Bodyworks: Calf Muscle Tear

How to recognise it, how to overcome it


Posted: 5 June 2000
by Patrick Milroy

Symptoms
Unlike compartment syndromes, this injury hits you with sudden pain, like a kick in the back of the calf. Trying to rise on tiptoe, let alone walk normally, hurts.

Signs
The doctor will certainly find a tender area in the calf, often with a change in density due to the burst blood vessels and formation of a bruise which may sometimes become visible.

Medical investigations
These are usually unnecessary, unless the tear is particularly slow to heal.

What else could it be?
There is a long list of possible alternatives, including: stress fractures, muscle pulls and tears, tibial periostitis, nerve and artery entrapment and blockage, referred pain from a lumbar disc, infections, tumours, and pronation syndromes of the foot.

Self-treatment
RICE, periodically, for the first 48 hours at least. Later, gradual stretching and strengthening, as with any other muscle injury.

Medical treatment
Ultrasound and, in the convalescent stage, massage by a physiotherapist, should restore full, painless movement. The tear should not be surgically drained. Since there is a chance that the damage to the calf could involve myositis ossificans (a formation of bone within a large bruise), treatment should never be over-enthusiastic.

Can you run through it?/Recovery time
One to four weeks, depending on the severity of the tear. The risks of worsening the injury are far greater than any benefit you might obtain from running through it.


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My training for a marathon in Sept. was going great until recently. While running in a 1/2 marathon at the beginning of May at about the 10 mile mark I started to get a really sharp pain in the lower area of my right calf.
Tried resting it for a week and then gave it another few days of gentle stretching and then tried a very gentle jog which seemed to be going ok until about a mile when this pain returned.
Grateful for any advice
Cheers
Posted: 06/06/2003 at 06:13

Sounds like a tear to the gastroc' muscle.

This a general rule of thumb for a medium sized tear.

Day 1-3 Rest and ice,

Day 3-10 Start to do gentle stretches and hold the stretches for 7 minutes for each muscle group 3 times a day! Build the stretches in intensity over the 10 days. you can also start to break down the scar tissue in this period with ultra sound and/or massage. During these 10 days you can start to excercise again but with no weight bearing activity, including cycling. Basicaly only swimming and then don't push off too hard on the turns.

Day 10-18. Do a bit of cycling or get on the cross trainer to start to strengthen the muscle. You must keep the stretching or the muscle will heal less flexible.

Day 18-42 Start to run again but build up your distance and intensity over this period.

It takes 21 days for muscle tissue to reform and a further 21 to strengthen. The scar tissue is not as flexible as the original tissue and is therefore more likely to tear again.

Good luck
Posted: 06/06/2003 at 09:08

The calf will feel fine after a week and you'll be tempted to run again, as you've already found out, DON'T.
Follow the above advice and you should be ok. The above will have you running again in 6 weeks. You must be patient with muscles tears or 6 weeks could turn into 6 months.
Posted: 06/06/2003 at 09:21

Pizza man

Thanks very much for the advice-the way things are going it looks as though you are spot on.(going to a sports injury clinic in the morning I'll let you know what s(he)says) If indeed you are right then its going to be at least another 4-5 weeks before I'm running again - whats the chances of a decent run in the Loch Ness marathon (Sept 28th.)
Once again thanks very much for your time and advice - much appreciated.
Martin
Posted: 08/06/2003 at 19:51

Pizza man
Just back from the clinic and as I said before it looks as tho. your diagnosis was spot on. However he was a little perplexed as to why it would happen so long into a race so he decided to delve a bit deeper and found that my spine is out of line - which drags the right side of my body up which in turn shortens my right leg (maybe I should take up cticket) and places a lot of stress on the lower part of that leg. Fortunately as I'm only 5'6" he will manage to realign the spine and bring my right leg back to it's full length I was worried that he would shorten the left leg which would have made me look like Latrouse Lautrec.
Anyway many thanks for your help it really is much appreciated
Posted: 09/06/2003 at 14:17

It's good to know why it tore.

Sounds like you did the right thing by going to a Sports Injury Clinic and not the Physio. They tend to look a bit deeper into the causes and rehab' as well as treating the acute injury.

Best of luck with the cricket~
Posted: 09/06/2003 at 15:29

I hope that I am not experiencing the same thing. I am training for the Lochness marathon as well and have felt a pain in my lower for the last two evening's runs. I will rest it and see how it goes.

I am getting into my training schedule and do no twant to stop doing the runs.

