Calf strains and calf tears are one of the most common muscle injuries. They occur when you push the muscle beyond it's limits. Often you will feel a sudden pain or even a pop at the back of your calf during exercise. It is often described as being "shot in the back of the leg". A calf strain is often called the 'old man's injury' as the risk of calf injury increases with age. Previous calf muscle injury is also a strong risk factor for future muscle strain.
Why do you get an increase risk of calf muscle strain with age?
As you get older there is a progressive loss of power output and force development. This is very important when it comes to running. The foot is only in contact with the ground for 0.39 seconds. The calf has to work hard, but also very quickly to propel you forward. This time is shortened even more with sprinting - 0.18-0.20 seconds.
Your calf is made up of three muscles at the back of your lower leg. Two of these are major muscles - gastrocnemius and soleus. The third is a smaller muscle, plantaris. Gastrocnemius and soleus join together to form the Achilles tendon, which attaches to the heel.
- Gastrocnemius is the most superficial and consists of two heads. It is the power muscle that points the foot and ankle and also bends the knee. It is important in running and jumping.
- Soleus is deep to gastrocnemius. Soleus only works at the ankle and is very powerful in plantarflexing the ankle and stabilising the ankle. Another important role of soleus is that of a blood pump. It pumps the blood back to the heart from the feet.
- Plantaris is a thin muscle with a long tendon. Curiously it is absent in between 10-20% of the population. The plantaris acts similarly to gastrocnemius, flexing the knee and pointing the ankle.
If you hear a pop or feel a pain at the back of the calf it could be a strain or tear. It is important to see a medical professional to rule out anything more serious. If it is a calf tear it is important to diagnose the muscle that has been injured and also determine what grade of injury has occurred. This will assist in rehabilitation, return to activity and ultimately prevention of further injury.
There are three grades of muscle tears:
the muscle is stretched causing small micro tears of the muscle fibres. There is no/minimal loss of strength and range of movement.
partial tearing of the muscle fibres. 10-50% of fibres may be disrupted. There is significant pain and swelling with a clear loss of strength and range.
this is the most severe strain with a complete tear or rupture of the muscle fibres. There is a complete loss of muscle function and a palpable defect or mass may be felt.
Following successful acute management of a calf strain (generally the RICE principles) a more active rehabilitation can follow. The goals of rehab are to restore the capacity oft he calf muscles and even improve them beyond their previous level of function to help prevent future injury.
Rehab needs to focus on:
Gastrocnemius strength - standing calf raises with a straight knee - increasing range, load and speed as able
Soleus strength - bent knee calf raises
Muscle length and joint range of movement
Managing the foot/ankle/calf and lower limb as a unit
Rehabilitation of the spring back into the calf
A planned return to sport and running.
Rehabilitation needs to be targeted and specific. Everyone recovers at a different rate and each injury is different. So progress exercises and load according to function rather than a timeline. Also make sure you finish off your rehabilitation. The biggest risk factor of a calf strain is a previous calf strain. You need to retrain your calf to do all the things you want it to do without skipping steps.
Calf strains and tears are common injuries which we see at The Movement Workshop, South Melbourne. To get started on your road to recovery, feel free to reach out to our staff.
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