Acute calf tears result in sharp sudden pain that onsets most commonly whilst jogging, sprinting or forcefully pushing off the toes. Sports or activities involving running are the most common setting for these types of injuries, however, many people will report their injury did not happen during a period of maximal exertion. When the force generated within the muscle exceeds the muscles capacity, tearing of the muscle fibres occurs.
Calf muscle injuries usually involve either the gastrocnemius or soleus muscle, both muscles are active during the push-off phase of running and walking. Both these muscles share the Achilles tendon, which is why the Achilles, gastrocnemius and soleus are the most common structures injured within the calf region. Tears involving the muscle belly heal faster than tendon tears because of the type of tissue and large vascular supply. As a result, recovery time and treatment can vary largely and is also impacted by the severity of the tear.
Calf tears result in bleeding within the muscle, swelling and problems pushing off the toes when walking.
There are three grades of calf tears;
Grade 1; Mild strain resulting in 0-20% tearing of the muscle fibres, 2 week recovery
Grade 2; Partial tear, 20-50% tearing of the muscle fibres, recovery over 4-6 week
Grade 3; Full thickness tear, 80% tearing of the muscle fibres, surgery with 6 month recovery
An acute calf injury is treated initially with the RICE regime; compression, ice, elevation and compression. Crutches may be required for walking with grade 2-3 tears to allow the muscle to rest and heal. As the acute symptoms settle treatment is progressed to include soft tissue massage whilst avoiding jogging, running and any stretching of the muscle or tendon. Progressive strengthening exercises are given early to increase the tensile load of the muscle or tendon tissue. This results in a strong and flexible scar tissue forming. As the strength and load tolerance increases the physiotherapist is then able to gradually increase the resistance on the calf. Once adequate strength is achieved a gradual return to running is commenced with a gradual return to sport.