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CALF MUSCLE STRAIN
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Background

A calf strain can occur in adults who participate in activities that require quick accelerations and decelerations, as well as rapid changes in direction. This includes sports such as basketball and tennis. It involves an injury to one or more of the muscles of the lower leg including the gastrocnemius, soleus, and plantaris.

The gastrocnemius actually begins as two separate muscles that merge together. The gastrocnemius and soleus have their own origin, but they end in the common Achilles tendon, which inserts at the heel. The gastrocnemius and the plantaris originate above the knee joint, and the soleus below the knee joint.

Calf strains commonly affect the middle portion of the gastrocnemius. Strains of the soleus muscle are less common because it only crosses one joint (ankle) while the gastrocnemius crosses two joints (ankle and knee).

Symptoms

The most common symptom is pain in the back of the lower leg or behind the knee. The injury is usually sudden, but chronic strains are possible. Patients often experience a tearing or popping sensation in the affected region, typically while pushing off the affected foot with the ankle bent upward and the knee straight. Patients may be unable to walk and notice bruising around and below the area of pain.

Soleus injuries are more subtle and can show up long after the actual injury. Symptoms include pain with activities and calf tightness, usually with no bruising or swelling.

Plantaris strains are similar to mild gastrocnemius strains. Pain is commonly over the outside of the lower leg or behind the knee.

Sports Medicine Evaluation and Treatment

Sports Medicine experts will perform an appropriate physical exam. This might include measurement of both lower legs, feeling the affected area for tenderness, and testing range of motion and strength of the calf muscles in various positions. Imaging is not always necessary, but may include x-rays, ultrasound examination, or MRI.

For mild strains, treatment can include the application of ice, medications like ibuprofen or acetaminophen for inflammation and pain control, compression, light range of motion exercises, and activity modification. More severe strains, or those not responding to conservative treatment, may need to be immobilized in a boot, referred to physical therapy, or considered for a steroid injection. Initially, the muscle needs to be relaxed by elevating the heel, possibly with the use of a heel wedge. Surgery is rarely needed for a calf muscle strain.

Injury Prevention

It is important to accommodate for colder temperatures when exercising by warming up properly. One must also be sure to use proper technique for the exercise performed. It is generally recommended that when starting a new activity or type of exercise that it be done gradually to allow time for the body to adapt.

Return to Play

Return to play is possible once range of motion and strength are close to normal. Depending upon the severity of the strain, this could take up to a couple of months. Trying to go back too early when the muscle is still damaged and weak could result in re-injury.

AMSSM Member Authors
Marc P. Hilgers, MD, PhD, FAAFP, Leonardo Oliveira, MD, FACP

References
Armfield DR, Kim DH, Towers JD, Bradley JP, Robertson DD. Sports-related muscle injury in the lower extremity. Clin Sports Med. 2006 Oct;25(4):803-42.
Fu FH, Stone DA. Sports injuries, mechanisms, prevention, treatment. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001.
Gallo RA, Plakke M, Silvis ML. Common leg injuries of long-distance runners: anatomical and biomechanical approach. Sports Health. 2012 Nov;4(6):485-95.
Jaervinen TA, Jarvinen TL, Kaarianen M, Jarvinen M. Muscle injuries: biology and treatment. Am J Sports Med 2005 may;33(5):745-64.

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