Calf Muscle Tear

In this article you will find out about all the common causes of a calf muscle tear and the most effective ways to treat the injury and prevent it from returning.

Calf injuries frequently involve the muscles like Soleus, Popliteal, Gastrocnemius, and Plantaris. It is a common injury involving a partial or complete tear in any of the muscles that can lead to sudden pain, Gastrocnemius muscle rupture and Soleus muscle sprains are associated with a significant amount of pain and swelling. In addition, since it involves the posterior calf, it may also lead to significant limping. Therefore, it is important to diagnose and differentiate calf muscle tear from other injuries affecting the lower leg. In addition, effective diagnosis of the back of the lower leg allows for the early management of scar tissue and quicker recovery of the pulled calf muscle.

Amongst all the muscles found in the posterior portion of the lower limb, Gastrocnemius is the bulkiest muscle of all. It also has two heads, which are known as the lateral and medial heads. These heads take origin from the two condyles of the femur. Few ligaments and fibers originate from the knee joint capsule to provide additional support. While it originated from the femur, it inserts into the Calcaneus bone, along the Soleus muscle. The tendon that connects both the Soleus and Gastrocnemius muscles is the Achilles tendon. The combination of these two muscles is also referred to as the Triceps Surae.

The gastrocnemius muscle is considered the primary flexor of the ankles and is supplied by the tibial nerve and posterior tibial artery. (1) This allows it to also play a role in the propelling force when an individual walks and prevents them from falling. (2)

Anatomy of Calf Muscles

The major muscle of the calf is the Gastrocnemius muscle and is considered the primary power generator for walking, running, or jumping movements. To uses both fast and slow muscle fibers to achieve this. The Soleus is another muscle that lies under the Gastrocnemius muscle. However, unlike the Gastrocnemius muscle, Soleus mainly consists of slow twitching muscle fibers. These slow twitch muscle fibers allow strength, endurance, and plantar flexion movements to be maintained over longer periods of time. Another muscle that is found between the two heads of the Gastrocnemius muscle is the Plantaris muscle. Even though this muscle does not play any essential functional role in the lower limb, it does assist in knee flexion and plantar flexion. (3) (4)

What Causes a Calf Muscle Tear?

A sudden unbalanced force can cause calf muscle tears on the calf that may either be associated with jumping or a rapid push-off. These movements cause a change in the position of the ankles from a plantarflexed position to a dorsiflexed position. Calf muscle tears are commonly seen in tennis players due to the sudden movement changes they have to undergo. When this mechanism occurs in tennis players, it is known as the Tennis leg, which is associated with a medial gastrocnemius muscle injury. (5)

Symptoms

Individuals who have a calf muscle tear often report a history of a calf injury after they undergo a sudden jumping or sprinting movement. The symptoms associated with this injury include a sudden tearing sensation, which a pop sound may accompany. There is also a sharp, sudden pain in the calf region, making it difficult to put any load on the affected leg. Patients often report improvement in symptoms on walking on toes while an increase in pain and cramping on passive dorsiflexion or active plantar flexion. (6)

How is Calf Muscle Tear Diagnosed?

The diagnosis of Calf Muscle tear initially involves history and examination of the affected site. The lower limb presents with swelling, signs of redness, and ecchymosis. On physical examination, the affected muscle is usually highly tender. The doctor may palpate the rupture of the muscle, and when the patient is asked to do a calf raise, they often present with difficulty. Some orthopaedic experts or sports medicine doctors may also conduct a Thompson squeeze test, which is conducted to test the Achilles tendon rupture. In calf muscle tear, this test is negative, with a normal plantar flexion.

Imaging studies like MRI may be conducted to assess the soft tissue injury and further confirm the diagnosis of Gastrocnemius injury; however, it is often not required. The severity of the injury and monitoring of the recovery over time may be evaluated by ultrasound. The ultrasound may help the doctor assess the muscle fiber disruptions or any fluid accumulations in the affected area. (7)

Treatment

The healthcare provider most commonly recommends the RICE method for allowing the healing of the torn calf muscle. RICE stands for:

•     Rest: Rest from any physical activity allows for the healing of calf muscle tear and prevents further injury or exacerbation of calf pain. This is why the orthopedic expert may recommend the patient to wear special boots or crutches for a few days to allow proper healing.
•     Ice: Ice helps prevent swelling in the affected calf. Icing should be done using an ice pack or a cold compress which can be applied to calf muscles every two hours for 20 minutes.
•     Compression: Compression of the lower limb allows a reduction in the blood flow to the injured area and lowers the chances of swelling and muscle pain. Compression may be achieved by using a compression wrap or a sleeve up to the calf.
•     Elevation: The affected leg must be lifted above the heart level to improve the swelling. This can be done by using pillows, blankets, or cushions as support to lift up the entire leg. (8)

Moreover, certain precautions that need to be taken during the healing period until they have been allowed by the healthcare provider themselves include:

•     Not to apply any heat to the affected area
•     Putting weight or any pressure on the calf
•     Performing any physical activity like walking, running, or jumping

Physical Therapy

After practicing RICE therapy for a few weeks, the doctor may recommend physiotherapy. Under the guidance of a good physiotherapist, physiotherapy can help the individual regain the strength and functionality of their calf muscles. It can allow the individual to heal from calf muscle strains and prevent re-injury or further injury to the lower limb. Some doctors may also recommend the use of over-the-counter pain killers like ibuprofen to allow a pain-free healing process. The physiotherapist may not only ask the individual to undergo stretching exercises, particularly targeting their injured leg. It is important to follow the physiotherapist’s guidance and prevent any weight-bearing activities or exercises that may overstretch the muscles.