Thanks for your advice and i'm going to think positive because the pain seems to go totally the next day.

Posted: 13/06/2003 at 16:26

Jane, it could well be you are getting a warning. Have a couple of days total rest and then resume your training on a x-tainer for a week. This should give your calves a chnce to recover.
A rest will probably do you good and you'll feel rested and rearing to go after 10 days off running. If you just transfer the sessions you would have run to the x-trainer you'll not looses any fitness.
Posted: 13/06/2003 at 22:16

Jane,

Hope you are feeling o.k. Take it easy there is still plenty of time.
I've not started running yet but I have spent the time carbo loading (pints and pints of Guinness) I know its a wee bit early but I was feeling a wee bit down.
Got my work cut out getting ready for Loch Ness but 'Hey we all we need a challenge in our lives'
Take care, hope you have a great Loch Ness experince, and by the way take notice of Pizza Man he seems to know what he's talking about.

Posted: 15/06/2003 at 20:45

Pizza man

Thanks for the advice. I have taken a few days off and I am feeling much better with no pain. I thought I would try a short 3 or 4 miles on Tuesday and see how I get on. The hardest part is being patient and resisting the urge to run.

Leg's O' Jelly

I hope you are feeling better and I'm sure that the Guinness has helped. I hope you have a good Lochness and perhaps I'll see you there.
Posted: 16/06/2003 at 10:20

Jane, glad to see you're feeling ok. Be carefull and listen to your body. take an extra rest day when you feel like it. Rest is a major factor in training as this when the body converts the training into fitness.
Posted: 16/06/2003 at 10:25

Interesting to see that you have similar problems to me. I was going very well as we gradually increased out mileage on sunday mornings from beginning of Jan towards London. The on one day at about 15 miles my calf just tightened up and i couldnt run any further. Interestingly i had run off road in different shoes for the first time the day before. That was mid april and i am still suffering. Thought all was ok and ran in the St Albans half and at 9 miles it went again. I suppose i must be patient and rest properly, but i am generally impatient and do too much too quickly.
Hope you get to Loch Ness
Posted: 06/07/2003 at 20:11

I wish I'd read this thread a week ago! Was about 10 minutes into a run, exactly a week ago, when for no apparent reason a pain came on in my lower left calf. Ignored it for a 20-30 yards but it was becoming more insistant/painful so I stopped but continued to walk/limp home. When I got home I massaged it and applied Deep Heat (what not to do!!!) Within a day I was walking without pain and a few days later it felt good as new. I could feel a definate bruise at the bottom of my calf. Being reasonably cautious I decided to give it a full week.
Have just been out for a run and took it very gently... I was within sight of the end just thinking how well it had gone when it came on again exactly as before... this time I stopped immediately and limped home.
I immediately referred to this forum and have applied ice. I might go to the local sports injuries clinic on Wednesday but this thread exactly describes the symptoms.
Possible reasons:
1) I've only just got back into running and bought some good shoes (New Bal 855s) which I've found to be very good from a cushioning/support viewpoint BUT after a long weekend away when I wore them continually (limited luggage) I found that they seem to have bruised my achilles tendon. So perhaps the pressure on my tendon is stretching the calf muscle?
2. Also I'm pretty heavy... have just lost 2 stone but am still 16.5 stones. Maybe I ought to continue my weight loss and postpone the running (cycle instead?) until I'm another stone lighter?
--
Cheers
Mark

Posted: 08/09/2003 at 15:25

And I wish I'd seen this thread weeks ago too! I have exactly the same symptoms, although my physio has not mentioned a muscle tear, more a strain I think...I hope that means that it's not as bad as I have the Great North Run on Sunday... I'm not sure whether I should just go for it or cut my losses?

Cheers, Anne
Posted: 15/09/2003 at 12:38

I had to pull out of todays 10k in Edinburgh soem exactly this injury. Had managed to get up to 9.5 miles on treadmill and good 8.5 miles outside where I live.

Took the week easy with a 5 miler on Tuesday and thought I would put in 3 miles on Friday night.

1.5 miles in and it felt as if I'd been shot in the calf. Went to doc yesterday who said Achilles ok but gastroc muscle possible torn.

I cannot believe this is going to take up to 6 weeks. I've just got my weight inc ontrol, got some good tone and started to really look forward to my runs.

Absolute bummer. I will tho go and try to find a sports clinic in Edinburgh and get a proper assessment.

