LEG PAIN - Calf Muscle Strain

Calf Muscle Strain
(Pulled Calf Muscle; Gastrocnemius Strain; Gastrocnemius Tear; Gastrocnemius Muscle Injury) 

by Laurie LaRusso, MS, ELS

Definition  

A calf muscle strain is a partial or complete tear of the small fibers of the muscles. The calf muscles are located in the back of your lower leg.

Causes  

A calf muscle strain can be caused by:

• Stretching the calf muscles beyond the amount of tension they can withstand
• Suddenly putting stress on the calf muscles when they are not ready for the stress
• Using the calf muscles too much on a certain day
• A direct blow to the calf muscles

Risk Factors  

Factors that increase your chance of developing a calf muscle strain:

• Participation in sports that require bursts of speed. This includes track sports like running, hurdles, or long jump. Other sports include basketball, soccer, football, or rugby.
• Previous strain or injury to the area.
• Muscle fatigue.
• Tight calf muscles.
• Poor conditioning.

Symptoms  

Symptoms may include:

• Pain and tenderness in the calf
• Stiffness in the calf muscles
• Weakness of the calf muscles
• Pain when pushing off the foot or standing on tiptoe
• Bruising on the calf
• Popping sensation as the muscle tears

Diagnosis  

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Most calf muscle strains can be diagnosed with a physical exam. Your doctor may want images of the area if severe damage is suspected. Images may be taken with MRI or ultrasound.

Muscle strains are graded according to their severity:

• Grade 1—Some stretching with micro-tearing of muscle fibers.
• Grade 2—Partial tearing of muscle fibers.
• Grade 3—Complete tearing of muscle fibers. This may also be called a rupture or avulsion.

Treatment  

Talk with your doctor about the best treatment plan for you. Recovery time ranges depending on the grade of your injury. Treatment steps may include:

Acute Care  

Rest  

Your muscle will need time to heal. Avoid activities that place extra stress on these muscles:

• Do not do activities that cause pain. This includes running, jumping, and weight lifting using the leg muscles.
• If normal walking hurts, shorten your stride.
• Do not play sports until your doctor has said it is safe to do so.

Cold  

Apply an ice or a cold pack to the area for 15-20 minutes, four times a day, for several days after the injury. Do not apply the ice directly to your skin. Wrap the ice or cold pack in a towel.

Pain Relief Medications  

To manage pain, your doctor may recommend:

• Over-the-counter medication, such as aspirin , ibuprofen , or acetaminophen
• Topical pain medication—creams or patches that are applied to the skin
• Prescription pain relievers

Compression  

Compression can help prevent more swelling. Your doctor may recommend an elastic compression bandage around your calf. Be careful not to wrap the bandage too tight.

Elevation  

Elevation can also help keep swelling down. Keep your leg higher than your heart as much as possible for the first 24 hours or so. A couple of days of elevation might be recommended for severe strains.

Recovery Steps  

Heat  

Use heat only when you are returning to physical activity. Heat may then be used before stretching or getting ready to play sports to help loosen the muscle.

Stretching  

When the acute pain is gone, start gentle stretching as recommended. Stay within pain limits. Hold each stretch for about 10 seconds and repeat six times. Stretch several times a day.

Strengthening  

Begin strengthening exercises for your muscles as recommended.

You may be referred to for physical therapy

If you are diagnosed with a calf muscle strain, follow your doctor's instructions .

