Sports Medicine
Sports Injury Prevention & Rehabilitation

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Soleus Strain

(Also known as Calf Strain, Strained Calf, Calf Muscle Strain, Torn Calf, Torn Calf Muscle, Pulled Calf, Soleus Tear, Torn Soleus)
What is a calf strain?
A calf strain is a common injury to the lower leg characterized by tearing of some or all of the calf muscle.
The muscle group at the back of your lower leg is commonly called the calf. The calf comprises of two major muscles one of which originates from above the knee joint (gastrocnemius) the other of which originates from below the knee joint (soleus). Both of these calf muscles insert into the heel bone via the Achilles tendon. The soleus muscle lies deeper than the gastrocnemius.
During contraction of the calf, tension is placed through the calf muscle. When this tension is excessive due to too much repetition or high force, the calf muscle can be torn. This is known as a calf strain.
A strained calf can range from a small partial tear whereby there is minimal pain and minimal loss of function, to a complete rupture of the calf which may require surgical reconstruction.

Causes of a calf strain
A strained calf commonly occurs due to a sudden contraction of the calf muscle. This frequently occurs when a patient attempts to accelerate from a stationary position or when lunging forwards such as while playing tennis, volleyball or track. They are also commonly seen in running sports such as football and athletics.
A calf strain involving the soleus muscle may also frequently occur due to gradual wear and tear associated with overuse. This may be due to activities such as distance running, repetitive jumping or walking excessively (especially up hills or on uneven surfaces)

Signs and symptoms of a calf strain
Patients with a strained calf usually feel a sudden sharp pain or pulling sensation in the calf muscle at the time of injury. Occasionally, the patient may experience increasing stiffness in the calf muscle in the lead up to their injury.
Patients usually experience pain in the calf that may increase during activities such as walking (especially uphill or on uneven surfaces), going up and down stairs, running, jumping, hopping, or standing on tip toe (particularly with the knee bent). It is also common for patients with a strained calf to experience pain or stiffness after these activities with rest, especially upon waking in the morning. Occasionally, walking and jogging may be more painful than sprinting in patients with a calf strain involving the soleus muscle.
Swelling, tenderness and bruising are often present in the calf muscle in patients with a calf strain. When the soleus muscle is involved these symptoms often present in the outer aspect of the muscle. In more severe cases, patients may be unable to weight bear or may walk with a limp.

Diagnosis of a calf strain
A thorough subjective and objective examination from a physical therapist is usually sufficient to diagnose a calf strain. Further investigations such as an MRI scan or Ultrasound may be required, in rare cases, to confirm diagnosis.

Treatment for a calf strain
Most patients with a calf strain heal well with appropriate physical therapy. The success rate of treatment is largely dictated by patient compliance. One of the key components of treatment is that the patient rests sufficiently from any activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the condition becoming chronic. Immediate, appropriate treatment in patients with a calf strain is essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times.
Diligently following RICE in the initial phase of injury (first 72 hours) will greatly assist in improving recovery time. This involves rest from aggravating activities, regular icing, the use of a compression bandage, and keeping the lower leg elevated. Anti-inflammatory medication may also help to reduce the inflammation, pain and swelling associated with a strained calf. The use of crutches or a heel raise when walking may be necessary to protect the calf muscle from further damage and to hasten healing.
A graduated flexibility and strength program guided by a physical therapist is essential to recondition the calf muscle and reduce the likelihood of injury recurrence. Careful assessment by the physiotherapist to determine which factors have contributed to the development of the injury, with subsequent correction of these factors is also important to ensure an optimal outcome. Occasionally, a review with a podiatrist may also be indicated for the prescription of orthotics to address any issues associated with foot posture.
For those patients who wish to return to running, a graduated return to running program is essential in the final stages of rehabilitation to recondition the calf muscle for running in a safe and effective manner.

Prognosis of a calf strain

With appropriate management, patients with a minor calf strain can usually recover in one to three weeks. With a more severe calf strain, recovery may take four to six weeks or longer depending on the severity. In cases of a complete rupture of the calf muscle surgery may be required with intensive rehabilitation to follow. Return to sport or activity may then take 6 months or longer.

Contributing factors to the development of a calf strain

There are several factors which can predispose patients to developing a calf strain. These need to be assessed and corrected with direction from a physical therapist. Some of these factors include:
  • poor calf flexibility
  • inappropriate training
  • poor biomechanics
  • poor foot posture (especially flat feet)
  • inadequate warm up
  • ankle joint stiffness
  • calf weakness
  • inadequate rehabilitation following a previous calf injury

Physical therapy for a calf strain
Physical therapy for patients with a calf strain is vital to hasten the healing process, reduce the likelihood of recurrence and ensure an optimal outcome. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • anti-inflammatory advice
  • stretches
  • joint mobilization
  • dry needling
  • ice or heat treatment
  • exercises to improve strength, flexibility or balance
  • education about a calf strain
  • activity modification advice
  • biomechanical correction
  • the use of a compression bandage
  • prescription of orthotics
  • footwear advice
  • establishing an appropriate return to activity or sport plan

Other intervention for a calf strain
In the event of a complete rupture of the calf muscle surgery if often indicated. It is vital that all patients with a potential calf muscle complete rupture seek physical therapy or medical assessment as soon as possible to determine if the muscle is completely ruptured. This is vital as delayed treatment may result in a poor outcome due to shortening of the torn calf muscle. The patient's doctor or physical therapist may then refer on to an orthopedic specialist if it is warranted clinically.
Surgical repair of the ruptured calf muscle is generally considered the most appropriate form of management for active individuals seeking the highest level of function. This often involves a period of immobilization in a plaster cast for one to two months following calf surgery and a rehabilitation period of three to six months involving extensive physical therapy.
Conservative management of a ruptured calf muscle may be appropriate for older individuals. This involves immobilizing the calf in a shortened position in a cast for approximately four weeks. The calf is then gradually stretched and strengthened over time.