Calf Strain (Soleus)
(Also known asCalf Tear, Strained Calf, Calf Muscle Strain, Torn Calf, Torn Calf Muscle, Pulled Calf, Soleus Strain, Soleus Tear, Torn Soleus)
What is a calf strain?
A calf strain is a common injury affecting the lower leg characterized by tearing of one or more of the calf muscles and typically causes pain in the back of the lower leg.
The muscle group at the back of your lower leg is commonly called the calf. The calf comprises of 2 major muscles one of which originates from above the knee joint (gastrocnemius) the other of which originates from below the knee joint (soleus). Both of these calf muscles insert into the heel bone (calcaneus) via the Achilles tendon (figure 1). The soleus muscle lies deeper than the gastrocnemius.
Figure 1 – Relevant Anatomy for a Calf Strain
During contraction or stretch of the calf, tension is placed through the calf muscle. When this tension is excessive due to too much repetition or high force, the calf muscle can be torn. When this occurs and the injury involves the deeper calf muscle, it is known as a calf strain of the soleus muscle.
A strained calfcan range from a small partial tear whereby there is minimal pain and minimal loss of function, to a complete rupture of the calf which may require surgical reconstruction.
Calf strains range from grade 1 to grade 3 and are classified as follows:
- Grade 1 Tear: a small number of fibres are torn resulting in some pain, but allowing full function.
- Grade 2 Tear: a significant number of fibres are torn with moderate loss of function.
- Grade 3 Tear: all muscle fibres are ruptured resulting in major loss of function.
The majority of calf strains are grade 2.
Causes of a calf strain
Astrained calfcommonly occurs due to a sudden contraction of the calf muscle (often when the muscle is in a position of stretch). This frequently occurs when a patient attempts to accelerate from a stationary position or when lunging forwards such as while playing tennis, badminton or squash. They are also commonly seen in running sports such as football and athletics.
A calf strain involving the soleus muscle may also frequently occur due to gradual wear and tear associated with overuse. This may be due to activities such as distance running, repetitive jumping or walking excessively (especially up hills or on uneven surfaces).
Signs and symptoms of a calf strain
Patients witha strained calfusually feel a sudden sharp pain or pulling sensation in the calf muscle at the time of injury. Occasionally, the patient may experience increasing tightness in the calf muscle in the lead up to their injury. Swelling, tenderness and bruising are often present in the calf muscle following the injury. When the soleus muscle is involved, symptoms tend to present more commonly in the outer (lateral) aspect of the muscle. In minor strains, pain may be minimal allowing continued activity. In more severe cases, patients may experience severe pain, muscle spasm, weakness, and an inability to continue activity. Patients with a severe calf strain may also walk with a limp or be unable to weight bear on the affected leg.
Patients with this condition usually experience pain in the calf that may increase during activities such as walking (especially uphill or on uneven surfaces), going up and down stairs, running, jumping, hopping, or standing on tip toe (particularly with the knee bent). It is also common for patients with a strained calfto experience pain or stiffness after these activities with rest, especially upon waking in the morning. Occasionally, walking and jogging may actually be more painful than fast running in patients with a calf strain involving the soleus muscle.
Diagnosis of a calf strain
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose a calf strain. Further investigations such as an MRI scan or Ultrasound may be required, in rare cases, to confirm diagnosis, assess the severity of injury and/or rule out other pathologies.
Treatment for a calf strain
Prognosis of a calf strain
With appropriate management, patients with a minor calf strain can usually recover in one to three weeks. With a more severe calf strain, recovery may take four to eight weeks or longer depending on the severity. In cases of a complete rupture of the calf muscle surgery may be required with intensive rehabilitation to follow. Return to sport or activity may then take 6 months or longer.
