Calf Strain

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Original Editors - Lynn Leemans

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Definition/Description

A calf strain is an injury to the muscle (or tendon) of the muscle of the lower leg. Strains or tears mean that muscle fibers are ripped as a result of overstretching. Strains are often called “pulled muscles”.
[8]

Clinically Relevant Anatomy

The “calf muscle” is a muscle that consists out of three different muscles. The gastrocnemius, soleus and plantaris all have the same Achilles tendon insertion on the calcaneus.
The gastrocnemius is located in the posterior compartment of the lower leg. It consists out of two “heads”. The medial head finds its origin on the medial condyle and the lateral head originates from the lateral condyle of the femur. Its function is flexing the leg at the knee joint, but also plantar flexing the foot in the joints of the ankle.
The plantaris also finds its origin on the lateral condyle of the femur and on the oblique popliteal ligament. Its function is plantar flexing the foot (in the ankle joint).
The soleus originates from the head of the fibula, and the facies posterior of the tibia and fibula. The function of this muscle is plantar flexion of the foot.
[6]

Epidemiology /Etiology

Internal and external factors can contribute to the forming of muscle strains. Bruises often come along with strains. There are different internal causes of strains. It can be due to an explosive power transmission without enough preparation or training. Another cause are movements of which the coordination isn’t optimal. Because of this, the antagonists can’t relax on time, and so the muscle has to work against a great resistance and tears.
An external cause usually is a direct trauma. It makes a huge difference if the muscle was hurt in condition of contraction, or if the muscle was relaxed. When the ankle is in full dorsiflexion and with the knee in extension, the gastrocnemius is stretched, and is more liable to tear as it contracts.
[1, 2, 3, 6, 7]

Differential Diagnosis

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Diagnostic Procedures

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Outcome Measures

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Examination

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Medical Management

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Physical Therapy Management

Acute treatment needs the use of RICE (= Rest, Ice, Compression, Elevation) and NSAIDs (Nonsteroidal anti- inflammatory drugs) during the first 2 or 3 days. If major bleeding had occurred, it is necessary to be careful with the use of NSAIDs.
The underlying skin can be ecchymotic if there is an intermuscular bleeding (which indicates a rupture of the muscle fascia). Also the flexibility of the muscle(s) should carefully be tested. On the third day after injury, the rehabilitation starts.
The task of the physiotherapist contains settling down the pain (1). After pain and swelling have decreased, physical therapy should start with restoring flexibility and strength (2)+(3).
Because of the particular way of stretching, it is important to differentiate between the two muscles. To stretch the gastrocnemicus, the knee must be in straightened position. To stretch the soleus, the knee must be in flexion.
Strains may cause long lasting pain, even if there have been an adequate early treatment. An injection of local anesthetic and cortisone in and around the area, followed by a right stretching and stretch training treatment, will often take away some of the symptoms.
[2, 5]

Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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