What is a Calf Muscle Tear?
How to Care for a Torn Calf Muscle
Calf pain felt in your calf muscle belly is often the result of a pulled or torn calf muscle. A torn calf muscle can sometimes be confused with an Achilles tendon rupture, significant Achilles tendinopathy, leg cramps or even sciatica or referred pain from your lower back.
Similar to the history of an Achilles tendon rupture, you may think you were “hit” in the leg. Potentially, you may feel a “pop” or “snap”. But in nearly 100% of cases, you will feel a sudden pain in the back of your calf. Over the next few hours, you’ll have difficulty walking properly or standing on your foot or rising onto your toes. Swelling or bruising in the calf muscle will be apparent in severe calf muscle tears.
What Causes a Calf Muscle Tear?
Calf muscle tears usually occur during acceleration or changes in direction, e.g. a change of running speed. However, there is a small percentage of the populations who can tear their calf muscle by merely walking.
The most commonly torn calf muscle is your medial gastrocnemius. Shields et al. (1985). However, you can tear any of your other calf muscles: lateral gastrocnemius, soleus, plantaris or flexor hallucis longus. Mid-belly calf muscle tears are most familiar with the Achilles musculotendinous junction second most likely. Campbell JT (2009), Delgardo et al. (2002).
Grades of Calf Muscle Tear Severity
Calf strain may be minor (grade 1) or very severe (grade 3). Your physiotherapist will grade your injury depending on their clinical findings or diagnostic tests such as MRI or diagnostic ultrasound.
Grade one calf muscle tears are a result of mild overstretching resulting in some small micro-tears in the calf muscle fibres. Symptoms usually are quite disabling for the first two to three days. In most cases, your recovery will take approximately one to two weeks if you do all the right things. Your physiotherapist can help you to fast-track your recovery.
Grade two calf muscle tears result in partial tearing of your muscle fibres. Full recovery takes several weeks, typically with proper rehabilitation. Return to high load or high-speed sport should be guided by your physiotherapist to prevent an unnecessary retear, which is reasonably common in moderate calf tears.
A grade three calf tear is the most severe calf strain with a complete tearing or rupture of your calf muscle fibres. You should seek professional assessment and treatment guidance specific to all grade 3 calf tears.
It is essential to determine whether an Achilles tendon rupture of grade 3 calf muscle tear has occurred. A diagnostic assessment may utilise an ultrasound or MRI. Full recovery can take several months. For Achilles ruptures, we recommend an orthopaedic surgeon’s opinion. Surgery may be required.
Deep venous thrombosis (DVT) is a potentially life-threatening condition that is caused by clotting in the leg veins. These clots can dislodge and travel to your heart, lungs or brain, resulting in life-threatening life-changing conditions such as a pulmonary embolism. You should seek the professional advice of your healthcare practitioner if you suspect or wish to exclude a DVT. Delgardo et al. 2002 found 10% of calf strains scanned had evidence of DVT.
Pulmonary embolism warning signs include:
- Sudden shortness of breath,
- Chest pain or discomfort that worsens when you take a deep breath or when you cough,
- Feeling lightheaded or dizzy, or fainting,
- Rapid pulse,
- Potentially, coughing up blood.
If you experience any of these signs, please seek urgent medical attention.
Sural Nerve Injury
Your sural nerve, which passes through your calf, may also be injured. If you experience heel or ankle numbness associated with a history of calf trauma, please consult your physiotherapist for diagnostic advice.
How to Treat a Calf Muscle Tear
Calf muscle tears are a prevalent condition that we see at PhysioWorks. Unfortunately, a torn calf muscle often recurs if you fail to rehabilitate your calf tear adequately and you return to sport too quickly.
There are mostly six rehabilitation stages that need to be covered to rehabilitate calf muscle tears and prevent a recurrence effectively. These are:
Phase 1 – Early Injury Protection: Pain Reduction & Anti-inflammatory Phase
As with most soft tissue injuries, the initial treatment is RICE – Rest, Ice, Compression and Elevation.
