A calf muscle tear is one of the most frustrating yet preventable injuries in active people. I’ve had torn calf muscles during my time as an athlete, I’ve experienced the pain first hand and most importantly, I know how to treat and prevent them. So I thought it would be a good idea to put this article together to share some advice regarding calf muscle tears.
Calf pain, just like many other pains, is very common amongst most sportspersons and gym-goers. Calf muscles are also prone to little tears or breaks when not warmed up or over-exercised. Although this injury may seem minor, if not treated/rehabilitated properly, it can undergo further complications and become a chronic (long lasting) issue.
And let’s be honest, most of the time when your Physiotherapist gives you rehab exercises to do…they don’t get done (I include myself in this category too!
So let’s start by explaining what causes a calf muscle tear, what the symptoms you will feel are and then how we go about treating it (and why completing your rehab diligently is so important) to help reduce the chance of reinjury in future!
What causes a calf muscle tear?
A calf muscle, and any muscle in your body, will tear when the force going through it exceeds its capacity to withstand that force. There are two components to this you may now see, as the equation for calculating force is Force = Mass x Acceleration (sorry to nerd out on you here, but it is important) What this means for you is that both the speed of a movement (acceleration or deceleration) and the weight being moved (mass) are critical in determining whether or not your calf muscle can successfully manage the load placed on it without tearing!
You can think of it like an elastic band, if you slowly increase the force up until the limit where it snaps, it will stretch a lot further than if you were to pull the band apart at high speed – in this case it would snap much earlier.
What this means practically for you is that you are at the highest risk of tearing your calf during extremely heavy weighted exercise (rather uncommon) or during an explosive acceleration movement; the latter being what we see commonly presenting in the clinic. This can be from sprinting, taking off from a stationary position or changing direction at high speed. The sports we see this in most often are:
- Running (more commonly in trail running compared to road running)
In these sports it is quite common to see a calf muscle injury shortly after returning from a sprained ankle, because the calf has experienced some deconditioning due to being unweighted to allow the ankle to heal. When we are helping a patient with sprained ankle rehabilitation we include education and a strength program for the calf to help reduce the incidence of calf tear. Similarly, we will include this in any other foot and ankle rehabilitation.
What does a torn calf muscle feel like?
The immediate signs and symptoms of a torn calf muscle are:
- Sharp pain at the site of injury
- Pain on stretch of your calf muscle
- Pain on contraction of your calf muscle
Within 24 hours of your calf muscle tear you may notice:
- Difficulty with stairs, especially going down stairs
- Inability to perform explosive movements such as running and jumping
- Weakness in your calf muscle
- Pain extending outwards from the initial injury area
- Bruising & increased swelling
We see many people present to our clinic with a torn calf muscle within 1 – 2 days of the injury occurring; with some people feeling as if they’ve had a really bad cramp that hasn’t quite gone away! The most commonly torn calf muscle is the medial gastrocnemius due to the biomechanics of your lower leg. The most common populations we see this injury in are males over the age of 35 and athletes who play sports with explosive movements/high-speed changes of direction.
It’s very important that deep vein thrombosis (DVT) is ruled out for anyone who presents with calf muscle tear symptoms. A DVT is where there is a small blood clot in the calf muscle which can present with pain, swelling, redness and decreased strength (due to pain). This is a very serious condition that requires immediate medical attention because it can be potentially life threatening if the blood clot dislodges and travels to the lungs, causing a pulmonary embolism.
The signs and symptoms to be aware of for a pulmonary embolism are:
- Shortness of breath
- Chest pain (that gets worse with breathing)
- Heart palpitations
- Fast heart rate
- Coughing with or without blood
If you have the above symptoms with what feels like a calf tear, it is important that you seek urgent medical attention.
What are the grades of a calf muscle tear?
There are 3 grades of a muscle strain (muscle tear):
A grade 1 calf muscle tear means that there has been a small amount of tearing in the muscle fibers, with minimal loss of function. A grade 1 calf muscle strain can have a recovery time of between 1 – 4 weeks for a full recovery, depending on your rehabilitation and contributing factors (eg. smoking, alcohol and age). Whilst a grade 1 muscle tear may not feel too bad, it’s important to note that a grade 1 tear can easily become a grade 2 or 3 muscle tear if you continue to overload it without allowing time to heal – it’s kind of like how if a piece of paper is quite strong when it is fully intact and being pulled from both ends, however if there is a small tear in the middle, it will tear the entire sheet in half with only a small amount of force applied.
