Calf hamstring pain arthritis

by Nathan Wei, MD, FACP, FACR

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

Click here: Second Opinion Arthritis Treatment Kit

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 forced into extreme contraction. Because the leg has many different muscles, it is vulnerable to several different types of muscle strains. Some of the more common ones are:

• Gastrocnemius strain (calf-muscle pull) — Calf muscle strains typically occur when the foot suddenly bends upward, stretching the calf muscle beyond its limits. At the time of injury, you may actually hear or feel a pop inside your calf — the sound of the muscle tearing, or shearing away from the Achilles tendon. Calf muscle strains are common in athletes, especially tennis players and joggers. However, they also can happen during a simple stroll, if your foot flexes upward when you step into a hole in the sidewalk, or if your 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 large bone of the upper leg), stretches across the knee joint and attaches to the back of the heel along with the Achilles tendon. Because the plantaris doesn't contribute much force in bending the knee, a tear in this muscle may not seriously affect your knee function. However, a severe plantaris strain can cause significant pain, usually at the back of your calf rather than near the knee. A plantaris strain can occur alone or accompany a gastrocnemius strain or a tear of the anterior cruciate ligament (a major, stabilizing ligament in the knee).
• Hamstring strain (pulled hamstring) — Hamstrings are long muscles that extend down the back of the thigh. Because hamstrings work to pull back the leg and bend the knee, they can be injured during running, kicking or jumping. As in gastrocnemius strain, you may feel a pop, usually at the back of the thigh, when the muscle tears.
• Quadriceps strain — The quadriceps are a large group of muscles in the front of the thigh that straighten out the knee, an opposite action from the hamstrings. Like hamstring strain, quadriceps strain is a common injury in runners. However, it also may occur during a strenuous leg press at the gym. The pain of a quadriceps strain is felt in the front of the thigh, and the strain may be described as a "groin pull" if the tear occurs fairly high in the muscle.


To help simplify diagnosis and treatment, doctors often classify muscle strains into three different grades, depending on the severity of muscle fiber damage.

• Grade I — Only a few muscle fibers are stretched or torn, so the muscle is mildly tender and painful, but muscle strength is normal.
• Grade II — A greater number of muscle fibers are torn, so there is more severe muscle pain and tenderness, together with mild swelling, noticeable loss of strength and sometimes bruising (called an ecchymosis).
• Grade III — The muscle tears all the way through. Either it rips into two separate pieces, or the fleshy part of the muscle breaks away from the tendon. Grade III muscle strains are serious injuries that cause complete loss of muscle function, as well as considerable pain, swelling, tenderness and discoloration. A Grade III strain also causes a break in the normal outline of the muscle, often producing an obvious "dent" or "gap" under the skin where the ripped pieces of muscle have come apart.


In the United States, leg muscle strains and leg sprains account for more than a million office visits to doctors every year. More than half of these injuries happen to active young adults between the ages of 25 and 44. Men are twice as likely to be injured as women. On the job, leg strains, sprains and tears are the second most common type of work-related injury in American adults, with approximately 100,000 cases reported annually to the U.S. Bureau of Labor Statistics. Leg muscle strains also are common among teenage athletes, especially those who participate in football, soccer or wrestling.

Symptoms of a strained leg muscle can include:

• Muscle pain and tenderness, especially after an activity that stretches or violently contracts the muscle. Pain usually increases when you move the muscle, but it is relieved by rest.
• Local muscle swelling, black and blue discoloration or both
• Either a decrease in muscle strength or (in a Grade III strain) a complete loss of muscle function
• Difficulty walking
• A pop in the muscle at the time of injury
• A gap, dent or other defect in the normal outline of the muscle (Grade III strain)


Diagnosis:

Your doctor will want to know what activity triggered your leg pain and whether there was a pop in the muscle when you injured it. The doctor also will ask about your symptoms, especially any decreased muscle strength or difficulty walking.

Your doctor may suspect that you have a strained leg muscle, based on your symptoms and the history of your injury. To confirm a diagnosis, the doctor will perform a physical examination. If the results of your exam point to Grade I or II muscle strain, then usually you will not need any additional testing. However, if the diagnosis is in doubt, x-rays or 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 begin to feel better within a few days. In most cases, symptoms are either totally gone, or very much improved, within eight to 10 weeks. Symptoms of a Grade III strain may persist until the torn muscle is repaired surgically.

To help prevent muscle strains in your legs, you can:

• Warm up before you participate in high-risk sports.
• Follow an exercise program aimed at stretching and strengthening your leg muscles.
• Increase the intensity of your training program gradually. Never push yourself too hard, too soon.


Treatment:

If you have a Grade I or Grade II strain, your doctor will probably recommend that you follow the RICE rule:

• Rest the injured muscle (take a temporary break from sports activities).
• Ice the injured area to reduce swelling.
• Compress the muscle with an elastic bandage.
• Elevate the injured leg.


