LEG STRAIN, CALF (Lower-Leg Strain) |
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General Information
DEFINITION--Injury to muscles and tendons in the lower leg (calf). Muscles, tendons and bone comprise units. These units stabilize the knee and allow its motion. A strain occurs at the weakest part of a unit. Strains are of 3 types:
Mild (Grade I)--Slightly pulled muscle without tearing of muscle or tendon fibers. There is no loss of strength.
Moderate (Grade II)--Tearing of fibers in a muscle, tendon or at the attachment to bone. Strength is diminished.
Severe (Grade III)--Rupture of the muscle-tendon-bone attachment with separation of fibers. Severe strain requires surgical repair. Chronic strains are caused by overuse. Acute strains are caused by direct injury or overstress.
BODY PARTS INVOLVED
Tendons and muscles of the calf and lower leg.
Leg bones (femur, tibia and fibula).
Soft tissue surrounding the strain, including nerves, periosteum (covering to bone), blood vessels and lymph vessels.
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SIGNS & SYMPTOMS
Pain when moving or stretching the foot or ankle.
Muscle spasm in the calf.
Swelling over the injury.
Loss of strength (moderate or severe strain).
Crepitation ("crackling") feeling and sound when the injured area is pressed with fingers.
Calcification of the muscle or the tendon (visible with X-rays).
Inflammation of tendon sheath.
CAUSES
Prolonged overuse of muscle-tendon units in the calf.
Single violent injury or force applied to the calf.
RISK INCREASES WITH
Contact sports such as football, soccer or hockey.
Sports that require quick starts, such as running races.
Any cardiovascular medical problem that results in decreased circulation.
Medical history of any bleeding disorder.
Obesity.
Poor nutrition.
Previous lower-leg injury.
Poor muscle conditioning.
HOW TO PREVENT
Participate in a strengthening and conditioning program appropriate for your sport.
Warm up before practice or competition.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care.
Self-care during rehabilitation.
Physical therapy (for moderate and severe strains).
Surgery (severe strain).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the leg, ankle, knee and foot to rule out fractures.
POSSIBLE COMPLICATIONS
Prolonged healing time if activity is resumed too soon.
Proneness to repeated injury.
Unstable or arthritic knee following repeated injury.
Inflammation at the attachment to bone (periostitis).
Prolonged disability (sometimes).
PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Torn ligaments and tendons require as long to heal as fractured bones. Average healing times are:
Mild strain--2 to 10 days.
Moderate strain--10 days to 6 weeks.
Severe strain--6 to 10 weeks. If this is a repeat injury, complications listed above are more likely to occur.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CAREIf a cast or splints are necessary, keep toes free and exercise them frequently. If a cast or splints are not necessary:
Use ice massage 3 or 4 times a day for 15 minutes at a time. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
Apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Wrap the injured leg with an elasticized bandage between treatments.
Massage gently and often to provide comfort and decrease swelling.
Elevate the heels of your shoes to relax the calf. Use 1/2 of a heel pad in each shoe.
MEDICATION
For minor discomfort, you may use:
Aspirin, acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe:
Stronger pain relievers.
Injection of a long-acting local anesthetic to reduce pain (rare).
Injections of a corticosteroid, such as triamcinolone, to reduce inflammation (rare).
ACTIVITY
For a moderate or severe strain, walk with crutches for at least 72 hours--longer with a cast or splints. See Appendix 3 (Safe Use of Crutches).
Resume your normal activities gradually as pain subsides.
DIETEat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when supportive wrapping is no longer needed. Use ice massage for 10 minutes prior to exercise. See section on 462 for rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a moderate or severe calf strain, or a mild strain persists longer than 10 days.
Pain or swelling worsens despite treatment.
The following occurs with a cast or splints:
Pain, numbness or coldness below the injury.
Dusky, blue or gray toenails.
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