This region of the body is formed by three main muscles, the two gastrocnemius muscles (medial and lateral) and the soleus muscle.
The body region commonly known as the calf is located on the back of the leg, just below the knee. To better understand the potential causes of calf pain, let’s first review its anatomy.
Another smaller muscle called plantar muscle is also present. There are also two bones in the calf region, the largest tibia and the smallest fibula.
Problems with any of these can cause pain in the calf.
Calf pain is a common occurrence in sports that includes running, jumping and landing. Your group of calf muscles consists essentially of two muscles (gastrocnemius and soleus) that attach to the Achilles tendon .
Calf injuries can occur in both muscle and tendon structures. They are usually caused by excessive forces during the explosive contraction, the eccentric control load or when the calf muscles become fatigued.
The calf muscles protect your shin from the back and on both sides. However, excessive loading through the shin (tibia) can cause shin pain and related injuries.
How does the pain in the calf feel?
The calf is made up of two muscles: the gastrocnemius and the soleus. These muscles are found in the Achilles tendon, which attaches directly to the heel. Any movement of the legs or feet uses these muscles.
Calf pain varies from person to person, but it usually feels like a dull, painful or sharp pain, sometimes with oppression, in the back of the leg. Symptoms that may indicate a more serious condition include:
- Feeling of coldness in the calf.
- Tingling or numbness in the calf and leg.
- Weakness of the leg
- Fluid retention.
- Redness, heat and sensitivity of the area.
If you have any of these symptoms other than pain in the calf, you should visit your doctor.
Causes of calf injuries
While muscle injuries are the most common cause of calf pain, there are others that can be due to circulation problems, knee joint problems and other conditions.
Determining the cause of the pain in the calf can help guide the appropriate treatment. Some of the most common causes include:
Calf muscle tension : this is the most common cause of acute onset calf pain. Usually, this injury occurs during a sports or exercise activity. The common symptoms of a strained calf include pain, swelling and bruising.
Medial gastrocnemius tension : the part of the calf muscle that is injured most often. The medial head of the gastrocnemius is one of the three main muscles of the calf that is the source of pain when the calf muscle is tensed.
Muscle rupture of plantaris : it is a thin and small muscle that is not even present in around 10 to 20 percent of the population.
The muscle runs along the gastrocnemius muscle but is a small fraction of the size. The plantaris muscle can break, causing sudden and abrupt pain in the back of the leg.
Because the muscle has no functional importance, the treatment is not operative.
Tendinitis / Achilles rupture : the Achilles tendon is the connection between the calf and heel muscles.
Calf pain is usually considered pain in the softer and more muscular part of the lower leg, while rupture of the Achilles tendon usually causes pain in the back of the heel.
Causes of calf injuries
Achilles tendon ruptures that occur higher in the tendon should be considered when evaluating calf pain.
Baker’s cyst : it is not a true cyst. Rather, it is a collection of joint fluid from the knee that has accumulated in the back of the knee.
When excessive amounts of fluid accumulate, it may cause pain in the back of the leg. Occasionally, Baker’s cyst will rupture, causing fluid to enter the calf region.
Blood clots : A blood clot should be considered as a cause of pain in the calf, especially when the pain in the calf is not the immediate result of an injury.
This can cause swelling and pain in the calf. Blood clots are more common in the days and weeks after injuries and surgical procedures.
Knowing if you have a blood clot is important. Without treatment, the clot can travel to the lungs, causing difficulty in breathing.
Calf pain is a common symptom of referred pain, for example, sciatica , or it may be due to deep vein thrombosis (DVT).
Sciatica is a condition caused by a pinched nerve in the lower back. Fortunately, it can usually be treated successfully with physiotherapy. The occasional patient requires spinal surgery.
The DVT is the most serious concern and can cause pulmonary embolism, stroke or potentially death. Calf pain should be excluded because of the possibility of deep vein thrombosis as an urgent priority.
Consult your doctor or physiotherapist to evaluate and exclude a deep vein thrombosis.
Leg cramps: cramps in the leg muscles are a common cause of pain in the calf. Usually, symptoms are intermittent (not constant pain) and relieved by stretching and applying heat.
Sciatica : is the result of problems with the sciatic nerve, a nerve that controls the muscles of the lower leg and the back of the knee.
It can cause pain, numbness and tingling in the lower back that can extend down the leg to the calf and other muscles.
In more severe cases, surgery may be necessary to treat sciatica.
