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Dr Lorenzo Masci: What is new in Treating a Calf Strain

Calf strains are a common acute soft tissue injury seen by sport doctors. Most calf strains occur in the inside of the large calf muscle called the medial gastrocnemius. We see calf muscle tears usually in middle-aged active patients in sports such as running, football and tennis. In fact, calf muscle tears are so common in tennis players that we refer to these calf injuries as ‘tennis leg’.

How do calf strains present?

Most patients report sudden pain in their calf with activity. More commonly, the pain is located on the inside of the calf. Patients may limp or have difficulty walking. Also, swelling or bruising of the calf may be present.

Assessment of the injury reveals tenderness at the inside of the calf. Swelling and bruising of the calf is often present. Patients may have problems standing on their toes because of pain and weakness in the calf.

It is important to exclude other injuries such as Achilles tendon ruptures, soleus muscle tears or bone injury.

Does your torn calf muscle need investigation?

Previously, we thought that most torn calf muscles did not require investigations. However, a new study published this week (and co-authored by me) suggests otherwise. This study examined hundreds of patients with calf strains. All patients had an ultrasound scan of the calf. Interestingly, the study found that the location of the tear influences the time to return to activity. For example, if the tear is only in the calf muscle, then the injury is short-lived. However, if the tear involves the muscle and the connective tissue or surrounding Achilles tendon, then the injury time is almost three times as long. Also, cases with bleeding in the calf muscle led to longer injury. It seems that ultrasound is useful at grading these calf strains.

How do we mange a torn calf muscle?

At the beginning, it is important to rest the calf. Compression with a bandage or sock is important to reduce further bleeding. A heel raise in a shoe will help with walking. Occasionally, in larger tears with bleeding in muscle, it may be necessary to remove the blood to help healing. This procedure of removing the blood is done with a needle under ultrasound-guidance’. Also, crutches or a walking boot may be necessary.

As pain reduces and walking becomes easier, patients start a slow and gradual exercise programme supervised by an expert such as a physiotherapist.

In summary, calf strains are a common injury in runners and other sports such as tennis. Seeing a sport doctor is important to grade the tear and rule out other injuries. A recent study shows that ultrasound helps with deciding on return to activity. These injuries are treated with exercise in most cases.

Dr Masci is a Sports and Exercise Medicine doctor with an expertise in the management of general musculoskeletal injuries including muscle injuries. An expert in MSK ultrasound with a specialisation in ultrasound-guided injections for joints and tendons, he has written 20 peer-reviewed papers. He has presented at international conferences including Arsenal football conference. Dr Masci consults at OneWelbeck. For enquiries, please contact info@sportdoctorlondon.com or visit his website www.sportdoctorlondon.com