I think it has something to do with me destroying lateral and cruciate about 3 years ago. Id didn't get surgery but managed so far without it. Maybe this is causing issues with right leg as I also get blisters on that foot only.

Still having watched GNR I will not let this stop me.

Tony
Posted: 21/09/2003 at 12:53

Wish I had read this before! Had this same injury in my right leg, rested and then got it in my left leg.

I went to see a sports therapist who told me it is because of pronation and that I should give up running altogether. I don't run very much, just started 3 years ago and do about half an hour 3 times a week. He said if I have to run then I need to go and see a podiatrist and get orthotics. I've always had my shoes fitted by a specialist in the past so was surprised.

All seems a bit depressing - I'm only 27! I do lots of other exercise: swimming, cycling, yoga, gym, but the running has been a real confidence-builder and I don't want to give it up.

I just wonder if the guy I saw was perhaps exaggerating, some people swear by core training and won't do any cardio activity?

Any thoughts from anyone?
Posted: 22/09/2003 at 14:26

having just recovered from achilles/calf problems in my right leg which took a course of physio and ultra sound over about 2 months, I was very dissapointed to get problems with the left leg.

The other posts on this thread sound very familiar, mine felt sore after a slow 4 mile training run but then went big time at 3 miles, half way up a steep hill on the Mersea Island 5 miler the other week. I thought someone had kicked a rock into my calf. I have been icing it daily and have been to see a physio who administered deep tissue massage to both calfs and achilles. This was possibly the most painful thing I have ever been through, but I felt a lot better afterwards.

As part of the physio session he asked me about stretching and I had to confess that I was not very strict about it. He told me that we should all be stretching every day, even if we don't exercise. My calfs are very tight and I wasn't able to get anywhere near the first stretch he showed me. I have to continue with the on I could do using a belt and see him in a couple of weeks when he gets back from hols.

He also noticed that I was slightly lopsided and he found that the muscle in my bum cheek (don't know the technical term) was vitually seized up. his may be due to carrying a heavy brief case on a shoulder strap on that side. Anyway that resulted in more excritiaing muscle mashing where he used his elbow to get deep into the muscle.

I'm hoping this guy is good, he was recomended by our club physio and went to Paris with the England team rec.

On Sunday I entered the Ingatestone 5 mile race although the area at the top of the achilles was still qite tender. I took it very gently, especially on the hills and found that the achilles pain dissapeared at about 3 miles but the pain returned higher up where it tore before. Still I managed to finish and although it hurts today, the achilles still feels ok and it's just the muscle that hurts. This is similar to the recovery I went through with the right leg so I'm hopeful that if I keep up the physio and stretching I will eventually be ok.

Hozza, I'd go and see a podiatrist if I were you, orthotics can work wonders. I have a pair prescribed when I started suffering from shin splints which I wear in a pair a motion control shoes.

cheers

colin
Posted: 22/09/2003 at 15:01

Jenks, thanks for the advice.

Second you on deep tissue massage, excruciating. Also got given some good stretching exercises to do.

Apparently it is really important to build up the muscles in your bum (that's your gluts) and your inner thighs, areas which you don't tend to work on typically. I'm told that building strength there can help to protect from injury in legs and back. Injuries are rarely caused in the place where the symptom ie the pain occurs.

Well done for finishing, hope you continue to recover.
Posted: 22/09/2003 at 15:11

jenks, did you get a "deep massage" on the achillies?
Posted: 22/09/2003 at 21:15

Pizza Man, I think I did, he certainly started his 'rubbing' from the back of my heal. There was a lump at the point where the top of the achilles meets the muscle and he spent a bit of time on that and it did reduce in size. I wouldn't say he 'went in deep' with the achilles though.

Worryingly he said he didn't go as deep as he could on this first session.....Next time I think i'll ask for an anesthetic or take some ibuprophen at least. Just take a deap breath Colin, and breath out slowly. Dificult to do, i'd barely get the breath in before I exhaled in about 2 nano seconds.

Mmm I'm really looking forward to the next session now...

Cheers

jenks
Posted: 23/09/2003 at 10:59

have a warm bath before you go. It'll warm and relax the muscles nicley.
Posted: 23/09/2003 at 12:44

I wish I could PM but I will be going straight from work. Mind you there is a pub across the road so maybe 11 pints would have a relaxing effect too...
Posted: 23/09/2003 at 16:56

Hi All

I went to see specialist in Edinburgh Monday and surprise surprise I have a course of deep massage and ultasound to face. Gastroc muscle is damaged but not severely. He says issue is that most people wait too long before seeing specialist and scar tissue forms which then leads to reoccurance of injury.