Prevention  

To reduce the chance of calf muscle strain:

• Keep your calf muscles strong and flexible, so they can absorb the energy of sudden physical stress
• Learn the proper technique for exercise and sporting activities to decrease stress on all your muscles

Last reviewed February 2014 by Michael Woods, MD

Source: http://www.med.nyu.edu/content?ChunkIID=11984

LEG PAIN - 8 Causes of Lower Leg Pain

8 Causes of Lower Leg Pain

By Catherine Moyer, DPM

Updated September 12, 2014. 
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

The lower leg is a common problem area for soreness. The muscles of the lower leg control foot motion and stability, so increases in activity or changes in footwear can sometimes cause sore muscles or tendonitis. An increase in physical activity is a leading cause of lower leg pain, but there are many other health conditions that can cause leg pain as well. Leg pain that is severe, sudden, or accompanied by swelling should always be evaluated by a physician. Some of the more common causes of lower leg pain include:

Yagi Studio/Digital Vision/Getty Images

1. Muscle Strain or Fatigue

Muscle fatigue or strain is the most common cause of leg soreness. Usually a muscle strain happens from increased activity and causes a minimal amount of soreness. The soreness is easily relieved by rest and cold or warm compresses. However, sudden or severe injuries can cause a muscle tear or tendon rupture which is significantly more painful. The gastronemius muscle of the calf is a common area for strain and tear. Stretching prior to exercise may help decrease the chance of muscle injury.

2. Exercise-Related Injuries

Shin splints, also known as medial tibial stress syndrome, is a common exercise-related injury. Shin splints often affect runners and those involved in sprinting or jumping sports. The pain is felt along the inside (medial) and back (posterior) part of the tibia bone where the calf muscles attach to the bone. Shin splints may be aggravated or triggered by foot conditions such as over-pronation or high-arched feet. A stress fracture of the tibia bone is another condition seen in running and jumping sports and like shin splints, causes leg pain with activity. A less common cause of exercise-related leg pain is exercise-induced compartment syndrome. This condition is more often associated with a recent increase in leg muscle mass and causes intense leg pain, cramping, and a tight feeling in the leg muscles with activity.

3. Tendonitis

Tendonitis is a common sports overuse injury but can strike anyone, regardless of activity levels. Tendonitis is inflammation surrounding a tendon, which is a strong, cord-like structure that anchors a muscle to bone. Abnormalities in foot structure such as flat feet or high arches can trigger tendonitis. Tendonitis presents as pain that increases with activity or stretching of the affected tendon. Common types of tendonitis that would cause lower leg pain around the ankle area are Achilles tendonitis and posterior tibial tendonitis. 

4. Vein Problems

The veins of the legs return blood back to the heart. When vein problems occur, leg swelling (edema) and sometimes pain or tenderness may occur. One common vein problem is venous insufficiency, which can lead to varicose veins, recurrent leg swelling, and skin changes such as a brown discoloration near the ankles. A serious and potentially life-threatening cause of leg pain is known as Deep Vein Thrombosis (DVT). A DVT is a clot in a leg vein that can break-off and travel to the lungs or other organs. 

5. Peripheral Artery Disease (PAD)

With PAD, blood flow to the leg is compromised because of narrowing of one or more leg arteries. PAD is associated with leg pain while walking that is relieved by rest. While vein problems often cause a redness or warmth in the leg, PAD can lead to a cold, and often pale limb that has an increased sensitivity to pain. Risk factors for PAD include a history of smoking, heart disease, and diabetes. 

6. Pregnancy

Foot and leg problems are a common problem for pregnant women, especially in the third trimester. Sore legs and feet are often due to the increase in weight plus hormonal changes that cause the foot's arch to relax and compress down a little more. This causes a tendency toward flat feet and can also cause the leg muscles to work a little harder at maintaining foot stability, resulting in sore leg muscles. Painful leg cramps in pregnancy may be caused by blood volume changes or from sciatic nerve compression by the expanding uterus. 

7. Medical Conditions

There are many medical conditions that can cause leg pain. Fibromyalgia sufferers frequently experience restless leg syndrome and painful lower leg cramps. Leg pain can also be associated with autoimmune disorders such as multiple sclerosis and rheumatoid arthritis.Thyroid disease can also cause pain in the legs. Also, medications for certain medical conditions are known to cause leg pain or cramps. Diuretics and statin drugs for high cholesterol are common examples. Check with your provider if you suspect your medication may be causing leg pain. 