Contributing factors to the development of a calf strain
There are several factors which can predispose patients to developing a calf strain. These need to be assessed and corrected with direction from a physiotherapist. Some of these factors include:
- poor calf flexibility
- calf weakness
- ankle joint stiffness
- inappropriate or excessive training or activity
- inadequate recovery periods from training or activity
- poor biomechanics
- poor foot posture (especially flat feet)
- inadequate warm up
- inadequate rehabilitation following a previous calf injury
- decreased fitness
- neural tightness
- poor balance
- training surfaces (such as wet /slippery conditions)
Physiotherapy for a calf strain
Physiotherapy for patients with a calf strain is vital to hasten the healing process, reduce the likelihood of recurrence and ensure an optimal outcome. Treatment may comprise:
- soft tissue massage
- the use of crutches or heel wedges
- Achilles tendon taping
- joint mobilization
- dry needling
- ice or heat treatment
- exercises to improve strength, flexibility or balance
- electrotherapy (e.g. ultrasound)
- anti-inflammatory advice
- education about a calf strain
- activity modification advice
- biomechanical correction
- the use of a compression bandage
- prescription of orthotics
- footwear advice
- a gradual return to running program
- establishing an appropriate return to activity or sport plan
Other intervention for a calf strain
In the event of a complete rupture of the calf muscle surgery may be indicated. It is vital that all patients with a potential calf muscle complete rupture seek physiotherapy or medical assessment as soon as possible to determine if the muscle is completely ruptured. This is vital as delayed treatment may result in a poor outcome due to shortening of the torn calf muscle. The patient’s doctor or physiotherapist may then refer on to an orthopaedic specialist if it is warranted clinically. Surgical repair of the ruptured calf muscle is generally considered the most appropriate form of management for active individuals seeking the highest level of function. This often involves a period of immobilization in a plaster cast for one to two months following calf surgery and a rehabilitation period of three to six months or longer involving extensive physiotherapy.
Conservative management of a ruptured calf muscle may be appropriate for older individuals. This involves immobilizing the calf in a shortened position in a cast for approximately four weeks. The calf is then gradually stretched and strengthened over time.
Exercises for a calf strain
The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.
Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should only take place provided there is no increase in symptoms.
Calf Stretch with Towel
Begin this calf stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your foot as demonstrated (figure 2). Using your foot, ankle and the towel, bring your toes towards your head as far as you can go without pain and provided you feel no more than a mild to moderate stretch in the back of your calf, Achilles tendon or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free.
Figure 2 – Calf Stretch with Towel
Resistance Band Calf Strengthening
Begin this exercise with a resistance band around your foot as demonstrated and your foot and ankle held up towards your head (figure 3). Slowly move your foot and ankle down against the resistance band as far as possible and comfortable without pain, tightening your calf muscle. Slowly return back to the starting position. Repeat 10 – 20 times provided the exercise is pain free.
Figure 3 – Resistance Band Calf Strengthening (left calf)
Begin this exercise lying on your back in the position demonstrated (figure 4). Slowly lift your bottom off the ground pushing through your feet, until your knees, hips and shoulders are in a straight line. Tighten your bottom muscles (gluteals) as you do this. Hold for 2 seconds then slowly lower your bottom back down. Repeat 10 times provided the exercise is pain free.
With your hands against the wall, place your leg to be stretched behind you as demonstrated (figure 5). Keep your heel down, knee straight and feet pointing forwards. Gently lunge forwards as far as you can go without pain and provided you feel no more than a mild to moderate stretch in the back of your calf or knee. Hold for 15 seconds and repeat 4 times at a mild to moderate stretch provided the exercise is pain free.
Begin this exercise for a calf strain standing at a bench or chair for balance (figure 6). Keep your feet shoulder width apart and facing forwards. Slowly move up onto your toes, raising your heels as far as possible and comfortable without pain. Repeat 10 – 20 times provided the exercise is pain free. Once you can perform 20 repetitions of this exercise consistently without pain progress to performing the exercise over a step (figure 7). Begin with only a few repetitions over the step initially and then build up to 20 repetitions gradually over a number of days provided there is no increase in pain.
Single Leg Balance
Ensure you begin this exercise in a safe environment (e.g. at a bench or with a spotter) to prevent falls and only provided the exercise is pain free. Standing on one leg, maintain your balance (figure 8). Try to hold for 1 minute provided there is no increase in symptoms. Once this exercise is too easy progress to eyes closed.
Single Leg Bridging
Begin this exercise lying on your back in the position demonstrated (figure 9). Slowly lift your bottom pushing through your foot, until your knee, hip and shoulder are in a straight line. Tighten your bottom muscles (gluteals) as you do this and hold for 2 seconds. Then slowly lower back down. Perform 10 – 20 repetitions provided the exercise is pain free.
Rehabilitation Protocol for a calf strain
Find a Physio for a calf strain
Find a physiotherapist in your local area to treat a calf strain
Physiotherapy products for a calf strain
Some of the most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:
To purchase physiotherapy products for a calf strain, click on one of the above links or visit the PhysioAdvisor Shop.
- Ice or Heat
- The R.I.C.E. Regime
- How to use Crutches
- Achilles Tendon Taping
- Choosing a Shoe
- Do I need Orthotics?
- Return to Running
- Return to Sport
- Warming up and Cooling Down
- Injury Prevention
- Lower Leg Diagnosis Guide
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A calf strain is a relatively common sporting injury causing pain in the lower leg and is characterised by tearing of one or more calf muscles. It typically occurs due to a sudden, forceful contraction of the calf often whilst in a position of stretch (e.g. a quick take off).
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