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Calf Muscle Strain
(Pulled Calf Muscle; Gastrocnemius Strain)

Definition:
A strained calf muscle is a partial tear of the small fibers of the calf muscles. The calf muscles are located in the back of your lower leg.

Causes:
A calf strain can be caused by:
  • Stretching the calf muscles beyond the amount of tension that they can withstand
  • Suddenly putting stress on the calf muscles when they are not ready for the stress
  • Using the calf muscles too much on a certain day
  • A direct blow to the calf muscles
Risk Factors:
A risk factor is something that increases your chance of getting a disease, condition, or injury. Risk factors for calf muscle strain include:
  • Sports that require bursts of speed, such as:
    • Running
    • Hurdles
    • Long jump
    • Basketball
    • Soccer
    • Football
    • Rugby
  • Fatigue
  • Tight calf muscles
  • Overexertion
  • Cold weather
Symptoms:
Symptoms of calf muscle strain include:
  • Pain and tenderness in the calf
  • Stiffness in the calf muscles
  • Weakness of the calf muscles
  • Pain when pushing off the foot or standing on tiptoe
  • Bruising on the calf (if blood vessels are broken)
  • Popping sensation as the muscle tears (possibly)
Diagnosis:
The doctor will ask about your symptoms and medical history, your recent physical activity, and how the injury occurred. The doctor will also examine your calf for:
  • Tenderness and/or bruising directly over the calf muscles
  • Pain when contracting the calf muscles, particularly against resistance

Muscle strains are graded according to their severity, with grade 1 being the least severe.

Grade 1
  • Stretching with some microtearing of muscle fibers.
  • Recovery can be complete in about 2-3 weeks.
Grade 2
  • Partial tearing of muscle fibers.
  • Recovery can take up to 1-2 months.
Grade 3
  • Complete tearing (rupture) of muscle fibers.
  • Complete recovery can take more than 3 months.

For a severe calf strain, professional and college athletes sometimes have MRI scans to help predict the length of their recovery period.

Treatment:
Treatment depends on the severity of the strain.

Treatment usually includes:

Rest – Do not do activities that cause pain, such as running, jumping, and weightlifting using the lower leg muscles. If normal walking hurts, shorten your stride. Do not play sports until the pain and local tenderness is gone.

Cold – Apply ice or a cold pack to the calf area for 15 to 20 minutes, 4 times a day, for several days after the injury. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.

Pain Relief Medications – Take aspirin, ibuprofen (Advil, Motrin), or acetaminophen (Tylenol) to help relieve pain. It is best to not take aspirin or ibuprofen during the first 24 hours if you have a lot of swelling because those meds interfere with the clotting mechanism. If you still have tenderness in the calf while taking these drugs, do not return to physical activity. Check with your doctor.

Compression – Wear an elastic compression bandage (e.g., Ace bandage) around your lower leg to prevent additional swelling. Wrap from the toes up the leg so as to not cause swelling below the wrapping. Be careful not to wrap the bandage too tightly.

Elevation – Keep your leg higher than your heart as much as possible for the first 24 hours to minimize swelling.

Heat – Do not use heat at all during the first 3 to 5 days. Use heat only when you are returning to physical activity. Then use it before stretching or getting ready to play sports.

Stretching – When the acute pain is gone, start gentle stretching as recommended by a health care professional. Stay within pain limits. Hold each stretch for about 10 seconds and repeat 6 times. Repeat stretches 4 to 6 times during the day.

Strengthening – Begin strengthening exercises for your calf muscles as recommended by a health care professional. This is very important to guard against further problems.

Prevention:
To reduce the chance that you will strain a calf muscle:
  • Keep your calf muscles strong so they can absorb the energy of sudden physical stress.
  • After a short warm-up period, stretch out your calf muscles before physical activity.
  • Learn the proper technique for exercise and sporting activities. This will decrease stress on all your muscles, including your calf muscles.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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