Calf Strain or Pull

The calf muscle is exposed to a broad range of injury-causing forces in athletic activity. This structure is a two-muscle composition, with an outer, visible component (the gastrocnemius) and an underlying partner muscle (the soleus). The outer muscle is the mechanism by which the heel is raised—a process referred to as plantar flexion—essential to walking, running, or jumping. The inner soleus is utilized to raise the heel when the knee is bent, as in cycling. As the muscles essential to generation of both efficient and explosive leg movements, any injury to this structure can limit athletic performance. As these muscles are connected to the Achilles tendon at one end, and the femur (thigh bone) at the other, tightness or any other imbalance in the flexibility of the calf in relation to the other major companion muscle or tendon groups of the leg, particularly the Achilles tendon, will create a risk of injury in leg structures.

A strain of the calf muscles, often referred to as a pull, is a term that is often, and incorrectly, used interchangeably with other athletic injury descriptors. Inexact language often arises among athletes because the location and the nature of the discomfort experienced are similar with each condition. The following are the common terms, with their respective distinctions:

• Strain or pull: Generally, a stretch or a partial tear of a muscle or a tendon; a calf strain is a partial tear of the calf muscle fibers, usually, but not exclusively, occurring in the gastrocnemius. The strain is accompanied by sharp, sometimes piercing pain that persists. The muscle may appear to spasm, and there is the presence of tenderness to the touch, swelling, and possible discoloration at the point of the injury.
• Sprain: A stretch of a partial tear of a ligament and corresponding joint. Therefore, a sprained calf muscle is not possible.
• Cramp: A knotting or pulsing sensation in the calf muscles that may feel similar to a strain. The muscle may begin to twitch, causing intense discomfort. A cramp tends to be short-lived discomfort; unlike a calf strain, a cramp is not the result of muscle damage, but usually caused by low electrolyte levels (sodium and potassium, in particular) and poor hydration.
• Lactic acid build-up: Lactic acid is a byproduct of the fuels burned by the body for energy during exercise. If the lactic acid wastes are not properly flushed from the bloodstream, the athlete will experience a burning sensation in the muscle, not unlike that of an injury to the muscle.

Calf strains can be the result of any one of the following causes: a movement that stretches one or both of the calf muscles beyond their ability to stretch; a sudden or explosive movement that generated forces for which one or both of the calf muscles was not equipped to sustain; overuse of the muscle, or muscle fatigue; or, when the calf muscle sustains trauma, by way of a direct blow.

While various athletic endeavors may cause a calf muscle to be stretched so as to cause an unpreventable injury, a failure on the part of the athlete to properly stretch, both prior to the intensity of competition and as a part of regular training, is a significant contributing factor to the incidence of calf strains. Attention to the stretching of the calf muscles, in combination with similar regular stretching of the Achilles tendon, quadriceps, and hamstrings, will serve to keep the leg muscles and tendons in balance. When these integrated systems are balanced, both sudden or explosive movements, as well as the forces directed to the calf, will be supported by the entire leg. When one or more of these groups becomes inflexible, or tight, it is that area that is more susceptible to strain.

As with muscle strains generally, calf sprains are graded according to the severity of the injury. Grading assists in the facilitation of the proper level of treatment and rehabilitation for the injury.

A first degree sprain is a mild overstretching or tearing of one or both of the calf muscles. The primary treatment for a first-degree sprain is the application of the RICE treatment: Rest, Ice, Compression, Elevation. A short period of rest should follow the injury. A second degree strain is a moderate overstretching and tear of the muscle fibers. In addition to RICE treatments, anti-inflammatory medications are often prescribed. A third degree strain is a severe tear to one or both of the calf muscles, to the extent that the athlete will be incapacitated from use of the leg without assistance. Serious tears of this nature often require surgical repair, and extensive rehabilitation.

Upon the athlete's return to competition or training, there must be a focus on a gradual, and not immediate, return to previous intensity levels. Effective rehabilitation will demand involvement in a year-round stretching and flexibility program; heel raises and other exercises that build flexibility between the foot, Achilles tendon, and calf muscles are important. Proper warm ups prior to competition are also essential to the prevention of recurring calf injuries. The athlete must also pay close attention to hydration, as dehydration risks muscle contractions that will contribute to the onset of a calf strain.

see also Lower leg anatomy; Lower leg injuries; Muscle cramps; RICE (Rest/Ice/Compression/Elevation) treatment for injuries; Sprains and strains.