Contusion or bruise : is the result of a trauma, such as a fall, a cut or a blow. The trauma causes the capillaries under the skin to explode, which causes discoloration.
Bruises usually heal alone. You should see a doctor if you have unexplained bruising or bruising that reappears in the same area without injury.
Diabetic peripheral neuropathy : is a form of damage to the nerves that affects the feet, legs, arms and hands. This condition is a common complication of diabetes that results from overexposure to high blood sugar , genetic factors or inflammation of the nerves.
Other symptoms of diabetic peripheral neuropathy include:
- Acute pain
- Muscle cramps.
- Muscular weakness.
- Loss of balance and coordination.
- Reduced ability to feel pain or changes in temperature.
Compartment syndrome : is a serious condition that occurs when a large amount of pressure builds up inside a muscle compartment. This usually happens after you have suffered a major injury in the area, such as a broken or broken bone. Symptoms of compartment syndrome may include:
- Severe pain that does not improve after rest or medication.
- Problems to move the affected area.
- A noticeable bulge in the affected muscle.
What causes a muscle tear in the calf?
There is a small percentage of reasons that can tear the calf muscle simply by walking.
The most common calf muscle that breaks is the medial gastrocnemius. However, it can tear any of your other calf muscles: lateral gastrocnemius, soleus, plantar or flexor hallucis longus.
Tears in the middle calf muscles are more common and the Achilles musculotendinous junction is the second most likely.
When should I see a doctor?
If you are not sure of the cause of your symptoms, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. The treatment of calf pain should be directed to the specific cause of your problem.
Some signs that should be seen by a doctor include:
- Inability to walk comfortably on the affected side.
- Injury that causes deformity in the lower part of the leg.
- Calf pain that occurs at night or while resting.
- Calf pain that persists beyond a few days.
- Swelling of the area of the calf or ankle joint.
- Signs of an infection, including fever, redness, heat.
- Any other unusual symptoms.
Degrees of muscle tear severity of the calf
The calf tension may be less (grade 1) or very severe (grade 3). Your physiotherapist will evaluate your injury based on your clinical findings or diagnostic tests such as MRI or diagnostic ultrasound.
The calf muscle tears of grade one are the result of a slight excessive stretching that produces small micro-tears in the muscle fibers of the calf.
The symptoms are usually quite disabling during the first two or three days. In most cases, your recovery will take approximately one to two weeks if you do things right.
Tears in the calf muscles of grade two result in a partial tear of the muscle fibers. Complete recovery usually takes several weeks with good rehabilitation.
Rejuvenation or high-speed sport should be guided by your physiotherapist to avoid unnecessary tearing, which is quite common in moderate breaks in the calf.
A tear of grade three is the most severe calf distension with complete breakage of the fibers of your calf muscle.
It is important to determine if there has been a rupture of the Achilles tendon of the calf muscle break grade 3. It is recommended a diagnostic evaluation using ultrasound or magnetic resonance imaging.
The total recovery may take several months and may not be 100% in some cases. An opinion of the orthopedic surgeon is recommended. A surgery may be required.
A professional evaluation and a specific treatment guide is strongly recommended for all grade 3 calf lacerations.
How to take care of a muscle tear in the calf
The calf pain felt in the belly of the calf muscle is often the result of a stretched or torn calf muscle.
A broken calf muscle can sometimes be confused with a ruptured Achilles tendon, a significant Achilles tendinopathy, leg cramps or even sciatica or referred pain from the lower back.
During the next few hours, you will have difficulty walking properly or standing on your foot or standing on your toes. Swelling or bruising in the calf muscle will be evident in severe tears of the calf muscle.
Unfortunately, a torn calf muscle often recurs if the calf rupture is not properly rehabilitated and sports are played again too quickly.
In essence, there are six stages of rehabilitation that must be covered to effectively rehabilitate calf muscle tears and prevent recurrence. These are:
Phase 1 – Protection against early lesions: pain reduction and anti-inflammatory phase
As with most soft tissue injuries, the initial treatment is: rest, ice, compression and elevation.
The muscles of your calf produce very high contractile forces that allow you to run and jump. In the initial phase of your torn calf muscle, you will not be able to walk without limping, so your recovery will need some strategies to avoid rest and avoid weight. This may include crutches or a walking wedge boot.
Request the advice of your health professional to obtain specific recommendations related to the breakage of the calf muscles.
