Pain in the Calf Muscle!!

Calf muscle injuries are a relatively common occurrence in active people.

The calf is actually made up of three individual muscles: soleus, plantaris, and gastrocnemius. The plantaris muscle is a small, thin muscle that runs from the medial aspect of the distal femur (inside area of your lower thigh) down the middle area of your lower leg until it meets the other muscles and they form the Achilles tendon. The gastrocnemius muscle has two heads which start from the medial and lateral aspects of the distal femur (the area just above your knee). They merge a few cm below your knee and continue down before joining the Achilles. The soleus muscle is the deepest of these. It originates on the posterior surface of the proximal tibia (the back of the main bone of your lower leg).

The plantaris muscle is rarely injured. The gastrocnemius is more commonly injured than the soleus, due to it crossing both the knee and ankle joints. Approximately 20% of people who sustain a calf injury reported feeling tightness in the week or so prior to injury.

calf Gastrocnemius injury commonly occurs when accelerating rapidly (e.g. starting a sprint), or changing direction particularly from a stationary position (e.g. while playing tennis), when the knee is straight and the foot dorsiflexed (toes pulled up).

Commonly people report feeling a stabbing pain or tearing sensation in the medial head of the gastrocnemius or in the musculotendinous junction (the area where the muscle fibres merge with the tendon fibres).

Calf injuries are separated into three grades – grade I is a tear in a small proportion (<10%), grade II is a larger tear (10-50%) and grade III is a larger to complete tear. Soleus injury is reported as being less common, but it may be frequently misdiagnosed.

Accurate diagnosis and appropriate treatment are essential to minimise disability and time off work/sport.

Initial treatment should consist of POLICE (Protection Optimal Load Ice Compression Elevation) for 48-72 hours. Heel raises should be used if weight bearing is painful. At about 36-48 hours gentle stretching should begin, as tolerated. Massage to release tight areas of muscle. A graduated strengthening program should begin with bilateral calf raises on a flat surface, progressing to single leg on a flat surface and two legged off the edge of a step to single leg off a step to heel drops and finally functional activities e.g jumping.

Recovery ranges from around two weeks for a mild grade I strain to about four months for a severe grade III, if you do get the right diagnosis and treatment.

So, if you have a calf injury, are experiencing any pain in the calf muscle OR are just feeling tight in your calf muscles get in to see a physio to assess it properly and help prevent future injuries.

POLICE Arrest Soft Tissue Injuries

The acronym PRICE:
  • Prevention – be well prepared for your chosen activity,
  • Rest – stop doing activity,
  • Ice – put ice on the injured area to decrease the inflammation,
  • Compression – put something tight around the injured area to help prevent swelling
  • Elevation – put the injured area up to allow gravity to minimise swelling
has been used for years as the initial treatment of acute soft tissue (muscle, ligament, tendon) injuries.   However, it has been shown that Rest may n fact be detrimental to the correct repair of soft tissues.  A British Study suggests that a new acronym POLICE should replace PRICE. This new acronym is:
  • Protection
  • Optimal Loading
  • Ice
  • Compression
  • Elevation
It still suggests some rest initially but only for a very short time as research shows that early mobilisation stresses tissues in the correct manner for full recovery, whereas rest can impair optimal recovery of soft tissue injuries.  The hard part of this is to correctly identify Optimal Loading, as it is different for different tissues and body parts.  Protection comes in as a way of achieving optimal loading – some injuries may require bracing, or crutches etc. to unload them enough to avoid further aggravation but still allow tissue stress to help with healing.  Althought there is little scientifice evidence for ICE there still seems to be enough anecdotal evidence to keep it for now.