The two muscles that work together to form the calf are the soleus (located deep inside) and the gastrocnemius (closest to the skin). These connect the heel to the back of the knee, and are responsible for plantar flexion of the foot, which is essential for running, walking, jumping and kicking. A calf tear usually occurs near the heel, near the Achilles tendon, and is caused by a sudden acceleration or deceleration. All muscle strains are classified by degree of severity: first degree ones involve a limited number of muscle fibers, second degree ones involve a large number of fibers, while third degree ones indicate complete laceration of the muscle. It is essential to obtain a correct diagnosis of the injury and its severity, as this determines the therapeutic approach and the rehabilitation protocol that must be followed.
Steps
Part 1 of 4: Contact the Doctor
Step 1. Make an appointment with your doctor
If you experience calf pain that doesn't go away within a few days, you should contact your GP. He will perform a physical examination of the leg, collect the medical history and ask you for information on the dynamics of the injury; eventually, he may prescribe an x-ray to rule out a fracture of the tibia and fibula. However, the primary care physician is not an orthopedist, so you will need to see a specialist.
The osteopath, the chiropractor, the physiotherapist and the massage therapist are all professionals who can give you advice and their personal opinion regarding your situation. However, be aware that, under Italian law, only a licensed surgeon is formally authorized to make a diagnosis
Step 2. See a specialist doctor
Calf injuries are typically mild first-degree tears but, in some very serious cases, surgery is required. In addition, there are other far more serious conditions that can trigger pain in the calf and lower leg, such as a fracture, bone cancer, osteomyelitis, venous insufficiency, sciatica caused by a lumbar disc herniation or complications related to diabetes. For these reasons, it may be necessary to see an orthopedist (a doctor who specializes in treating the locomotor system), a neurologist (a nervous system specialist) or a physiatrist (who specializes in physical medicine and rehabilitation) to rule out a more severe etiology of your pain.
- Doctors use several tools, such as x-rays, ultrasound, MRI, bone scan, and computed tomography, to diagnose the source of your calf pain.
- Calf muscle injuries are relatively common among basketball, football, volleyball, rugby players and all track and field athletes.
Step 3. Learn about the various therapies available
Make sure that your doctor clearly explains the diagnosis, especially (if possible) the cause of the problem, and that he explains the various treatments that you can undergo in your specific case. Rest at home and ice packs are only indicated for cases of mild to moderate tearing and obviously have no effect on more serious trauma such as fractures, infections, tumors, diabetes or disc degeneration, which they must be resolved with more invasive therapies or treatments that only the doctor can practice.
- Do some research on the internet about calf injuries (visit only reputable medical sites), so you can learn more about the problem and learn more about the treatments and results you can expect.
- Risk factors that predispose some individuals to muscle tears are older age, previous muscle injuries, poor flexibility, lack of strength, and fatigue.
Part 2 of 4: Treating a First Degree Calf Strain
Step 1. Determine the severity of the injury
Most calf strains are minor injuries that go away on their own within a week; pain intensity, bruising, and inability to move the limb are all indicators of the severity of the damage. First degree tears involve microlacerations in no more than 10% of the muscle fibers. They are characterized by mild pain in the back of the leg, usually near the heel. The patient experiences minimal loss of strength and range of motion. In this case it is possible to walk, run or play sports, while experiencing some discomfort and stiffness.
- Tearing occurs when muscle fibers are subjected to such severe strain that they tear; generally the lesion is located near the junction with the tendon.
- Most first degree tears in the leg cause pain for 2-5 days after the injury, but it takes a few weeks to completely resolve, depending on the portion of the muscle bundles involved and the type of therapy required.
Step 2. Use the "R. I. C. E
". It is a very effective procedure for most strains and tears and it owes its name to the English terms R.east (rest), THEce (ice), C.ompression (compression) e ANDlevation (lifting). The first thing to do is to rest the limb by stopping all physical activities, in order to manage the injury. Then you have to put in place the cold therapy (an ice pack wrapped in a cloth or a bag of frozen vegetables) as quickly as possible, to stop any internal bleeding and reduce inflammation, better with the leg raised, leaning against a chair or a pile of pillows (this also fights inflammation). Ice should be applied for 10-15 minutes every hour, then the frequency should be reduced as the pain and swelling subside, usually within a few days. The compress should be kept compressed against the calf with an elastic bandage or other similar support; this way you can reduce the bleeding of the torn fibers and the inflammation associated with them.
Do not tie the compression bandage too tightly and do not leave it in place for more than 15 minutes, as complete interruption of blood circulation could cause further damage to the leg
Step 3. Take over-the-counter medications
Your family doctor will recommend anti-inflammatories such as ibuprofen, naproxen or aspirin or even pain relievers such as acetaminophen to counteract the inflammation and pain associated with the trauma.
Remember that these medicines are quite aggressive in the stomach, liver and kidneys, so you shouldn't take them for more than two consecutive weeks
Step 4. Do calf stretches
Mild jerks respond well to some light stretching exercises, as these provide relief from contracture and promote blood circulation. After the inflammatory phase of the injury, scar tissue forms on the muscle which is not as flexible as the original fibers. Stretching helps these scars reshape and gain flexibility. Take a towel or elastic bandage and wrap it under the foot, near the toes. Then grab the ends of the cloth and slowly pull them towards you as you gently stretch your leg and feel a deep calf stretch. Hold the position for 20-30 seconds, then gradually release the tension. Do this exercise 3-5 times a day, every day for a week, as long as the pain doesn't get worse.