8. Back Problems

Compression of the leg nerves as they exit the spine causes shooting pain that can extend all the way down to the foot. The pain typically starts at the buttock and is felt on the side and back of the leg. Often called sciatica, this type of pain may be caused by a herniated spinal disc, spinal stenosis, or irritation from a tight muscle, such as seen with piriformis syndrome.

Source: http://foothealth.about.com/od/exercisefeet/tp/Lower-Leg-Pain.htm

LEG PAIN - Calf Strain

A calf strain is a tear to one or both of the muscles at the back of the lower leg, usually the gastrocnemius muscle in the middle at the junction between the muscle and tendon. We explain a tear of the calf muscles as well as treatment and rehabilitation to return you back to full fitness.

Symptoms

Symptoms of a calf muscle strain can vary significantly but in general include a sudden sharp pain at the back of the lower leg. The calf muscle will be tender to touch at the point of injury and swelling and bruising may appear. Depending on how bad the calf injury is the athlete may be able to continue in some discomfort or they may be unable to walk in severe pain.

Calf strain explained

The calf muscles consist of the gastrocnemius muscle which is the big muscle at the back of the lower leg and the soleus muscle which is a smaller muscle lower down in the leg and under the gastrocnemius. 

Gastrocnemius is the larger of the two muscles which attaches above the knee joint and inserts into the heel bone via the achilles tendon. The Soleus attaches below the knee joint and then also to the heel via the achilles. Either of these two muscles can be strained. 

Both muscles act to plantar flex the ankle or point the foot away from the body as in standing up on tip toes. A calf strain usually occurs at the muscular tendinous junction where the muscles meet the achilles tendon. If the Soleus muscle is damaged there may be pain lower in the leg and also pain when you contract the muscle against resistance with the knee bent.

Calf injuries usually occur through a sudden pushing off force or an over-stretching of the calf muscles such as in jumping or changing direction quickly.

How bad is my calf strain?

A calf muscle tear is graded from 1 to 3, with grade 3 being the most severe.

Grade 1 symptoms

Grade 1 calf strain is a minor tear with up to 10% of the muscle fibers effected. The athlete will feel a twinge of pain in the back of the lower leg. They may be able to carry on playing or competing in mild discomfort. There is likely to be tightness and aching in the calf muscles two to five days after injury.

Grade 2 symptoms

Symptoms of a grade 2 strain will be more severe than a grade one with up to 90% of the muscle fibers torn. A sharp pain at the back of the lower leg will be felt with significant pain walking. There is likely to be swelling in the calf muscle with mild to moderate bruising. Pain will be felt on resisted plantar flexion or pushing the foot downwards against resistance. There may be tightness and aching in the calf muscle for a week or more.

Grade 3 symptoms

There will be severe immediate pain at the back of the lower leg. The athlete will be unable to continue and unable to walk. There will be considerable bruising and swelling appearing and the athlete will be unable to even contract the calf muscle. In the case of a full rupture, often there is deformity where the muscle can be seen to be bunched up towards the top of the calf. A grade three is a near, or complete rupture of the muscle.

See calf strain assessment and diagnosis for more detailed information.

Treatment

What can the athlete do?

Applying R.I.C.E. (Rest, Ice, Compression, Elevation) is essential. Cold therapy should be applied as soon as possible to help to quickly stop any internal bleeding. Ice can be applied for 10 to 15 minutes every hour initially reducing frequency as pain and swelling goes down.

Use a compression bandage, calf support or sleeve. A compression bandage can be applied immediately to help stop swelling but it should only be applied for 10 minutes at a time as restricting blood flow completely to the tissues could cause more damage.

Wear a heel pad to raise the heel and shorten the calf muscle hence taking some of the strain off it. It is a good idea to put heel pads in both shoes or one leg will be longer than the other creating an imbalance and possibly leading to other injuries including back injuries.

See a sports injury professional who can advise on a full calf strain rehabilitation program with stretching and strengthening exercises.