A grade 2 calf muscle tear is when there is a moderate to large tear, presenting with large amounts of pain, swelling and a distinct loss of function. There may also be a palpable tear in the muscle one the swelling subsides. A grade 2 calf muscle strain can have a recovery time of between 3 – 8 weeks for a full recovery, depending on your rehabilitation and contributing factors (eg. smoking, alcohol and age).
A grade 3 calf muscle tear is a complete tear of one of the calf muscles, presenting with sharp pain, excessive swelling, sometimes an inability to weight bear and a large loss of function of the lower limb. There will likely be a palpable deficit in the calf muscle where the tear is located (more pronounced once the swelling has subsided). A grade 3 calf muscle strain may need surgery and can take 2 – 6 months to fully recover from; and it can be even longer if surgery is required or if there is an achilles tendon rupture, requiring extensive post-operative physiotherapy.
Why do I keep pulling my calf muscle?
The most common reasons for a recurrent calf muscle tear are calf weakness, improper training schedule (too much load without enough recovery periods), previous calf muscle tear and a lack of proper rehabilitation/going back to high intensity exercise too soon.
The time that you are at highest risk of reinjury is during the rehabilitation phase when the pain has gone but the strength and conditioning has not yet returned to your calf muscle. Typically people report that it ‘feels pretty good’, so they return to activity at a higher intensity than their rehabilitation has been prescribed, not surprisingly resulting in a worse injury than they initially presented with. It’s important to understand that pain and injury and not directly correlated, and that just because the pain has now subsided it doesn’t mean you can cease your rehab and get back to sport!
We also encourage all of our athletes who participate in explosive sports to have specific loading protocols to strengthen their calves in order to prevent these injuries. This could look like a combination of weight training and explosive plyometric training which would increase in the off-season and taper down throughout the season to avoid overtraining and excessive fatigue.
Torn calf muscle treatment
Treatment for a torn calf muscle has 4 different phases which are all happening concurrently, however with a larger emphasis on different aspects of each at different times throughout the healing journey.
When you tear your calf muscle there will be bleeding at the injury area for up to 24 hours after the injury due to damage to the blood vessels in the area; this can present as a bruise at the injury site. Importantly, the amount of bruising does not equate to the amount of tissue damage or the severity of the muscle tear.
The inflammatory phase will help to stop the bleeding phase, beginning about 6 hours after the injury and lasting for 2 – 4 weeks in total. Inflammation is a natural and necessary part of the healing process and helps to bring the ‘building blocks’ for repair to the injury site. If there is excessive inflammation we can control this with elevation, compression bandages and movement, however it is recommended not to take anti-inflammatory medication if it can be avoided because it can slow the healing process.
In the proliferation phase your body will begin its creation of scar tissue at the injury site, essentially knitting the muscle back together. This stage of recovery may last up to 3 weeks.
The remodelling phase is the final stage of recovery and begins at the height of the proliferation phase. This is where the scar tissue forms the functional tissue that it is replacing. Scar tissue is still functional and it doesn’t necessarily mean that the muscle will be at a higher risk of future injury when rehabilitated properly.
How to sleep with a pulled leg muscle
We often get asked how to best sleep with a pulled calf muscle, and this will depend a lot on what you find to be the most comfortable position – sleep is extremely important in the recovery process so it’s important that we spend some time working with you on finding the most comfortable position. For many people the position that will allow them to get the best night’s sleep is sleeping either on their back with their injured calf raised on a pillow or on their side with a pillow between their legs and their injured calf on the top. This will also help with preventing excessive pain and swelling by using gravity to assist the fluid to move away from your calf.
Can I run with a calf strain?
The severity of your calf strain will determine how soon after injury you can return to running, however you can’t run in the acute phase of a calf muscle strain because it will place too much stress on the remodelling process happening within your calf muscle, potentially causing a larger tear than your initial injury.