Calf Muscle Tear Surgery

Individuals with severe pain associated with calf muscle injuries, which is not resolved with RICE and physiotherapy, may require surgery. Individuals who are particularly considered fit for surgery are those who are athletes belonging to younger age groups and want to return to high-impact physical activities as soon as possible. Hence, it may not be recommended for middle ages individuals with calf pain. These individuals often have a complete calf muscle tear, which is associated with swelling and internal bleeding. (9)

Complications OF Calf Muscle Tears

Even though complications with Torn calf muscles are rare, they may include compartment syndrome, superficial thrombophlebitis, and deep vein thrombosis. While compartment syndrome is associated with severe swelling, deep vein thrombosis (dvt) and superficial thrombophlebitis involve the formation of a blood clot. (10)

Prevention

Calf Muscle tear can be a highly painful condition for individuals, particularly belonging to the older age groups, due to a deterioration in their healing abilities. However, the incidence of these injuries may be prevented by:

•     Taking rest in between physical activities – particularly if they are highly strenuous. This may apply to sports, games, and everyday fitness workouts.
•     Undergoing regular strengthening exercises to keep the calf muscles strong
•     Following proper instruction from the expert, whether it is while playing sports or undergoing exercises in the gym
•     Warming up the calf muscle before physical activity
•     Using supportive footwear, particularly while playing sports.

Frequently Asked Questions

What happens if your calf muscle pops?

A popping sound may be heard when the calf muscle known as Gastrocnemius is strained or pulled. After this, the individual finds difficulty in standing on the affected foot and experiences sudden sharp pain. Moreover, if the strain is severe, they may also experience bruising.

Can you walk with a torn calf?

Calf muscle tears may be complete or incompletes and are a source of pain and inactivity. Individuals with torn calf muscles experience swelling and pain in their lower leg, which keeps them from walking without aid. This is because activities like walking can lead to stress on the affected area, which causes significant pain to the individual.

What is the difference between a calf strain and a tear?

Usually, calf muscle strains are described as a feeling of tightening and weakness in the calf area. On palpation, the area is also tender. On the other hand, calf muscle tears are associated with sudden pain and a popping or tearing sensation. While the tears may be complete or partial, they are also associated with swelling and a limited range of motion.

References

1.   Park, K. B., Joo, S. Y., Park, H., Rhee, I., Shin, J. K., Abdel-Baki, S. W., & Kim, H. W. (2019). The architecture of the Triceps Surae Muscles Complex in Patients with Spastic Hemiplegia: Implication for the Limited Utility of the Silfverskiöld Test. Journal of clinical medicine, 8(12), 2096. https://doi.org/10.3390/jcm8122096
2.   Rodrigues, V., Rao, M. K., & Nayak, S. (2016). Multiple Heads of Gastrocnemius with Bipennate Fiber Arrangement- A Clinically Significant Variation. Journal of clinical and diagnostic research : JCDR, 10(8), AD01–AD2. https://doi.org/10.7860/JCDR/2016/20094.8340
3.   Gallo, R. A., Plakke, M., & Silvis, M. L. (2012). Common leg injuries of long-distance runners: anatomical and biomechanical approach. Sports health, 4(6), 485–495. https://doi.org/10.1177/1941738112445871
4.   Campbell J. T. (2009). Posterior calf injury. Foot and ankle clinics, 14(4), 761–771. https://doi.org/10.1016/j.fcl.2009.07.005
5.   Millar A. P. (1979). Strains of the posterior calf musculature (“tennis leg”). The American journal of sports medicine, 7(3), 172–174. https://doi.org/10.1177/036354657900700306
6.   Delgado, G. J., Chung, C. B., Lektrakul, N., Azocar, P., Botte, M. J., Coria, D., Bosch, E., & Resnick, D. (2002). Tennis leg: clinical US study of 141 patients and anatomic investigation of four cadavers with MR imaging and US. Radiology, 224(1), 112–119. https://doi.org/10.1148/radiol.2241011067
7.   Kwak, H. S., Lee, K. B., & Han, Y. M. (2006). Ruptures of the medial head of the Gastrocnemius (“tennis leg”): clinical outcome and compression effect. Clinical imaging, 30(1), 48–53. https://doi.org/10.1016/j.clinimag.2005.07.004
8.   van den Bekerom MP, Struijs PA, Blankevoort L, Welling L, van Dijk CN, Kerkhoffs GM. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? J Athl Train. 2012 Jul-Aug;47(4):435-43. doi: 10.4085/1062-6050-47.4.14. PMID: 22889660; PMCID: PMC3396304.
9.   Cheng Y, Yang HL, Sun ZY, Ni L, Zhang HT. Surgical treatment of gastrocnemius muscle ruptures. Orthop Surg. 2012 Nov;4(4):253-7. doi: 10.1111/os.12008. PMID: 23109311; PMCID: PMC6583476.
10.   Coffey R, Khan YS. Gastrocnemius Rupture. [Updated 2022 May 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560869/