Professional calf strain treatment

A doctor or medical professional may prescribe anti-inflammatory medication e.g. ibuprofen which is beneficial in the first few days after the injury. Do not take ibuprofen if you have asthma.

Use electrotherapy such as ultrasound therapy. In the early stages this can help with pain relief and to reduce swelling. In the later stages of rehabilitation a micro massage effect can help stimulate blood flow in the muscle.

Use sports massage techniques for calf muscles after the initial acute phase. Sports massage can help by stimulating blood flow, stretching the muscle and loosening any tight knots, lumps and bumps in the muscle. Scar tissues is softened and new fibers aligned which will aid the healing process and help prevent re-injury.

Prescribe a full calf strain rehabilitation program with calf stretching and strengthening exercises.

Once the initial healing has taken place it is essential the lower leg is fully strengthened in order to reduce the likelihood that the injury will reoccur or have an adverse effect on future performances. For more detailed information on calf strain rehabilitation see our calf strain rehab page.

Source: http://www.sportsinjuryclinic.net/sport-injuries/ankle-achilles-shin-pain/calf-strain

LEG PAIN - Calf Muscle Tear

Article by John Miller

What is a Calf Muscle Tear?

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 at 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:

Grade 1:

The muscle is stretched causing some small micro tears in the muscle fibres. Recovery takes approximately 2 to 4 weeks if you do all the right things.

Grade 2:

There is partial tearing of muscle fibres. Full recovery takes approximately 4 to 8 weeks with good rehabilitation.

Grade 3:

This is the most severe calf strain with a complete tearing or rupture of muscle fibres 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 at PhysioWorks 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 a pain reducing medication.

As you improve a compressive bandage, supportive taping or an 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 remould 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 mobilisations. Signs that your 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 other 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 customised 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.

Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to 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 minimised your chance of future injury.

Summary

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 PhysioWorks physiotherapist.

Source: http://physioworks.com.au/injuries-conditions-1/calf-muscle-tears

LEG PAIN - Calf Pain

Article by John Miller

Calf Pain

Calf pain is a common occurrence in sports that include running, jumping, hopping and landing activities. Your calf muscle group essentially consists of two muscles (gastrocnemius and soleus) that attach to your Achilles tendon. 

Calf injuries can occur to both muscle and tendon structures. They are commonly caused by excessive forces during explosive contraction, eccentric control loading or when your calf muscles fatigue.

Your calf muscles protect your shin bone from the rear and both sides. However, excessive load through your shin bone (tibia) can result in shin pain and its related injuries. 

Common Sources of Calf Pain

The most common sources of leg pain include a torn calf muscle, achilles tendonitis and leg cramps. 

Here is a list of some common causes of calf pain.

Achilles Tendon Rupture

Achilles Tendonitis / Tendinitis

Calf Muscle Tear

High Ankle Sprain

Muscle Strain (Muscle Pain)

Overuse Injuries

Pinched Nerve

Sciatica

Severs Disease

Shin Splints

Sprained Ankle

Stress Fracture

Referred Calf Pain & Blood Clots

Calf pain is commonly as a result of referred pain eg Sciatica or can be due to Deep Venous Thrombosis (DVT's). 

Sciatica is a condition caused by a pinched nerve in your lower back. Fortunately, it can usually be treated successfully with physiotherapy. The occasional patient requires spinal surgery.

DVT's are the most serious concerns and can result in pulmonary embolism, stroke or potentially death! Your calf pain should be excluded for the possibility of a DVT as au URGENT PRIORITY. 

Please consult your doctor or physiotherapist to assess and exclude a DVT.

Calf Pain Treatment

With accurate assessment and early treatment, most calf pain responds extremely quickly to physiotherapy allowing you to quickly resume pain-free and normal activities of daily living.

Please ask you physiotherapist for their professional treatment advice.

Source: http://physioworks.com.au/Injuries-Conditions/Regions/calf-pain-leg-pain