Step 5. Consult your doctor or physiotherapist before performing this type of exercise and proceed with great caution
This type of exercise can sometimes make the situation worse and prolong the healing of the injury.
To prevent injuries such as strains, cramps and tears, it is necessary to properly warm up the muscles before any sporting activity
Part 3 of 4: Treating a Second Degree Calf Strain
Step 1. Locate the injured muscle
In the most serious injuries, it is important to understand whether the injured muscle is the soleus (which is deep) or the gastrocnemius (more superficial). An MRI or ultrasound may be needed to determine the location and severity of the injury. Second degree tears are very extensive and involve 90% of muscle fibers. The pain is more intense (patients describe it as "excruciating") and muscle strength and range of motion are greatly reduced. The swelling is more severe and the hematoma develops rapidly due to internal bleeding of the muscle bundles.
- A person suffering from a second degree tear cannot perform physical activities, such as jumping or running, and therefore will need to rest for a while (a few weeks or more).
- The gastrocnemius muscle has a higher risk of being torn because it joins two joints (the knee and ankle) and, in proportion, has many fast-twitch type 2b muscle fibers.
- The medial head of the gastrocnemius is more prone to injury than the lateral one.
Step 2. Implement the "R. I. C. E
". This also applies to second degree injuries, although you will need to apply ice for longer periods (20 minutes at a time) if the soleus was the primary site of the injury. Unlike what happens for first degree tears (where the therapy lasts a few days), it will be necessary to continue the treatment for a week or even more.
- Most second-degree tears cause severe pain for a week or two after the injury, depending on the portion of the muscle that is damaged and the type of treatment chosen. This type of injury takes a month or two to completely resolve, and no sporting activity will be possible before this time.
- For moderate and severe cases, the intake of anti-inflammatories should be limited to the first 24-72 hours after the injury, due to the high risk of bleeding (anti-inflammatories are mild anticoagulants).
Step 3. Undergo physical therapy
A second-degree tear is relatively severe damage to the musculoskeletal system, involving the formation of abundant scar tissue, as well as a noticeable reduction in range of motion and strength. For this reason, once the swelling, pain and hematoma have almost completely resolved, your doctor will recommend that you go to a physiotherapist or sports medicine specialist to undergo a series of personalized strength exercises, stretches, massages. and targeted therapies such as ultrasounds (which reduce inflammation and break down scar adhesions) and electrostimulation (to strengthen muscle bundles and increase blood circulation).
- You will be able to return to your normal exercise regimen when the pain has subsided and you have regained full range of motion and strength in the limb. The recovery process could take a few weeks or more.
- People between the ages of 30 and 50 are more prone to calf tears.
Part 4 of 4: Treating a Third Degree Calf Strain
Step 1. Go to the emergency room immediately
A third degree tear involves complete rupture of the muscle or tendon. It is a very painful trauma (burning or intense pain) at the point where inflammation and hematoma immediately develop; the patient feels muscle spasms and, at times, it is possible to hear the "snap" as the muscle tears. An abnormal swelling can be detected at the level of the muscle, as the torn muscle has contracted with great force. The patient cannot walk, so it is imperative that someone take care of the transfer to the emergency room. The muscle bundles will not be able to reunite spontaneously, even with the formation of scar tissue, and surgery is required.
- Sudden rupture of a tendon (such as Achilles' tendon) is extremely painful and some people define it as if someone had shot them in the leg or had been stabbed with a sharp object. In the weeks following the surgery, powerful painkillers are needed, which can only be purchased with a prescription.
- A third degree tear causes profuse internal bleeding; blood accumulates in the foot which will turn black and blue.
Step 2. Undergo surgery
Third-degree tears (and some second-degree tears) must be resolved with reconstructive surgery, during which the muscle flaps and / or tendon are reattached. In these cases, time is of the essence, because the longer the muscle remains torn and contracted, the greater the difficulty in stretching it and regaining normal tone. Furthermore, internal bleeding could cause local necrosis (death of surrounding tissues) and also trigger bleeding anemia. Tears at the level of the muscular abdomen heal faster, because this area is more supplied with blood, while for those near the tendon the convalescence is longer. After the operation it is necessary to rely on the "R. I. C. E." protocol.
- In cases of complete muscle rupture, it will take approximately 3 months to heal after surgery and rehabilitation.
- After the surgical reconstruction you will need to wear a special compression brace (similar to a boot) and use crutches for a short period of time, before moving on to more advanced rehabilitation exercises.
Step 3. Follow a rehabilitation protocol
Just like in cases of second degree tears, it is also necessary to undergo physiotherapy exercises in this case, especially if surgery is required. Under the guidance of a physiatrist or physiotherapist, you will have to perform customized isometric, isotonic and finally dynamic exercises, moving from less demanding to more intense ones as function improves and pain recedes. The aim of these exercises is to strengthen the calf muscles and restore their tone. Usually you can slowly return to sporting activity within 3-4 months, although there will always be a high risk of new injuries in the future.
Poor foot posture or inadequate biomechanics contribute to calf injuries, so after your rehabilitation period, you may benefit from using custom orthotics to avoid other injuries
Advice
- Insert a heel pad into the shoe for a few days to lift the heel and keep the injured calf muscle compact; by doing so you reduce the pain and muscle tension a little. Don't forget you're wearing it though, as it impairs the balance and alignment of your pelvis and lower back.
- Ten days after the injury, the developing scar tissue has the same tensile strength as the surrounding muscle, and you can start doing more challenging rehabilitation exercises.
- Remember to warm up your calf area before engaging in any physical activity and apply ice packs at the end. This is the general rule of thumb for injury prevention (especially if you've already had one in your leg).
