Muscle strains are a very common injury, and frequently involve those that work over 2 joints and have higher number of fast twitch fibres.
The calf is made up of three muscles:
The gastrocnemius is the largest and most commonly strained muscle. It crosses three joints, knee, ankle and metatarsals in the foot. The most common place for a strain is on the middle inside portion of the muscle. Halfway up on the inside of the leg the largest flashiest part of muscle. Soleus and plantaris strains are less common and present lower down the leg near the Achilles
The symptoms of a strain include;
- Palpable area of pain
- Loss of power – in the push-off phase
It occurs when the load experienced by the muscle fibers has been too high causing some of the fibers to tear. Muscle tears are felt when you are contracting the muscle. A tear symptom would last for a few days to a few weeks depending on the severity of the tear. Cramps are momentary involuntary muscle contractions and settle when you stop running and stretch. A tearing pain would not ease in this manner. In regard to other injuries, the key difference is you can pinpoint a tear, and it feels more tender with activity in the initial phases. Also, at rest its symptoms ease.
In most cases the diagnosis is based on history and clinical findings. MRI and ultrasound scanning should be reserved only for when the diagnosis or severity of injury is uncertain.
Unlike delayed muscle soreness, Calf strains are characterized by immediate pain, and difficulty weight bearing. As well as notable pain, they can cause prolonged disability, and are at risk of re injuries and becoming chronic issues. Potential complications include fibrosis, pain, reinjury and residual weakness.
Despite the increased attention to and knowledge of these injuries, the rates of new and recurrent injuries have not improved, and if anything, they are slowly increasing.
MRI gradingof size of tears can provide a guide to predicting return to sport, however this prone to bias and does not factor in other anatomical and physiological factors.
Grade 1 : signal change without disruption (this usually means a tear of few muscle fibres, whilst fascia remains intact)
Grade 2 : less than 50% of the width of muscle disrupted and fascia intact.
Grade 3 : more than 50% of the width of muscle disrupted with partial tearing of fascia.
Grade 4 : complete tear of fascia and muscle.
The approximate time frames for return to sport range from 1-2 weeks for grade 1, to 6-8 weeks for grade 3. There is a balance to be had between early return to sport and risk of reinjury.
The mainstay and well-established treatment remain conservative. There is some emerging evidence albeit, in limited, and underpowered studies (more so in hamstring injuries), to support leucocyte poor platelet rich plasma injections allowing earlier return to sport.
For grades 3-4 tears using a removable vacoped dynamic boot under supervision is recommended for 3-4 weeks.
Cryotherapy or application of ice and compression is recommended to counteract the adverse effects of oedema and haematoma formation, as well as to ease pain.
Although surgical treatment can be considered in complete ruptures, the repair process and quality arevariable, and most surgeons believe non operative treatments provide equivalent or superior results. Surgery can be useful for removing severe fibrosis or muscle calcification in rare cases.