Good news is that he thinks if I stop running for about a week and go thru this course I should be fine.

Bit worried tho that he didn't seem to really come back on the cause of this.

Still, time to grit teeth, go thru this and get running again.

Finally he did tell me to order insteps from Trimilin and to wear them for about 3 months in work shoes and trainers.

Will get back when I have been thru first massage tomorrow.

Cheers
Posted: 24/09/2003 at 15:22

The usual reason for a torn gastroc' is inflexable muscle tissue. You need to realy streeeeeeetch both sets of calf muscles on both legs, maybe 6/7 times a day with 3 sets of 30 secs on each muscle. It's time consuming but it'll lenghthen the muscle.

Whilst you're going through a period of intense stretching your muscles will become prone to injury for a short while as the stretching will have to break them down to lengthen them. So maybe use this period to cross train. It takes about 3 weeks of continous stretching to lengthen the muscles.

As for running within a week of a trauma .... be careful!

There are other reasons for the gastroc' to tear.
Incorrect foot-wear.
Terrain.
Blood supply.
Overuse.
Muscle imbalance.
Biomechanics.

Good luck Tony

Posted: 24/09/2003 at 17:55

PM, What stretches do you recommend for someone loke myself with rock hard oversized calfs and having difficulty getting my foot very far beyond beyond 90 degrees.

Ta

jenks
Posted: 25/09/2003 at 11:50

PM, i tore my laft calf during the GNR and I'm intrigued with your suggestion re incorrect footware. I've recently bought a pair of adidas Supernova's and never having experienced calf problems previously, I suffered in my right calf 2 weeks before the GNR and now a complete tear.

Coincidence or just bad luck, any suggestions?


Posted: 29/09/2003 at 20:45

Hi PM

I'm experiencing some problems with my calf its been along on going problem, I sometimes get a tingling feeling in my calf and then it cramps up. Then I after walk or limp back home it then takes ages o get back into running again and after build up slowly. I'm now in a period of building up slowly again up to 20min running 3 x week and stretching after.

I live in Vietnam and things are a little hot over here some a lose alot of fluid when I run. Could dehydradtion contribute to problem? What are the best exercises and stretching to do while building up? I had the tingly cramp things about 3 weeks ago?

Rocket
Posted: 30/09/2003 at 08:26

Hi All

Update as promised. I went to get massage and ultrasound. Massage wasn't too painful and seemed to do the trick.

Physio said coming along nicely and to try 20 min runs over weekend.

So Friday morning did 20 mins. Felt like crap but leg ok. Sunday did 2.8 m and followed up with 5 miler tonight in gym.

So far so good. Lots of calf stretching now in routine. Funny thing though in trying to avoid road on Sunday I stepped up to get on grass and went over on left ankle !!! DOH !!!

Next massage session later this week.

Thanks for help and advice. My feedback to anyone with this is GO SEE A SPECIALIST.

You wouldn't try to fix a Ferrari yourself so why do it with your body !!

Good luck all.
Posted: 30/09/2003 at 22:02

Calf muscle injury - help! Out for a gentle run one evening 2 weeks ago when I got this sharp pain in lower left calf - limped home. Iced it then tried again a week later - the pain came on again even though I thought it had gone away during the week. Went to a physio who did the interferential/ultrasound bit with deep massage. She says it is not a bad tear and could be ready in 21 days. Problem is, I am due to run the FLM on 18 April. Does anyone think this is now feasible? Should add that whilst I have a few marathons under my belt from recent years my training started late this time and I had only got up to about 12 miles. I'd be happy to amble round the FLM slowly but is this doable?
Posted: 23/02/2004 at 12:30

I'm doing the FLM as well and injured my calf today. Seeing specialist on Friday. Hoping I will be OK for the 18th, even if I have to rest for next3 weeks. Shame as my training was going so well and my lastlong run was too be this weekend. I'll be gutted if all my chasing for sponsorship is wasted.
Posted: 24/03/2004 at 22:28

Hi all,
I also have a calf injury.It started about 7 miles into last sundays long run of 22 miles,however I kept going even though I know I should have stopped.
The problem is in my left calf,the outer part of the calf is very tender to touch, but doesn't hurt when I walk,I also have soreness at the top of the calf just below the knee which is okay when I'm walking but if walking up/down stairs is painful.

