Calf Strains 101: Recovery, Prevention, and Getting Back on Your Feet
Calves - the second problem child of the running community (glutes being the first). If not strained, torn, or injured - they are likely tight, weak, and tight. And let me tell you, anything that is both tight AND weak is prone to injury, especially if it is also overworked. Let’s review the anatomy of the calves.
The muscles of the calf area make up the posterior compartment of the lower leg (fun fact, you have 4 compartments - anterior, posterior, lateral, and medial). And, to further complicate things, the posterior compartment has a deep and a superficial layer. The organization looks like this:
Deep musculature:
Popliteus
Flexor digitorum longus
Flexor hallucis longus
Posterior tibialis
Superficial musculature
Gastrocnemius
Soleus
Plantaris
When we experience a calf strain, we are mainly referring to the superficial layer of muscles, and more specifically the gastrocnemius and possibly the soleus. These two muscles are the primary plantarflexors of the foot - AND - the gastrocnemius provides some movement and stabilization at the knee joint through its attachment at the distal femur. Plantarflexion refers to the motion at the ankle, where you move the toes downward - or - away from your shin (i.e. when you press on a gas pedal, or lift up onto the ball of your foot). This happens A TON while running, especially uphill or while sprinting. These muscles tend to be much more dominant while forefoot striking; therefore, even if you are running flat and slow distances, you could be experiencing tightness and sore calf muscles from always striking on the forefoot.
During the gait cycle, your gastrocnemius and soleus muscles experience the greatest amount of stretch in mid-terminal stance - when you are about to enter the push off phase and accelerate your leg/foot forward. In this moment, your ankle requires around 10-15 degrees of dorsiflexion (opposite of plantarflexion) while your knee is in near extension (straight). So - if the knee is straight and the foot is bent upwards while on the ground, your calf muscles will be experiencing a stretch RRIIIGGHHHTTT before they are asked to generate a high amount of force for forward propulsion. Typically, this is a good thing and speaks to the elastic/spring mechanism of force generation in muscles and tendons. However, injuries typically arise from too much of a good thing - let me explain.
How Does A Calf Strain Happen?
If I have not said this already, strains and/or tears in muscle tissue typically occur when a muscle is in an elongated state (i.e. stretched) for either too long or if it is asked to generate power during an eccentric contraction (lengthening). Small micro tears happen with acceleration, stretching, and deceleration; however, pain and swelling are more noticeable when enough fibers are strained/torn together. Let me provide some examples.
Playing the guitar requires tightening of strings to create specific musical tones. A string that is too loose will vibrate at a frequency that is flat, off-tone, and downright awful. A string that is pulled just right plays a perfect pitch with the strumb of your fingers. BUT - if you tighten and stretch that string too far and you apply force with your thumb- SNAP - the string breaks. Now, your song “B Flat”.
Take a roll of pizza dough on your fists and spin it up in the air. Twirl after twirl, the pizza dough expands while maintaining a beautifully even circular form. BUT - twirl that baby for too long, and all of a sudden the middle falls thin, wraps itself around your arms like a cocoon, and you are left with a sticky dough mess that is anything BUT a beautiful circle. It has not torn - although it definitely can - but it has gone limp and is hard to mold. Shoot. Looks like you “knead” lessons in pizza twirling.
Finally, let’s take this back to your calves. While running (or walking), your calves are going through an eccentric contraction as your ankle moves into dorsiflexion in the stance phase, but your foot is flat on the ground. At this time, the muscles are getting longer, but also working to stabilize the ankle against the ground forces acting against it. THEN -your ankle moves into plantarflexion with help from the calf muscles, so that your hip and knee can drive forward through the swing phase. In this super brief moment, the gastrocnemius is also helping stabilize the knee joint in stance phase - while again - stretched at this attachment. So, as the gastrocnemius is stretched to its limits and you quickly apply a force to slow down dorsiflexion (and simultaneously start push off), the calf muscles are torn or strained.
How Does a Calf Strain Feel?
This injury bears no crackles, but it can surely “snap” and “pop” as the fibers are strained and/or torn. Initially, the pain can either be sharp and severe, or sudden yet mild depending on the severity of the injury. Mild cases will experience minimal pain and still allow normal walking patterns and some swelling. Moderate to severe strains and/or tears will of course be more painful. It will hurt to walk and maybe even cause a limp. The swelling will commence either later the same day or starting the following day, and this swelling can occur at the site of the injury as well as into the knee joint or into the ankle depending on exactly where the fibers have been injured. You may notice bruising for moderate to severe cases as well. Here is a handy dandy chart:
What Activities are Safe with a Calf Strain?
Or should I say - what “calf” you do?
Ankle and knee range of motion are important to maintain especially if you are experiencing swelling in the surrounding areas. Things like bending and straightening your knee or rolling your ankle in circles can help with this. You can also spend time on all of those super fun glute exercises we are told are important for us and never do. I’m talking clamshells, bridges, squats, lunges - make sure those bad boys can still fire (or activate, whatever your PT said). Physical activity that is considered safe includes aqua jogging, swimming, walking (if not painful and you are not limping), and biking. Again, consult a healthcare provider before you start any physical activity especially if you continue to experience pain and swelling. Returning to sport too fast or too soon can cause worsening issue OR other injuries due to compensations.
How Long Does It Take for a Calf Strain to Heal?
Thanks to the lovely chart provided above, I suppose you already know how long it will take to recover from the injury. Unfortunately, because of the swelling and inflammation you can expect it to take more than just a few days. The initial inflammatory process lasts for a minimum of 3 days, so you will likely still have some pain and swelling during this time. Then, it is time for your cells to start proliferating and making new tissue. Again, the more something is damaged then the more it needs to be “rebuilt” and healed. That doesn’t always mean you have to be away from physical activity for the entire time, but activity modification is important as you focus on range of motion, strength, and balance.
REFERENCES
https://www.physio-pedia.com/Calf_Strain
https://www.sciencedirect.com/topics/engineering/inflammatory-phase#:~:text=1.1%20Inflammatory%20phase,clot%20and%20damaged%20host%20cells.