Calf hamstring pain arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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A muscle strain is a stretch or tear of muscle fibers.

In the leg, muscle strains happen when a muscle is either stretched beyond its limits or goes into extreme contraction. The leg has many muscles; therefore, it is vulnerable to a variety of muscle strains. Some of the more common ones are:

•Gastrocnemius strain (calf-muscle pull) — Calf muscle strains typically occur when the foot bends upward unexpectedly, stretching the calf muscle beyond its usual limits. At the time of injury, there may be a "pop" — the sound of the muscle tearing away from the Achilles tendon. Calf muscle strains are common in athletes, especially tennis players and joggers. They also can happen during normal activities. Examples are if a person were to step into a hole in the sidewalk, or their heel slips off the edge of a curb.

•Plantaris strain — The plantaris is a thin muscle that begins at the lower end of the femur (the upper leg bone), stretches across the knee and attaches to the back of the heel along with the Achilles tendon. A severe plantaris strain can cause significant pain, usually at the back of the calf. A plantaris strain can occur alone or accompany a gastrocnemius strain.

•Hamstring strain — Hamstrings are muscles that extend down the back of the thigh, extending from the pelvis to the back of the knee. Hamstrings pull the leg back and flex the knee. They are injured during running, kicking or jumping. As in gastrocnemius strain, the patient may feel a pop, at the back of the thigh when the muscle tears.

Some possible causes of a hamstring injury.

• Difference in leg length.
• Tight hamstrings.
• Unequal strength between hamstring muscle groups.
• Muscle fatigue.
• Poor posture.
• Incorrect form when running, such as taking too long of a stride.
• Stopping or turning quickly during sports, such as football, soccer, or basketball.

The most important part of treating a hamstring injury is resting the leg while it heals. Resting will lessen swelling and keep the pain from getting worse.

Ice causes blood vessels to constrict which helps lessen inflammation (swelling, pain, and redness). Ice should be used for a minimum of two to three days.

Wrapping the leg with tape or an elastic bandage to keep the thigh from swelling can help.

Anti-inflammatory medicines also can help reduce pain.

A physical therapist can provide treatment to help the hamstring injury heal faster. These treatments will include massage, ultrasound, and electrical stimulation. It may take 1 or more months for your hamstring injury to heal.

The physical therapist will provide specific exercises to stretch and strengthen your hamstring muscles. Exercises are the first step to eventual recovery. Always do stretching exercises before working out. This will loosen muscles and lessen stress on the hamstrings. Rest between workout programs. Do cool-down exercises after working out.

Muscle strains are classified into three groups or grades:

•Grade I — Only a few muscle fibers are stretched or torn, so the muscle is tender and painful, but muscle strength is normal.
•Grade II — More muscle fibers are torn, so there is more severe muscle pain and tenderness, together with mild swelling, noticeable loss of strength and sometimes bruising.
•Grade III — The muscle tears completely. Grade III muscle strains are serious injuries that cause loss of muscle function, as well as considerable pain, swelling, tenderness and discoloration.

Symptoms of a strained leg muscle can include:

1. Muscle pain and tenderness, especially after an activity that stretches or contracts the muscle. Pain increases with movement and is relieved by rest.
2. Local muscle swelling, discoloration, or both
3. A decrease or loss in muscle strength
4. Difficulty walking
5. An audible "pop" at the time of injury
6. A gap in the normal outline of the muscle (Grade III strain)


A history and physical examination will generally point towards the diagnosis. If the results of your exam suggest a Grade I or II muscle strain, then usually no additional testing is needed. However, if the diagnosis suggests a more serious issue, a magnetic resonance imaging (MRI) scan may be necessary. Also, in calf muscle injuries, Doppler studies may be done to check for a blood clot.

Most Grade I or Grade II strains improve within a few days. Symptoms are very much improved within eight to 10 weeks. Symptoms of a Grade III strain may persist until the torn muscle may require surgery.

To help prevent muscle strains in your legs:

•Warm up before sports.
•Work on stretching and strengthening leg muscles.
•Increase the intensity of your training program gradually.


Grade I or Grade II strain:

•Rest the injured muscle.
•Ice the injured area to reduce swelling.
•Compress the muscle with an elastic bandage.
•Elevate the injured leg.

Non-steroidal anti-inflammatory drugs (NSAIDs) may ease pain and relieve swelling. A rehabilitation program can help restore normal range of motion in your leg and strengthen the injured muscle.

Grade II strains may require a cast for a number of weeks.

Grade III strains may need to be repaired surgically.

The prognosis depends on the location and severity of the muscle strain. In general, almost all Grade I strains heal within a few weeks, whereas Grade II strains may take two to three months. After surgery to repair a Grade III strain, most patients regain normal leg muscle function after several months of rehabilitation.

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