Calf Muscle Tear
What is a Calf Muscle Tear?
Calf Trigger Points
How to Care for a Calf Muscle Tear
Pain that occurs in the calf muscle on the lower part of the leg often is the result of a pulled or torn calf muscle.
A torn calf muscle is similar to an Achilles tendon tear or rupture but occurs higher up in the back of the leg. A sign of a torn calf muscle is similar to that of an Achilles tendon rupture. You may think you’ve just been hit in the leg and potentially hear a “pop.” There is sudden pain in the back of the calf. Then you’ll experience pain, swelling, or bruising in the calf muscle, and you’ll have difficulty walking properly or standing on your toes.
Calf muscle tears usually occur during acceleration or changes in direction. However, we have known people to tear their calf muscle by simply walking across the road.
Calf strain may be minor or very severe. Your physiotherapist will grade the injury accordingly:
The muscle is stretched causing some small micro-tears in the muscle fibers. Recovery takes approximately 2 to 4 weeks if you do all the right things.
There is partial tearing of muscle fibers. Full recovery takes approximately 4 to 8 weeks with good rehabilitation.
This is the most severe calf strain with a complete tearing or rupture of muscle fibers in the lower leg. Full recovery can take 3-4 months and, in some instances, surgery may be needed.
How to Treat a Calf Muscle Tear
Calf muscle tears are one of the most common problems that we see and it is, unfortunately, an injury that often recurs if you return to sport too quickly – especially if a thorough rehabilitation program is not completed.
Researchers have concluded that there are essentially 6 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence – these are:
Phase 1 – Early Injury Protection: Pain Reduction & Anti-inflammatory Phase
As with most soft tissue injuries the initial treatment is RICE – Rest, Ice, Compression, and Elevation.
Your calf muscle is a large powerful group of muscles that can produce sufficient force to run, jump, and hop. In the early phase, you’ll be unable to walk without a limp, so your calf needs some rest from weight-bearing loads. You may need to be non or partial-weight-bearing, when crutches or a wedged Achilles walking boot may be the best treatment.
Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.
Anti-inflammatory medication (if tolerated) and natural substances eg arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as pain-reducing medication.
As you improve a compressive bandage, supportive taping or elastic calf support will help to both support the injured soft tissue and keep the blood from pooling in your foot.
Keep your foot elevated above your heart (where possible) to allow for gravity to help drain your calf and lower leg swelling.
Phase 2: Regain Full Range of Motion
If you protect your injured calf appropriately the torn muscle will successfully reattach. Mature scar formation takes at least six weeks. During this time period, you should be aiming to optimally remold your scar tissue to prevent a scar that will re-tear in the future.
It is important to lengthen and orientate your healing scar tissue via massage, muscle stretches, and neurodynamic mobilizations. Signs that you have full soft tissue extensibility includes being able to walk without a limp and able to perform calf stretches with a similar end of range stretch feeling.
Phase 3: Restore Concentric Muscle Strength
Calf strength and power should be gradually progressed from non-weight bear to partial and then full weight bear and resistance loaded exercises. You may also require strengthening for another leg, gluteal, and lower core muscles depending on your assessment findings.
Phase 4: Restore Eccentric Muscle Strength
Calf muscles work in two directions. They push you up (concentric) and control you down (eccentric). Most calf muscle tears occur during the controlled lengthening phase. Your physiotherapist will guide you on an eccentric calf strengthening program when your injury healing allows.
Phase 5: Restore High Speed, Power, Proprioception & Agility
Most calf injuries occur during high-speed activities, which place enormous forces on your body (contractile and non-contractile). In order to prevent a recurrence as you return to sport, your physiotherapist will guide you with exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.
Depending on what your sport or lifestyle entails, a speed, agility, proprioception, and power program will be customized to prepares you for light sport-specific training.
Phase 6: Return to Sport
Depending on the demands of your chosen sport, you will require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.
The perfect outcome will have you performing at full speed, power, agility, and function with the added knowledge that a through rehabilitation program has minimized your chance of future injury.
There is no specific time frame for when to progress from each stage to the next. Your injury rehabilitation status will be determined by many factors during your physiotherapist’s clinical assessment.
You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.
It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration.
For more specific advice about your calf injury, please contact your PT physiotherapist.
They start as a cramp, and as one continues to run on it the muscle fibers tear in the area around the cramp. This leads to even more muscle damage. The day after, the calf is very painful to the touch and I can hardly walk on it. The pain can last for a while and the site of the injury becomes a locus for future injuries to the muscle.
When you injure the muscle tissue the body attempts to heal it. There is an inflammatory reaction around the site of injury and sometimes even bruising. As the body heals the damage, scar tissue can be laid down. You can feel this scar tissue with your fingers in the weeks after the injury as a painful knot deep in the muscle. It can sometimes feel like a hard marble embedded in your calf. This is a knot of scar tissue and the remains of the inflammatory material. Even after there is no pain and you can run if this knot is present it will be a site that re-injures again. The idea is to get rid of this knot so the muscle can function more normally.
What to do
If you feel your calf cramp up and it becomes painful try these steps.
- Stop running! If you continue to run you can either create tears in the muscle or simply make the injury worse. Unless you are in the waning miles of an important race, pull up and call it quits.
- Ice. As soon as you can, ice the calf well. This is often tough to do since the injury is deep in the muscle. I use an ice wrap around the calf. Others have recommended using the frozen Dixie cup trick for use as an ice massage. At least 15 minutes.
- Don’t stretch. One of the temptations is to try and stretch the muscle. If it is damaged, stretching can simply exacerbate the injury. You want it to heal up first, worry about increasing flexibility later.
- Time off. One of the hardest things to do is to take enough time off for the calf to heal. You should do anything that makes the calf hurt. If you can walk without much pain, fine. But if it hurts when you run, don’t even think about running. Depending on the extent of the injury, this can take from 1 to 4 weeks.
- Massage. Besides not making it worse, this is the most important thing you can do. You need to massage that painful knot in the calf muscle 2-3 times a day until it is no longer painful and until you can no longer feel it with your fingers. The best solution is to see a massage therapist have them do it for you. I’m too busy and broke so I do it myself. This is a great application for The Stick. Roll across that knot, or massage it with your fingers or thumbs. The point is that you have to do it hard. What you are trying to do is gradually break down the adhesions between the muscle fibers so they can slide smoothly again. If not, as the muscle works this scar tissue will just create new micro-tears in the muscle tissue. The massage hurts, a lot. Follow every massage with ice to keep the inflammation down and take some NSAIDs if your Doc has OK’ed it. Again, keep this up until the site is no longer painful and you can’t feel that knot anymore.
- Stretch. Once the calf doesn’t hurt (except when you are massaging it, you can start to stretch. The idea is to increase flexibility to help avoid the same problem in the future. The stretching isn’t going to help cure the existing injury but is just prevent it again. Stretch gently!
- Coming back. As soon as you feel any pain in the area of the injury STOP. If you keep running you will just slow down your eventual recovery.
The best thing to do is to go see a physical therapist so they can give real professional help.
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
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