Sudden calf pain during sport is often due to a calf tear or pulled calf muscle. A calf tear, also known as a calf strain or tennis leg, is common among active individuals, particularly athletes. However, calf pain may also be caused by other conditions, including an Achilles tendon tear, a blood clot, blood vessel swelling (also called an aneurysm), or a Baker’s cyst. Therefore, your doctor must confirm a pulled calf muscle or tennis leg diagnosis.

What is a pulled calf muscle? 

A pulled calf muscle, also known as a calf strain or torn calf muscle, is an injury to the muscle rather than ligaments, as occurs in a sprain. In a calf strain, the muscles are overloaded and overstretched, causing tearing and swelling. Overload occurs due to excessive force on the muscle during acceleration or a sudden change in direction.

Calf tears can occur in one of two muscles in the calf: the superficial gastrocnemius muscle or the deeper soleus muscle.

Tennis leg

Tennis leg is the name given to tears of the gastrocnemius muscle. This injury presents as sudden calf pain while playing sports, including tennis. Often, you experience sudden calf pain and a snapping or popping sensation. Usually, you can’t continue with your exercise due to pain. Later, you develop significant swelling and bruising in the calf and find it challenging to bear weight on the leg.

Tennis leg is associated with a rupture of the medial gastrocnemius muscle, and swelling collects between the calf muscles.

Recently, Dr Masci co-authored a paper on the use of ultrasound to diagnose a gastrocnemius muscle tear. Significantly, the exact location of the torn calf muscle determines how long it takes to heal and return to sport. The bottom line is that you need an ultrasound if you pull your gastrocnemius muscle to know how to treat it properly. For example, if you develop bleeding in the muscle, we recommend draining the bleeding to promote healing and avoid excessive scar tissue. Moreover, a large tear will require a boot for a few weeks.

Can I swim with a pulled calf muscle?

Generally, the answer is yes. Swimming engages muscles other than the calf and is an effective option for maintaining fitness during recovery.

How to treat a pulled calf muscle

We suggest rest from sport, compression, ice packs for 10 minutes every 2-4 hours, heel lifts, and crutches if you are limping. This acute treatment should continue for 48-72 hours. Sometimes, we recommend a walking boot. Once you can walk without pain, we recommend initiating a calf-strengthening program supervised by a physical therapist. Then, once you’ve regained strength, you can progress into skipping, jumping, and finally running.

You must see an experienced sports doctor to properly diagnose a torn calf muscle and discuss timeframes for returning to sport. 

pulled calf muscle on ultrasound

Soleus tear    

A tear of the deeper soleus muscle is also a cause of calf pain. However, symptoms are often different from those of gastrocnemius tears. Firstly, pain is often of a gradual onset rather than sudden. Secondly, you typically can continue playing sports even after developing a soleus tear. But as you continue, you find the pain unbearable and must stop.

Unlike gastrocnemius tears, soleus tears can be misdiagnosed as tight muscles or muscle cramping, especially during the early stages. In addition, unlike gastrocnemius tears, soleus tears are hard to find on ultrasound. Therefore, we suggest an MRI scan to diagnose a tear. Additionally, the site of the tear determines the duration of time off sport, with central tendon tears requiring the most time.

Other causes of calf pain

While most link sudden calf pain to a sprained calf muscle, there are other causes, and some are pretty serious, such as a blood clot. You must see your doctor to get a better idea of a diagnosis. Potential causes include: 

Calf muscle cramping

A far less severe cause of calf pain is a simple cramp. Sometimes, cramping can be challenging to distinguish from a torn calf muscle. Often, symptoms are milder and short-lived.

Blood clot

A blood clot in the veins can produce swelling, pain, and redness in the calf. The clot can dislodge and move to the lungs, causing a life-threatening complication. Therefore, if we suspect a blood clot, a special ultrasound or blood test is needed.

Difference between a pulled calf muscle and a blood clot:

Generally, a blood clot forms without an acute injury. There is swelling and pain at the back of the calf. Sometimes, it can be not easy to distinguish. Rarely can these two conditions co-exist.

Blood Vessel Aneurysm

The swelling of a blood vessel at the back of the knee is also called an aneurysm. The reasons some people develop swelling remain unknown. The danger of aneurysms is the increased risk of rupture, which can lead to limb loss. If they are prominent or causing symptoms such as pain at the back of the knee or calf, immediate surgery is needed.

Baker’s cyst

A Baker’s cyst is a pocket of fluid at the back of the knee that comes from the knee joint. The cyst can increase and decrease in size depending on swelling in the knee joint. Sometimes, the cyst can burst, causing pain and swelling in the calf, similar to a sprained calf muscle or a blood clot. Dr Masci has written about Baker’s cyst in a previous blog.

Achilles tendon rupture

Calf pain due to Achilles tendon tear

 

Most people don’t realise that the Achilles tendon starts from the heel and extends to the mid-calf. So, sudden pain in the mid-calf could be a tear of the Achilles tendon rather than a calf muscle. Tears of the Achilles tendon can resemble a tennis leg or gastrocnemius tear, presenting with sudden mid-calf pain and a popping sensation. A complete Achilles tendon tear will need immobilisation in a walking boot, followed by a slow recovery. In some cases, we suggest a surgical repair.

Shin Stress Fractures 

Excessive running or sports can lead to bone fatigue, swelling and fracture. Stress fractures are common in the tibia and fibula and can present with acute calf or shin pain. Often, we use an MRI scan to diagnose a stress fracture in the shin or calf. Generally, treatment consists of a period of rest from running until the bone has healed. Sometimes, a walking boot helps offload the bone in the acute phases. 

Muscle disease: McArdle’s disease   

McArdle’s disease is a genetic disorder affecting glycogen breakdown in muscle. It often presents with pain, tiredness, cramping, and muscle weakness during exercise. Symptoms settle almost immediately with cessation of exercise. Sometimes, muscle breakdown occurs with higher-intensity exercise, leading to severe muscle pain and dark urine. 

Diagnosis of McArdle’s disease is based on blood tests (CK) and a muscle biopsy. Genetic testing confirms the diagnosis. 

Treatment consists of maintaining an active lifestyle with aerobic and strength training, drinking sugary beverages 5 minutes before exercise, and taking creatine supplements. 

Other Frequently Asked Questions about a Pulled Calf Muscle  

Can your calf muscle pop? 

Yes. Sometimes, a gastrocnemius muscle tear can cause a sudden pop, followed by pain and swelling in the calf. However, a pop can also result from a rupture of the Achilles tendon.

Can a torn calf muscle lead to a blood clot? 

Yes. Occasionally, a torn calf muscle can lead to a blood clot in the leg veins, also known as DVT. We hypothesise that a clot forms due to reduced movement caused by the calf tear.

Should you drain a haematoma secondary to a torn calf muscle? 

Yes. Generally, we think that draining a calf tear will speed up healing and prevent excessive scar tissue.

Can a pulled calf muscle cause bruising? 

Yes, if the calf tear extends to the superficial tissue, leading to bruising in the lower calf, ankle or foot. 

Final Word from Sportdoctorlondon about a Pulled Calf Muscle

If you experience sudden, severe pain in your calf, you need an expert to determine the cause. Often, imaging modalities such as ultrasound or MRI are required. Finally, you need proper treatment to get you back to sport or prevent complications, some of which could be life-threatening.

Other related conditions to a pulled calf muscle: