visit the calf pain section to find out more.

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