Calf Muscle Tear

Calf Muscle Tear

Article by John Miller

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 tendinopathyleg 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, a small percentage of the population can tear their calf muscle by merely walking.

Shields et al. (1985) found the most commonly torn calf muscle is your medial gastrocnemius. However, you can pull 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

torn calf muscle

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 1:

Grade one calf muscle tears result from 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 2:

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.

Grade 3:

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 ultrasound or MRI. Full recovery can take several months. For Achilles ruptures, we recommend an orthopaedic surgeon’s opinion. You may require surgery.

Exclude DVT

Deep venous thrombosis (DVT) is a potentially life-threatening condition 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 disorders such as a pulmonary embolism. Delgardo et al. 2002 found 10% of calf strains scanned had evidence of DVT. You should seek your healthcare practitioner’s professional advice if you suspect or wish to exclude a 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?

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, muscle stretches, rolling, active movements and neurodynamic mobilisations. Signs that you have full soft tissue extensibility include walking without a limp and performing 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 a non-weight bear before proceeding to partial weight bear, full weight bear, and 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 sidelines you for a few weeks, 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, forcing 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 your sport or lifestyle’s specific requirements, your physiotherapist will introduce appropriate exercises and activities. These exercises will usually 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 your activity or sport’s physical needs 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 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.

Summary

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.

What Can Cause Pain In Your Calf Muscle?

The most common sources of leg pain include calf muscle strain (torn calf), Achilles tendinopathy and leg cramps.

calf injury

Other sources of calf pain can include the following:

Calf Muscle Strain

Other Muscular Conditions

Achilles Injuries

Shin Pain

Systemic Conditions

Neurological Conditions

Article by John Miller

Common Youth Leg Injuries

Why are Children's Injuries Different to Adults?

youth sports injuries

Adolescent Leg Injuries

Adolescent injuries differ from adult injuries, mainly because the bones are still growing. The growth plates (physis) are cartilaginous (strong connective tissue) areas from which the bones elongate or enlarge. Repetitive stress or sudden large forces can cause injury to these areas.

In the adolescent leg, common injuries include:

Osgood-Schlatter's Disease

Pain at the bump just below the knee cap (tibia tubercle). Overuse injuries commonly occur here. The tibia tubercle is the anchor point of your mighty quadriceps (thigh) muscles. Because of excessive participation in running and jumping sports, the tendon pulls bone off and forms a painful lump that will remain forever. This type of injury responds to reduced activity and physiotherapy.

More info: Osgood Schlatter's Disease

Sinding-Larsen-Johansson Disease

Pain at the lower pole of the knee cap (patella). Overstraining causes Sinding-Larsen-Johansson disease. Because of excessive participation in running and jumping sports, the tendon pulls bone off the knee cap. This type of injury responds to reduced activity and physiotherapy.

More info: Sinding Larsen Johansson Syndrome

Anterior Knee Pain

Anterior knee pain or patellofemoral syndrome frequently gets passed off as growing pains. Cause of this pain includes overuse, muscle imbalance, poor flexibility, poor alignment, or more commonly, a combination of these. Anterior knee pain is one of the most challenging adolescent knee injuries to sort out and treat. Accurate diagnosis and treatment with the assistance of a physiotherapist with a particular interest in this problem usually resolves the condition quickly.

More info: Patellofemoral Pain Syndrome

Knee Ligaments

The cartilage between the leg bones has a better blood supply and is more elastic in adolescents than adults. As adolescents near the end of bone growth, their injuries become more adult-like. Hence more meniscal and ACL (anterior cruciate ligament) injuries are likely. MCL (medial collateral ligament) injuries result from a lateral blow to the knee. Pain felt on the inner side (medially) of the knee. MCL injuries respond well to protective bracing and conservative treatment.

More info: Knee Ligament Injuries

ACL (Anterior Cruciate Ligament) Injuries

This traumatic knee injury is significant. Non-contact injuries of the ACL are becoming more common than contact injuries of the ACL. Adolescent females are at high risk. Combination injuries with MCL or menisci are common. Surgical reconstruction is needed if the adolescent wishes to continue participating in "stop-and-start" sports.

More info: ACL Injury

Meniscal Injuries

Your meniscus is crescent-shaped cartilage between the thigh (femur) and lower leg (tibia). Meniscal injuries usually result from twisting. Swelling, catching, and locking of the knee are common. If physiotherapy treatment does not resolve these damages within six weeks, they may require arthroscopic surgery.

More info: Meniscus Tear, Discoid Meniscus

Sever's Disease

Heel pain is commonplace in young adolescents due to the stresses of their Achilles tendon pulling upon its bony insertion point on the heel (calcaneum). It is a common overuse injury due to excessive training and competition, particularly when loads are increased dramatically in a short period. Diminished flexibility and muscle-tendon strength mismatching may predispose you. Physiotherapy, reduced activity, taping and orthotics are the best ways to manage this debilitating condition for the active young athlete.

More info: Sever's Disease

Ankle Sprain

An ankle sprain is probably the most common injury seen in sports. Ankles sprains involve stretching of the ligaments and usually occur when the foot twists inward. Treatment includes active rest, ice, compression and physiotherapy rehabilitation. With the correct treatment, a low ankle sprain usually improves in two to six weeks. Your ankle physiotherapist should check even simple ankle sprains to eliminate high-ankle sprains. A residually stiff ankle post-sprain can predispose you to several other lower limb issues.

