Calf Strain and Muscle Spasm of the Leg

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A calf strain is an injury to the muscles of the back of the leg. Most commonly, calf strains are minor tears of some muscle fibers, but the bulk of the muscle tissue remains intact. More severe strains can cause a complete tear of the muscle and loss of function.

When to See a Doctor for Calf Strain
Verywell / Kelly Miller

Calf Strain Symptoms

Typically, individuals who sustain a calf strain notice a sudden, sharp pain in the back of the leg. The most common muscle injured when a calf strain occurs is the medial gastrocnemius. This muscle is on the inner side of the back of the leg.

The injury usually occurs just above the midpoint of the leg (between the knee and ankle). This area of the calf becomes tender and swollen when a muscle strain occurs.

An acute calf strain can be quite painful, depending on the severity of the injury. Calf strains are usually graded as follows:

  • Grade I calf strain: Mild discomfort, often minimal disability. Usually minimal or no limits to activity.
  • Grade II calf strain: Moderate discomfort with walking, and limited ability to perform activities, such as running and jumping; may have swelling and bruising associated.
  • Grade III calf strain: Severe injury that can cause the inability to walk. Often patients complain of muscle spasm, swelling, and significant bruising.

When to See a Doctor

If you have symptoms of a severe calf strain, you should be evaluated for proper treatment. Some signs of a severe calf strain include:

  • Difficulty walking
  • Pain while sitting or at rest
  • Pain at night

Causes

The calf muscles span the distance from the knee to the ankle, becoming the Achilles tendon in the lower part of the leg. The calf muscle is made of two major muscles, the two-headed gastrocnemius muscle and the soleus muscle.

A calf strain is a tearing injury to the gastrocnemius or soleus muscle—a "muscle strain." When a muscle is overstrained, the muscle fibers can tear. With less severe strains, the muscle remains intact.

Calf strains are most common in men between the ages of 30 and 50.

Diagnosis

A calf muscle strain is usually a clear diagnosis, but there are other causes of calf pain that should be considered. Other causes of calf pain include a baker's cyst, leg cramps, and blood clots.

Severe calf strains should be evaluated because, in some very rare situations of complete muscle rupture, surgery may be necessary to reattach the torn ends of the muscle. This is rarely needed, even in patients with Grade III calf strain injuries, since these patients can usually undergo successful nonoperative treatment.

If you are unsure if you have a calf strain or your symptoms do not quickly resolve, you should be seen by your doctor. As described above, other conditions can be confused with a calf strain, and these should be considered if your symptoms do not resolve promptly.

Treatment

Treatment of a calf strain is usually guided by the severity of the injury. Resting a pulled calf muscle is the key to successful treatment. As a general rule of thumb, if you have a calf strain, you can do activities that don't aggravate your injury.

You should rest until you are pain-free to allow the injured muscle to heal. Resting inadequately may prolong your recovery.

The following are the common treatments used for calf strains:

  • Rest: It is important to rest following the injury to allow the injured muscle to properly heal. Allow pain to guide your level of activity; activities that cause symptoms should be avoided.
  • Calf muscle stretching: Gentle stretching is helpful, but it should not be painful. Stretching excessively can be harmful and slow the healing process. There are some simple calf stretches that can help you along with your rehab.
  • Icing the injury: Apply ice to the injured area in the acute phase (first 48 hours after injury) and then after activities. Ice will help calm the inflammatory response by slowing blood flow to the area and decreasing swelling.
  • Heat applications: Before activities, gentle heating can help loosen the muscle. Apply a heat pack to the calf prior to stretching or exercising. As a general rule of thumb, remember to heat the area before and ice after.
  • Anti-inflammatory medications: Oral anti-inflammatory medications (such as ibuprofen, Aleve, or Motrin) can help relieve symptoms of pain and also calm the inflammation. These medications are most effective when started in the early stages immediately following the injury.
  • Physical therapy: Physical therapists can be helpful in guiding treatment that may speed your recovery. Certain modalities, such as ultrasound or therapeutic massage, may be helpful in addition to exercise-based therapy. You should work with your physical therapist to determine the treatment appropriate for your condition.

The length of time needed for healing a calf strain depends on the severity of the injury. A typical grade I calf strain will heal in seven to 10 days, a grade II injury within about four to six weeks, and a grade III calf strain within about three months.

The most common injury is a grade II calf strain, which takes about six weeks for complete healing.

Surgery is generally not necessary for a calf strain injury. Unlike an Achilles tendon rupture, calf muscle injuries do not completely separate and will heal with noninvasive treatments rather than needing surgery. An Achilles tendon rupture is more likely to need surgical treatment to achieve complete healing.

A Word From Verywell

Calf strain injuries are a common injury, especially in middle-aged athletes and weekend warriors. Symptoms of calf strain are typically severe at first but quickly settle down with proper treatment.

Complete healing of a calf muscle injury can take several months, but the vast majority of people are able to return to most activities much sooner. Sports activities often take a few months before resumption.

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  1. Bryan Dixon J. Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Curr Rev Musculoskelet Med. 2009;2(2):74-7. doi:10.1007/s12178-009-9045-8

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