Sports medicine

Pull in Calf muscle: Cause, Symptoms, Treatment, Exercise

▶️What is a pull in calf muscle?

A pull in calf muscle is also called calf muscle strain it occurs when the
muscles in the calf (the soleus and gastrocnemius) get overstretched
during performing any activity of leg
The calf muscles are located in the lower leg behind the shin bone and
extend from the base of the thigh down to the heel They work as flex
and bend the foot, ankle, and knee A calf strain can cause pain and
make difficulty to perform running, jumping, and doing other activities
A pull in calf muscle can result in partial tear or complete tears
depends upon level of injury A torn calf muscle may require surgery to
repair it

▶️What is the difference between muscle strain or muscle pull or a

sprain?
Pull in Calf muscle also you can say A calf strain but it isn’t a sprain.
Strains mean injuries to muscles or tendons (tissues that attach
muscles to bones) while Sprains occurs injuries to ligaments (tissue
that connects bones or cartilages or holds a joint along)

▶️Where is the calf muscle located?

The calf muscle is a group of two main muscles the gastrocnemius
muscle, the soleus muscle and additionally plantaris muscle
These two muscles the gastrocnemius and soleus muscles are
collectively big muscles with two sections
A small muscle called the plantaris travels between the gastrocnemius
and soleus muscle throughout the length of the lower leg. These 3
muscles are also called the triceps surae. However, not everyone have
a plantaris muscle. Mostly 100 % of individuals have 2 larger muscles
Gastrocnemius Muscle is the larger Calf Muscle Forming The bulge of
Muscle mass and visible beneath the skin Gastrocnemius has 2 heads
which looks like Diamond shape
The Soleus Muscle is a Small Muscle, Flatt and located underneath The
Gastrocnemius Muscle

▶️Insertion:
Both Muscle Insertion merge via Tendo Achiilis and the Achilles tendon
inserts into the heel bon(calcaneus)

▶️Action:
Calf Muscle is one of strong lower limb Muscle which Planter Flex from
Ankle Joint
This muscle is anti-gravity Muscle and normally all anti gravity Muscle
require high Power that's Why All anti gravity Muscles are Bulky and
Strong
Running, Jumping, Dancing, Cycling all this Activity uses Calf Muscle
Jumping is the activity where Highest uses Calf Muscle

▶️Who gets Pull in Calf muscle?

Anyone can have a pull in calf muscle But these pull are most
commonly seen in sports person who perform lots of stop-and-go
movements with jerky bursts at ankle such as Sprinters football players
Hockey players soccer players and tennis players are at risk of calf
muscles strain Eventually the injury is also called tennis leg

▶️What is the causes of pull in calf muscles?

Call muscle pull mostly occur when someone suddenly moves or
overstretches in the calf muscle during moving or playing activity such
as Fast pivots, jumps, or abrupt stops can cause muscle strains. This
injury is mainly common when ankle get forced upward (toward the
body) and the ankle stretches the calf muscles down too rapidly

▶️Following are the most common cause of calf muscle pull, these are :
1-Not warming up correctly before sports or physical activity
2-Calf Muscle tightness (deficient flexibility)
3-Calf muscle weakness (deficient conditioning)
4-Overexercise or Over physical activity (Overexertion and fatigue)

▶️Acute calf muscle pull occurs during Slip body, jump, run, throw
something, raise something heavy, lift something while clumsy
position

▶️Chronic calf muscle pull occurs during Sports like row, playing
Hockey, tennis, golf, or baseball, poor posture, holding back or neck in
an ungainly position for long periods of time, like after work at a desk

▶️Overuse:
Repeated ankle movement can lead to microtrauma of calf muscle will
cause overuse calf muscle pull
Don’t stretch or warm up prior to exercise: Stretching prior to calf
exercise step by step will increase how much stress you place on
muscles
Calf muscle tightness: If your calf muscles are tight and not flexible to
high intensity activity in full range then your calf muscles (and the
fibers in them) are tighter, which build them additional risk to strains
▶️Other risk factors for calf muscles pull are:
Age: People over 40 may be more likely to have muscle strains during
physical activity
Sex: Men are more likely to get calf muscle pull as compared to
females
Calf muscle weakness: It’s important to do warm up and stretch your
calf prior to any physical activity and condition muscles before the
start of a sports activity
▶️The Calf muscle pull is classified into three grades:
Grade 1: It is the type of muscle strain that occurs once a overstretch
causes very few micro-tears among the muscle fibers It could also be
ready to resume an activity without pain or with gentle discomfort
Mostly post activity tightness and aching Full recovery take within 1
weeks Average time to return to sport 10-12 days Sign-pain on
unilateral calf raise or hop
Grade 2: This strain include a partial tear of the muscle fibers. You may
acquire to limit activity, but full recovery takes around five to eight
weeks. Average time to return sport after 20 to 30 days. Sign-pain with
active plantar flexion, pain and weakness with resisted plantar flexion,
loss of flexion
Grade 3: severe injury and instantly pain in the calf, and involves a
complete tear or rupture of the affected muscle fibers. Full recovery
can take 3 to 4 months and, in some instances, surgery may even be
required. Average time to come sport 6 months after surgery. Sign-
inability to contract calf muscle may have the palpable defect,
Thomson’s test positive

▶️What are the symptoms of a pulled calf muscle?

