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Core Knowledge

Injury/Pain

Avoid a Calf Muscle Strain

Overview

A strained or pulled calf muscle is one of sport’s most common injuries. The two large muscles in the back of the lower leg (the soleus and gastrocnemius) are called calf muscles and they are at risk every time you push off—even if you're just walking. When the muscles are stretched beyond their normal capacity, the muscle fibers tear away from the tendon. In a grade 1 strain, only a few fibers are torn and the symptoms are relatively mild. A grade 2 strain involves even more tears and more serious symptoms, and a grade 3 strain means the tendon or muscle has been completely ruptured.

How It Happens

In sports, a strained calf muscle (or any other muscle) is subject to a tear when it is asked to do more than it’s used to doing, especially if other factors are involved, such as fatigue, inadequate warm-up or extreme weather conditions. In calf strains, the foot suddenly bends upward, stretching the calf muscle beyond its limits and tearing the muscle fibers away from the tendon or tendons away from the bone.

Typical scenarios for a pulled calf muscle include:

  • a sprinter coming out of the starting blocks
  • a tennis player rushing the net or changing directions in the backcourt
  • a high jumper or long jumper accelerating before taking off
  • a soccer player sprinting toward a ball
  • a runner or jogger

By the Numbers

20
Percentage of athletes who report calf tightness several days before a strained calf muscle.

25-44
Age range of athletes most likely to sustain a strained (pulled) calf muscle.

Who’s At Risk

Football players, tennis players, hurdlers, runners, and sprinters are in the high-risk group, but any athlete who “pushes off” frequently can strain a calf muscle. Soccer players, baseball, basketball, rugby and lacrosse players are among those also subject to the injury. Men sustain more calf muscle strains than women.

Symptoms

  • Sudden pain in the back of the lower leg between the knee and the heel
  • Pain when pushing off or standing on toes
  • Stiffness
  • Weakness
  • Bruising
  • Gap or indentation of the muscle (grade 3)

Initial Treatment

  • Rest. Avoid activities such as running, jumping, and weightlifting that require lower leg strength and power.
  • Apply ice or cold packs for 15-20 minutes, 3-4 times a day for the first 48-72 hours.
  • Apply moist heat after the first 48-72 hours for 15-20 minutes, 3-4 times a day.
  • Use an elastic wrap or bandage around the area to minimize swelling.
  • Use a pillow or cushion to elevate the affected leg as much as possible during the day and while sleeping at night.
  • Aspirin, ibuprofen and naproxen may relieve pain and reduce inflammation.

Comeback Strategy

Following a grade 1 or grade 2 strain, the symptoms should start to diminish within a few days and should completely subside within 8-10 weeks. When surgery is required to repair a grade 3 strain, recovery will take three months or longer. Return to action should be determined by the absence of symptoms and the return of strength and range of motion, not by a set number of days, weeks, or months.

Resume normal training only after you are able to perform all the movements required in your sport without pain.

Apply ice packs for 15-20 minutes after an exercise session.

Prehab

Incorporate these prehab exercises into your comeback routine:

  1. Massage Stick / Tennis Ball - Lower leg (Give yourself a self-massage with either of these tools)
  2. Standing Ankle Dorsiflexion Stretch in Neutral and Internal Rotation
  3. Eccentric Calf Raises (Do 2 sets of 10)
  4. Intrinsic Towel Crunches in Plantar Flexion (Perform 2 sets of 25)

Remember that athletes who have had a strained calf muscle are more likely to sustain the same injury than those who have not been injured.

How to Avoid This Injury

  • Do not increase the level of exercise intensity, frequency, or duration more than 10 percent a week.
  • Work with a qualified coach or trainer to learn proper sport-specific technique that minimizes the stress placed on calf muscles.
  • Allow for extra warm-up time in cold weather.
  • Change running shoes every 300-500 miles.
  • Wear athletic shoes that have cushioned insoles that reduce calf muscle stress.
  • Avoid running on uneven surfaces.

Movement Prep

Incorporate these movement prep exercises into your warm-up routine:

  1. Rope Stretch: Calf AIS
  2. Rapid Response 2-Inch Runs
  3. 1 Leg Step Over Run - Shin
  4. Wall Drill - Load and Lift

Jim Brown, Ph.D. has written 14 books on health, medicine, and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.


Tags: Injury Prevention, Calves, Injury

References

  1. Anna J. Hartman, MS, ATC, CSCS, Manager, Performance Physical Therapy Services, Athletes’ Performance, Phoenix, Arizona
  2. American Academy of Family Physicians
  3. American Orthopaedic Society for Sports Medicine
  4. American Running Association
  5. eMedicine.com
  6. Mount Sinai Medical Center

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