Calf Muscle Tear
The calf is composed of three different muscles, the gastrocnemius, soleus and plantaris. These muscles go from the back of knee to the ankle where they merge into one single tendon, the Achilles’ tendon which inserts behind the heel.
Calf strains or tears are the most common calf injuries, and they can be a result of poor technique (overstretch) or overuse (muscle fatigue). This injury is more likely to occur when the knee is fully straight and the ankle is in full dorsiflexion, especially if there is a sudden rapid stretch.
This injury is more common in middle-age or older patients however it can also be found in younger people who play racquet and running sports.
The severity/symptoms of the calf tear depend on its grade:
- Grade 1 calf tear – sharp pain at the time of the injury, often can continue activity. There is minimal to no loss of strength or range of movement able to perform single leg heel raise with some degree of pain
- Grade 2 calf tear – normally requires stopping activity. Main findings are pain and weakness when flexing the foot, loss of ankle dorsiflexion (pointing toes up), mild bruising and swelling,
- Grade 3 calf tear –expect to see bruising and swelling, severe or complete loss of plantar flexion (flexing the foot) strength and pain on bilateral heel raise – this grade will require further investigation with a visit to an orthopaedic surgeon.
Grade 1 and 2 calf tears. During the acute stage, the treatment for this injury involves: Active rest – avoid stretching and heavy load contractions; Using a heel wedge can help to off load the muscle; Compression, elevation, and ice.
This stage should take approximately 7 days. Once symptoms start to subside and range of movement has improved mild stretches, eccentric load and isometrics should begin under the guidance of a physiotherapist followed by concentric contractions and dynamic exercises.
To prevent calf tears or strains, warming up and cooling down is very important before and after activity as well as good strength conditioning of the calf muscles.
If your symptoms are severe or do not improve within two days of self-management please seek medical advice:
Pain in the calf area can also be indicative of a blood clot, deep vein thrombosis (DVT) or nerve damage.
Bryan Dixon J. Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Curr Rev Musculoskelet Med. 2009 Jun;2(2):74-7. doi: 10.1007/s12178-009-9045-8. Epub 2009 May 23. PMID: 19468870; PMCID: PMC2697334.
Hsu D, Chang KV. Gastrocnemius Strain. 2021 Aug 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 30521187.