In addition, you can take a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin and other brand names) or aspirin, to ease pain and relieve swelling. As pain gradually subsides, your doctor may recommend a rehabilitation program to restore the normal range of motion in your leg and to gradually strengthen the injured muscle.

For many Grade II strains, evaluation by a specialist, such as an orthopedist, will be appropriate. To allow the injured muscle to heal, you may need to wear a cast for a number of weeks.

If you have a Grade III strain in your leg, the torn muscle may need to be repaired surgically by an orthopedic specialist. One exception is a Grade III plantaris strain, which usually is treated without surgery.

Call your doctor promptly if:

• You hear or feel a pop in your leg muscle at the time of injury
• You have severe pain, swelling or discoloration in the injured muscle
• Your injured leg is obviously weak compared to your uninjured leg
• You have difficulty walking
• You have milder leg symptoms that do not improve after 48 hours


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.

A hamstring injury is when one or more of the hamstring muscles are torn or sprained. There are 3 muscles that make up the hamstring muscle group in the back of the thigh. These muscles hook to the hip, femur, tibia and fibula . The hamstring muscles work with other muscles in the buttock (rear end) to help the hip extend. The hamstrings also work with muscles in the thigh and calf to help the knee bend. And, the hamstrings help the leg turn in and out.

Causes: Often the exact cause of a hamstring injury is not known. Following are some of the 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.


Signs and Symptoms: The signs and symptoms of a hamstring injury depend on how bad the hamstring is injured. You will have some or a lot of bruising, pain, and difficulty moving your leg.

• The pain and stiffness may not start until resting after the activity that caused the injury. Bruising may not show up until 1 to 2 days later.
• You may feel a snap or tear and have trouble bending your knee with a worse hamstring tear.
• If the hamstring ruptures you will have very bad pain, bleeding in the muscle, swelling, and won't be able to move your leg. And, you may be able to feel a lump or a hole where the muscle ruptured.


Treatment:

• Physicians will work to lessen pain and inflammation when your hamstring is first injured.
o The most important part of treating a hamstring injury is resting your leg while it heals. Resting your leg as much as possible will lessen swelling and keep the pain from getting worse. When the pain decreases, begin normal, slow movements.
o Ice causes blood vessels to constrict which helps lessen inflammation (swelling, pain, and redness). Put crushed ice in a plastic bag and cover it with a towel. Put this on the back of your thigh for 15 to 20 minutes every hour as long as you need it. Do not sleep on the ice pack because you can get frostbite. Depending on how bad your hamstring injury is, your physician may suggest using ice for at least 2 to 3 days.
o You may wrap your leg with tape or an elastic bandage to keep your thigh from swelling. You may be told to keep your leg raised on a stool or pillows which also helps to lessen swelling.
o You may use ibuprofen and acetaminophen for your pain. These may be bought as over-the-counter medicine. Do not take ibuprofen if you are allergic to aspirin.
• Your doctor may want you to go to physical therapy. A physical therapist will do treatments and exercises to help your hamstring injury heal faster. It may take 1 or more months for your hamstring injury to heal.
o Therapists may use ultrasound to increase blood flow to the injured area. This may help your hamstrings heal faster.
o Therapists may use massage to stretch the tissue and bring heat to the injury which increases blood flow. This can help your leg heal faster and better.
o Your physical therapist may give you specific exercises to stretch and strengthen your hamstring muscles. Start exercising when caregivers say that it is OK. Make sure you remain pain-free as you use your leg more. You will increase to jogging, stationary bicycling, and knee curls with time as your pain goes away. Always do stretching exercises before working out. This will loosen your muscles and lessen stress on your hamstrings. Rest between workout programs. Do cool-down exercises after working out.


Call your physician if:

• Your pain and swelling increase.
• You have new symptoms.
• You have a temperature over 100.4 F (38 C).


For some patients, certain situations may predispose to acute or recurrent lumbar sprain/strain. These include:

• weak abdominal muscles,
• tight muscles/poor flexibility (e.g., hamstring, calf, back)
• poor posture (standing, sitting, or running).


Some examples of poor running posture are, hunched or stooped-over position, too much curvature in the low back (butt sticks out with excess arching of the lumbar spine), and pelvic tilt (anterior or lateral).

Arthritis in the knee can be aggravated by weakness or injury involving the muscles in the legs.

Several muscle groups support the knee. The two main muscle groups that control knee movement and stability are the quadriceps and the hamstrings.

THE QUADRICEPS is a four-part powerful muscle that run along the front of the thigh and attach to the front of the shinbone, just below the knee. The quadriceps control the straightening of the knees and movement of the kneecap. The quadriceps is used to extend the leg, and is essential for standing up, walking upstairs, walking uphill, and running.

THE HAMSTRINGS are muscles that run make up the back of the thigh, and attach to the back of the shinbone, just below the knee. The hamstrings are used to bend the knee and are also needed when you are pushing against something.

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