I have been to sports injury/Massage and was told that the area at the top of the calf was "a bit crunchy" (what on earth does that mean?)but nothing to worry about and that I had just overloaded the muscle on the long run.I haven't run since Sunday thought the rest would help and have done some stretching but the problem still seems to be there.I will be tapering from Sunday.

I'm doing the FLM and am definatley worried in case the problem doesn't heal,like so many of you I have put in alot of time and effort with my training and would be totaly gutted if I had too pull out.

Any advise would be appreciated.
Posted: 25/03/2004 at 07:49

Cybill, my calf isn't as bad as I thought. It is a strain rather than tear. Your symptoms seem the same as mine and I have been told to have 2 more tratments this week with plenty of Ice / heat and gentle stretching. In a week should be able to do some cycling / xtraining and in 2 weeks should be able to run. Which leaves 1 week before London. I'm hoping to be OK and think you should be as well, but it may be best to leave any running for at least a week, rather than it flare up again. If you have done enough training, you won't loose that much fitness.
Posted: 27/03/2004 at 19:52

Hi Nick,
I ran (9.2 miles) for the 1st time in a week yesterday after deciding the rest would help the calf.I had no problems with the top of the calf behind the knee, however I found that the lower inner area of the calf became very tight.
After plenty of stretching a hot bath and gentle massage the tightness isn't so bad this morning,gonna go to the gym tonight and go on the bike then my regular appt for massage tomorrow.If need be will then rest 'tll next Sunday.
Posted: 29/03/2004 at 07:55

Cybil,glad to hear you are OK. Just take it easy. Don't want to strain itagain. Plenty of stretching. Had physio tonight and should be able to go out for a gentle run later in the week. So things are looking OK for 18th.
Posted: 30/03/2004 at 21:03

Had calf tear, saw phsyio for deep tissue massage, podiatrist who gave me 4mm inserts for shoe on the leg that was shorter than the other, saw consultant to oversee treatment, gait analysis to get right shoes, 6 months with no running but lots of gym time - cross-trainer in particular, lots of stretching of calf and hamstring then started running a month ago - 10 minutes of calf stretching before each run - built up to 7 miles and then ping - another calf injury!!! Someone out there please help - there must be a way of stopping this from happening????
Posted: 23/09/2004 at 21:07

Thanks guys ,just read some of the threads regarding calf tears.Trained pretty well for the Swansea 10K,even managed a personal best.Ran an 8 mile training run with a mate a few days later had the same "just been kicked" feeling in my right calf with about 3 miles to go.Was painful to touch for a couple of days after.Gave it a week and tried another 10k, again the pain returned with about 2 miles to go.Taking some of the posted advice,and will take it easy for a bit.
Posted: 21/10/2004 at 20:25

I was taking part in a level one football coaching course on 19th Feb and felt a sharp pain to rear and side of my right calf.I visited the doctor today who thought I might be out for 6 weeks. I have an appointment with the sports physio tomorrow 22nd Feb. Does this mean that for this Tommy the London Marathon is over? i just ran my best 1/2 marathon last week 1.36. Or Will I be able to cross train my way around it and still partake?
Posted: 21/02/2005 at 14:34

Can anyone differentiate between a tear and a strain, and if people think its the latter how soon can I try and run again (like this Sunday) ? Is there any different approach to recovery for a strain than a tear ? Last night got a pain in my calf, mid back, after 10 mins but carried on. Seems to be much milder that what many have experienced. A bit confused because I found uphill easier than down. Can now still feel it but is more apparent with leg bent up than when its stretched straight.
Posted: 24/02/2005 at 10:37

I wouldn't give up if I was you, it happened to me about 3-4 weeks when I upped my mileage one week, I rested completely 1 week and am fine now and back on schedule. I don't know if what it was but it couldn't have been a tear. Like everyone else has descibed though it was a very sharp pain and I had to hobble back to mates house, had pain for few days and massage and since then (touch wood) its been fine. Strange one..
Posted: 24/02/2005 at 13:36

Thanks for your replies definately a torn calf as confirmed by Doc and Physio. Now into heavy sessions of physio and ultra sound but my physio has also introduced accupuncture to ease off muscles that have locked up.Physio has not given up hope and will give it two more sessions next week.With regards to accupunture no pain and definately has eased off locked muscles.Also recommended use of arnica cream to bring out bruising (You can also try pills instead of cream).
Posted: 25/02/2005 at 12:43

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