Phase 2: recover the full range of movement
The torn calf muscle will be repaired successfully with collagen scar tissue in most cases through the natural healing process of your body.
During these first six weeks, it is ideal to optimally modify the scar tissue to avoid an unaligned lumpy scar that will potentially re-tear in the future when placed under a high load or velocity.
Successful rehabilitation includes lengthening and orienting healing scar tissue through massage, muscle stretching, active movements and neurodynamic mobilization.
Phase 3: restore concentric muscle strength
The power of your calf muscle should progress gradually. This involves performing your exercise initially in a position other than weight, before progressing to a partial weight position, a full weight position and then performing heavy resistance exercises.
It’s amazing how a few days of training can affect your overall muscle strength.
If the break of your calf muscle is going to leave you out for a few weeks, then you may also need to strengthen your two legs, including the muscles of the thighs and buttocks, as well as the lower central muscles.
Please, check with your physiotherapist.
Phase 4: restore eccentric muscle strength
Your rehabilitation should always include an eccentric training regimen in preparation for a return to speed and complete sport-specific or functional activities.
Your physiotherapist is an expert in exercise prescription and will guide you in a calf strengthening program when appropriate.
Phase 5: restoration of high speed, power, proprioception and agility
Your best prevention strategy to avoid a recurrent break of the calf will be guided by your physiotherapist.
Depending on the specific requirements of your sport or lifestyle, your physiotherapist will present exercises and activities that will address your speed, agility, proprioception and power to prepare for a specific training for lower recurrence risk.
Phase 6: return to sport
All sports are different. Depending on your chosen sport, your physiotherapist will address the physical needs of your sport and incorporate them into your specific program of sports exercises.
Your progressive training regimen, including neuromuscular training, is your best chance to allow a safe and injury-free return to your chosen sport.
Your physiotherapist will discuss your specific goals, rehabilitation schedules and your training programs to optimize the rehabilitation of calf muscle breaks for a complete and safe return to sport.
The perfect result will make it work at full speed, power, agility and performance with the added knowledge that a complete rehabilitation program has minimized your chance of suffering future injuries.
Treatments for calf pain
The treatment of calf pain depends completely on the cause of the problem. Therefore, it is very important that you understand the cause of your symptoms before embarking on a treatment program.
If you are not sure of your diagnosis, or how serious your condition is, you should consult a doctor before starting any treatment plan.
Not all of these treatments are appropriate for each condition, but they may be useful in your situation.
Anti-inflammatory medications: Non-steroidal anti-inflammatory drugs are some of the most commonly prescribed medications, especially for patients with calf pain caused by acute inflammation.
You may be tempted to self-diagnose or treat your calf pain on your own, instead of visiting the doctor. The good news is that most conditions that cause pain in the calf do not need surgery.
Home remedies to relieve pain in the calves:
The methods of treatment for calf pain vary according to the cause, but most causes can be addressed at home. For calf pain caused by overuse or mild to moderate trauma, here are some tips:
Rest, ice, compression and elevation : ice therapy and leg lift are two common common principles for calf pain. Try elevating your leg to the level of your heart or above it to decrease swelling. Applying an ice pack at 20 minute intervals can also help.
Stretching : before and after all training, helps repair and strengthen the calf, therefore, prevent future pain and injury. Make sure you have enough time to rest between workouts to help facilitate muscle repair and growth.
Light stretching can help relieve pain in the calf. After the symptoms diminish slightly, you should stretch the calf muscles. Common exercises to accomplish this include:
- Calf raising.
- Position of the dog upside down (yoga).
- Straight calf stretch.
Stay hydrated : this is because dehydration directly contributes to muscle cramps.
Slowly increase the exercise : it is important to start or increase the exercise to do it gradually. Increasing your activity level too abruptly can cause injuries. Find an online exercise plan or work with a trainer.
However, you should make sure you know the cause of your symptoms because some of these conditions require acute treatment. In addition, conditions such as blood clots can be more serious and require urgent treatment to prevent systemic complications.
While the degree of tearing of the calf will determine if your rehabilitation process will take days, weeks or months, there is no specific time period for your progression from each stage to the next.
All this is considered by your physiotherapist during your clinical evaluation.
Each of your progressions will be carefully monitored by your physiotherapist. The last thing you want is to try to progress prematurely to the next level and cause a new injury and the consequent frustration of a prolonged rehabilitation period.
For specific advice on your calf injury, seek advice and guidance from your trusted physiotherapist.