👉Difficulty stretching the calf muscles or standing on toes or limping

during walking
👉Calf Muscle pain when flexing ankle or pointing toes

👉Difficulty in knee movement or painful knee movement

👉Snapping or popping sensation in calf muscles

👉Sudden pain spasm in the back of lower leg

👉Swelling in calf muscle and also Ankle swelling

👉Bruising on calf area

Most people with a pulled calf muscle shows that not able to do their
regular activity instantly following the injury

▶️Differential diagnosis:

👉Medial leg bone stress syndrome

👉Plantar fasciopathy

👉Ankle Joint sprain

👉Medial leg bone stress syndrome

👉Leg injuries related to sports with same symptoms and treatment as

a calf strain are mentioned below

👉Chronic exertional compartment syndrome (CECS)

👉TendoAchilles tendinopathy

👉Popliteal Artery entrapment Syndrome (PAES)

▶️Diagnosis and tests:

You may require imaging study to checkout if there are any partial or
complete tears in calf These tests can also rule out other conditions
that related lower leg pain such as Achilles tendon ruptures or deep
vein thrombosis (DVT)
Ultrasound to examine for calf tears or fluid buildup within the calf
muscles
MRI to examine for blood clots a tear or internal bleeding
▶️Subjective assessment
Ask the patient pain history with associated symptoms
Mechanism of injury:
Inciting trauma- side and magnitude of injury force
Recurrent trauma-faulty postural related injuries

▶️Objective assessment

👉Examine the foot and ankle in supine and standing position

👉Ankle Active range of motion

👉Ankle Passive range of motion

👉Resisted strength check the ankle and foot

👉Knee Active ROM and manual muscle testing

▶️On objective assessment, there will be:

👉muscle Tenderness- to touch at the point of injury

👉Swelling

👉Bruising may appear within hours or days

👉Stretching of the muscle will reproduce pain

👉Pain on resisted plantar flexion

▶️Treatment of Pull in Calf muscle:

Medical Treatment
Calf muscle pull treatment mostly depends upon grade of injury Grade
1 or Grade 2 muscle strain recover with few days rest with Pain
relieving medicine mostly Non-Steroidal Anti-Inflammatory Drugs
(NSAIDs) and use of RICE Principle

▶️RICE Principle are:

R- rest
I-Ice for cooling
C- compression: tapping and splinting
E- elevation
Few days rest helps to recover calf muscle strain to heal properly while
ice pack helps to relieve pain and swelling
Elevation of limb is required if Ankle swelling is present otherwise not
required
Crep bandage or taping also helps to stabilize calf muscles
After few days rest pain will disappear and other related symptoms
such as muscle spasm swelling is relived exercise is the best option to
return to normal activity

▶️Physiotherapy Treatment:
Physiotherapist will assess your condition and accordingly start the
treatment depends upon severity of injury and symptoms
Mostly Physiotherapist uses pain relieving Electrotherapy modalities
such as Transcutaneous electrical nerve stimulation (TENS)
Interferential therapy(IFT) Ultrasound therapy machine This electro
Modalities helps to relieve pain, swelling and muscle spasm
Physiotherapist teaches you initially light exercise and as pain and
other symptoms relive they give you stretching and strengthening
exercise of calf muscles

▶️Pull in calf muscle rehabilitation exercises:

👉Use of ice pack 3 times par day

👉Rest

👉Avoid exercise or do only isometric pain free exercise

▶️Phase two- the 2nd and 3rd weeks after injury

👉Start active Ankle range of motion (ROM) exercises

👉Avoid painful activities.

👉Range of motion exercise: knee flexion exercise

👉Knee extension

👉Plantar flexion-dorsiflexion

👉Genital pain free calf resisted exercise

👉Gradual pain free calf stretching exercises

👉Use of ice appliance 15-20 min, after exercise

▶️Phase three-3 to 4 weeks after injury

Gentle strengthening exercises:

👉Knee flexion-extension

👉Plantar flexion- dorsiflexion

👉Gental pain-free calf stretching

👉You can also start with thera-band resisted calf exercise(pain free)

Following are the few best exercise you can start at home in pain free
manner
1-Towel calf stretch:
https://youtu.be/jaMpFVNrCRk
2-Seated heel Raises
https://youtu.be/HYYi5jYGZ70
3-Standing calf stretch
https://youtu.be/YfjeXeiREic

Special test
Thompson test
https://youtu.be/z-7cJ7LpCqY

👉Calf pain or strain stretching exercises

https://youtu.be/XibsfBav_04

👉Calf strength exercises

https://youtu.be/C7qnbmpLNGI
https://youtu.be/U4UaKKEFODc

‫ محمود طلعت البدوي‬/‫ د‬:‫🚫 إعداد‬

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