Calf strain

Dr. Nadheer K M (AIIMS)MBBS

January 15, 2020

March 06, 2020

Calf strain
Calf strain

You may have experienced cramps in your leg while playing a sport or running, or sometimes even out of nowhere like while sitting or lying down. Most of the time those cramps occur at the back of the lower leg, or the calf muscles. 

Although a common phenomenon, most people choose to ignore the overall health of their legs and feet, especially in the gym or while working out (skipping leg day in common speak). Some of the largest muscles in the body are in the legs, and keeping an eye on the condition of our legs is essential towards maintaining a healthy body.

Largely considered to be a collection of two major muscles called gastrocnemius and soleus, the calf is actually a collection of three muscles, which is why it is termed the triceps surae, Latin for the three-headed calf. The third muscle that completes the calf is the plantar muscle. All three attach to the Achilles tendon.

If you try to walk on your tiptoes, you will feel the pressure on your calves. Calf muscles are also pretty much in constant use when you walk, as you can’t bend the knee without engaging them. 

Knee flexion happens as a result of the gastrocnemius muscle in the calf and the hamstring muscles in the thigh working in unison. The extension of the foot (plantar flexion) is made possible by the calf muscles as well.

Symptoms of calf injury

A strain in the calf occurs primarily due to overuse of the muscles, is common among runners, and usually affects the larger gastrocnemius muscle as it is used for propulsion while setting off for a run or during a jump. A strain in the gastrocnemius muscle is also known as a ‘tennis leg’, because the first cases of calf strains were reported among tennis players in 1883.

Some of the common symptoms of having suffered a calf strain are:

  • Mild pain while resting that increases with physical activity
  • Swelling in the affected calf
  • Tightness in the muscle along with redness or bruising
  • Inability to stand on your toes

A calf strain, much like other muscle strains, is also categorized into three types between Grade 1 and 3, depending on the severity of the strain or tear in any of the three calf muscles.

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Causes of calf strain

People engaging in running or sporting activities are prone to injuries in their legs due to the overuse of the leg muscles. Along with problems in the knee, a calf strain is a common injury noticed in long-distance runners. Some of the common causes for suffering a calf strain include:

  • Overstretching the calf muscles while pursuing sports or fitness activities that involve running.
  • Sudden cramping in the calves.
  • Climbing, jumping or running uphill.
  • A sudden change of direction while playing a sport or running.
  • Not warming up properly.
  • Ill-fitted footwear.
  • Having flat feet or overpronation that leads to the foot landing inwards.

Much like other muscle strains, calf muscle injuries are also either acute, which means it was caused by a sudden event or chronic, which means that it developed over time with overuse.

Prevention of calf strain

A majority of calf injuries occur among sportspersons or those who engage in fitness activities only over weekends or after work hours. As is the case with avoiding any injury, conditioning the lower leg muscles is key in staying away from muscle strains and tears.

  • Warming up before pursuing a sport or going for a run is the thumb rule to prevent any kind of injury, as it helps activate the muscles before more intense physical activity.
  • Strengthen your calf muscles by performing specific exercises like calf raises, jump rope and climbing stairs with the use of your toes.
  • Wearing additional support like compression socks that go all the way up to your knees, keeping the muscles warm and compressed.
  • Wearing heel cups in your shoes which can help in shortening the range of movement for your calf muscles.
  • Use a foam roller or massage the back of your legs after engaging in intense physical activity.
  • Perform cooling down exercises and stretch your muscles after a workout or a run.
  • Hydrate yourself adequately while engaging in physical activity, as loss of water through sweating can increase the likelihood of muscle strains. 

Diagnosis of calf strains

Calf strains can be notoriously painful when they occur suddenly while running or in the middle of a game you’re playing, and initial signs should be paid attention to.

  • A physician will look for visible symptoms like swelling and bruising in the calf region.
  • The doctor will perform a physical exam to locate the source of the pain, including asking you to lift yourself on your toes.
  • Ultrasounds and MRI scans are performed to determine the degree of the calf strain.
  • In the case of severe tears, especially in pro-level athletes, surgery may be advised to repair the injured muscle.
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Treatment for calf strains

Like in the case of many musculoskeletal injuries, calf strains are also treated conservatively at first, and the time required to recover is dependent on the severity of the injury.

  • The RICE method is the first step towards treatment of a calf strain or a tear, by first resting the injured area via immobilising it completely, then applying ice several times during the course of a day and finally compression and elevation the affected leg to bring down the pain and swelling.
  • Use of over-the-counter pain medications such as ibuprofen to bring down the inflammation in the calf.
  • Gradual increase in movement with slow and light-footed steps at first.
  • Physical therapy, including light stretching exercises to regain strength and mobility in the affected leg, may be recommended. Resistance bands (exercising equipment) are considered helpful in the journey towards recovery.
  • Stronger pain medication should only be used on the advice of a doctor.

Risks and complications of calf injuries

Calf injuries are frustrating as they intrude into basic activities such as walking and restrict your movements, depending on the severity of the injury. But here are some factors to keep in mind that can lead to sustaining calf strains:

  • If you have suffered a calf injury before, chances are you will again. Calf muscles are under constant pressure while performing running-related movements, or even while walking uphill, which cause them to tense up.
  • If you have flat feet or your foot turns inwards while running, it puts you at a greater risk of suffering lower limb injuries like a calf strain.
  • Wearing high heels while walking keeps your calf muscles constantly engaged, increasing the risk of an injury.
  • Weak muscles in the lower half of your body, like hip flexors or hamstrings, tend to put unnecessary pressure on your calves, as you try to shift the workload to other muscle groups. This can lead to injury.
  • Not warming up the calves before going on long runs or playing a sport.
  • Overusing your calf muscles in activities that you frequently indulge in like running can lead to strains.
  • Overlooking an initial ‘pulled’ calf muscle and continuing to use it can lead to more severe problems like a tear in the calf muscle.

They may seem harmless residing at the back of the legs, but calves perform an essential role in moving your body. Even a slight strain or a cramp is painful enough to make you limp or walk gingerly and keeping the calves in good shape and health is imperative for performing exercises or playing sports freely and without trouble. Frequent stretching and strengthening of the calf muscles must be done to be able to sustain the rigours of a long run or a game of football under the hot sun.


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