More info: Sprained Ankle

Patellar Instability

Patellar (kneecap) instability can range from partial dislocation (subluxation) to dislocation with a fracture. Partial dislocation treatment is conservative. Dislocation with or without fracture is a much more severe injury and usually will require surgery.

More info: Patella Dislocation

Osteochondritis Dissecans

The separation of a bone from its bed in the knee joint is Osteochondritis Dissecans (OCD). This injury is usually due to one major macro event with repetitive macro trauma that prevents complete healing. This injury is potentially severe. Treatment varies from rest to surgery. An Orthopaedic Surgeon's opinion is vital.

More info: Juvenile Osteochondritis Dissecans (JOCD)

Growth Plate Fractures

A fracture through the growth plate can be a severe injury that can stop the bone from growing correctly. These fractures should be treated by an Orthopaedic Surgeon, as some will require surgery.

Avulsion Fractures

youth pelvis hip avulsion

Image source: https://radiologyassistant.nl/pediatrics/hip/hip-pathology-in-children

An avulsion fracture occurs when a small segment of bone attached to a tendon or ligament gets pulled away from the main bone. The hip, elbow, and ankle are the most common locations for lower limb avulsion fractures in young sportspeople.

Treatment of an avulsion fracture typically includes active rest, ice and protecting the affected area. This active rest period is followed by controlled exercises that help restore range of motion, improve muscle strength and promote bone healing. Your physiotherapist should supervise your post-avulsion exercises. Most avulsion fractures heal very well.  You may need to spend a few weeks on crutches if you have an avulsion fracture around your hip. An avulsion fracture to your foot or ankle may require a cast or walking boot.

An excessive gap between the avulsed bone fragment and main bone may not rejoin naturally in rare cases. Surgery may be necessary to reunite them. In children, avulsion fractures that involve the growth plates also might require surgery. All avulsion fractures should be reviewed and managed by your trusted physiotherapist or an Orthopaedic Surgeon.

For more information regarding your youth sports injury, please consult your physiotherapist or doctor.

Youth Leg Injuries

Pelvis & Hip

Knee

Heel & Ankle

Common Youth & Teenager Sports Injuries

Common Youth Neck & Back Pain

Common Youth Arm Injuries

Article by John Miller

Elite Sports Injury Management

You probably already know that a sports injury can affect not only your performance but also your lifestyle. The latest research continues to change sports injury management considerably.  Our challenge is to keep up to date with the latest research and put them to work for you.

How we treated you last year could vary significantly from how we treat you this year. The good news is that you can benefit considerably from our professional knowledge.

What Should You Do When You Suffer a Sports Injury?

Rest?

Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases.  The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days.  After that, you need to get it moving, or other problems will develop.

Ice or Heat?

We usually recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.

Once the "heat" has come out of your injury, you can use heat packs. We recommend 20-minute applications a few times a day to increase the blood flow and hasten your healing rate. The heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to discuss your situation specifically.

Should You Use a Compressive Bandage?

Yes. A compressive bandage will help to control swelling and bleeding in the first few days.  In most cases, the compressive dressing will also help support the injury as you lay down the new scar tissue. This early healing should help to reduce your pain. Some injuries will benefit from more rigid support, such as a brace or strapping tape. Please ask us if you are uncertain about what to do next.

Elevation?

Gravity will encourage swelling to settle at the lowest point.  Elevation of an injury in the first few days is beneficial, especially for ankle or hand injuries.  Think where your damage is and where your heart is. Try to rest your injury above your heart.

What Medication Should You Use?

Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek professional advice as certain medications can interfere with other health conditions, especially asthmatics.

When Should You Commence Physio?

sports injury

In most cases, "the early bird gets the worm".  Researchers have found that the intervention of physiotherapy treatment within a few days has many benefits.  These include:

  • Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
  • Improving your scar tissue using techniques to guide the direction it forms
  • Getting you back to sport or work quicker through faster healing rates
  • Loosening or strengthening of your injured region with individually prescribed exercises
  • Improving your performance when you return to sport - we'll detect and help you correct any biomechanical faults that may affect your technique or predispose you to injury.

What If You Do Nothing?

Research tells us that injuries left untreated take longer to heal and have lingering pain.  They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve.  The sooner you get on top of your symptoms, the better your outcome.

What About Arthritis?

Previously injured joints can prematurely become arthritic through neglect. Generally, there are four main reasons why you develop arthritis:

  • An inappropriately treated previous injury (e.g. old joint or ligament sprains)
  • Poor joint positioning (biomechanical faults)
  • Stiff joints (lack of movement diminishes joint nutrition)
  • Loose joints (excessive sloppiness causes joint damage through poor control)

What About Your Return to Sport?

Your physiotherapist will guide you safely back to the level of sport at which you wish to participate.  If you need guidance, ask us.

What If You Need Surgery or X-rays?

Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, but they'll also refer you elsewhere if that's what's best for you. Think about it. You could be suffering needlessly from a sports injury.  Please use our advice to guide you out of pain quicker. And for a lot longer.

If you have any questions regarding your sports injury (or any other condition), don't hesitate to get in touch with your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.