Your calf muscles are a large, powerful group of three calf muscles (soleus plus your medial and lateral gastrocnemius). Your calf muscles produce very high contractile forces that enable you to run, jump and hop. In the early phase of your torn calf muscle, you’ll be unable to walk without a limp, so your calf will need some rest and weight-bearing avoidance strategies. Active rest may include crutches or a wedged walking boot.
Please seek the advice of your healthcare professional for specific recommendations relevant to your calf muscle tear.
General Recommendations: Calf Muscle Tear Treatment – Phase 1
Phase 2: Regain Full Range of Motion
Your torn calf muscle will successfully repair itself with collagen scar tissue in most cases through your body’s natural healing process. It is important to note that mature collagen scar formation can take at least six weeks. During these initial six weeks, it is ideal that you optimally remould your scar tissue to prevent a clumpy non-aligned scar that will potentially re-tear in the future when placed under high load or speed.
Successful rehabilitation includes lengthening and orientating your healing scar tissue via massage, and muscle stretches, rolling, active movements and neurodynamic mobilisations. Signs that you have full soft tissue extensibility includes being able to walk without a limp and able to perform calf stretches with a similar end of range stretch feeling.
Phase 3: Restore Concentric Muscle Strength
Gradually progress your calf muscle strength and power. Progressions involve performing your exercise initially in non-weight bear, before proceeding to partial weight bear, full weight bear, and then eventually, resistance loaded exercises.
It is incredible how, just a few days off training can affect your global muscle strength. If your calf muscle tear is going to sideline you for a few weeks, then you may also require strengthening for both of your legs including your thigh muscles and gluteals, plus your lower core muscles. Please ask your physiotherapist for advice.
Phase 4: Restore Eccentric Muscle Strength
Calf muscles work in two directions. They push you up (concentric) and control you down (eccentric). Researchers suggest that most calf muscle tears occur during the controlled lengthening or eccentric phase. Your rehabilitation should always include eccentric and plyometric components within your training regime in preparation for a return to speed and full sport-specific or functional activities.
Your physiotherapist is an expert in exercise prescription and will guide you on an eccentric calf strengthening program when injury appropriate.
Phase 5: Restore High Speed, Power, Proprioception & Agility
Most calf injuries occur during high-speed activities, which place enormous forces on your contractile and non-contractile calf muscle structures. Your physiotherapist will guide your best prevention strategy to avoid a recurrent calf tear.
Depending on the specific requirements of your sport or lifestyle, your physiotherapist will introduce appropriate exercises and activities. These exercises usually that will address your speed, agility, proprioception and power to prepare you for lower recurrence risk sport-specific training.
Phase 6: Return to Sport
All sports are different. Depending on your chosen sport, your physiotherapist will address the physical needs of your activity or sport and incorporate them into your specific return to sport program. Your progressed training regime, including neuromuscular training, is your best chance to enable a safe and injury-free return to your chosen sport. Hubscher et al. (2010).
Your physiotherapist will discuss your specific goals, rehabilitation time frames and your training schedules to optimise your calf muscle tear rehabilitation for a complete and safe return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a thorough rehabilitation program has minimised your chance of future injury.
While the grade of your calf muscle tear will determine whether your rehabilitation process will take days, weeks or months, there is no specific period for your progressions from each stage to the next. Your injury rehabilitation status determined by many factors, including your functional ability and tissue healing maturity. These are all things considered by your physiotherapist during their clinical assessment of you.
Your physiotherapist will carefully monitor each of your progressions. The last thing you want is to attempt to progress prematurely to the next level and lead to re-injury and the resulting frustration of an extended rehabilitation period.
Sources of Calf Pain
Other sources of calf pain can include the following:
Calf Muscle Strain
Other Muscular Conditions
- Shin Pain
- Shin Splints
- Stress Fracture
- Tibialis Posterior Tendinopathy