A calf strain is a tear to one or more of the muscles at the back of the lower leg. Our treatment and rehabilitation program includes cold therapy, massage, stretching, strengthening and sports specific exercises.
Calf strain symptoms
Symptoms of a calf strain vary significantly depending on how bad your injury is. A mild strain may feel more like an ache during or after exercise. With a more severe strain you will feel a sudden sharp pain at the back of the lower leg at the time of injury. Calf muscle strains are graded from 1 to 3, with grade 3 being the most severe.
- A grade 1 strain is a minor tear of the muscle with less than 25% of the muscle fibres affected.
- You may complain of a twinge in the back of your lower leg, or simply a feeling of tightness.
- It may be possible to carry on playing or competing with minimal pain.
- However, there is likely to be more tension or aching in your muscle later, which may take up to 24 hours to develop.
A grade 1 strain can easily turn into a grade 2 strain if they are not treated properly or ignored.
- A grade 2 strain is more severe, with between 25% and 90% of the muscle fibres torn.
- You will feel a sudden sharp pain at the back of the lower leg, with swelling likely.
- Bruising may also develop over the following couple of days.
- Trying to stand on tip-toes (resisted plantar flexion) will be painful.
- You will have significant weakness in the muscle.
- A grade 3 tear is the most severe with 90 to 100% of the muscle fibres torn. A complete tear is often reffered to as a rupture.
- You will have severe and immediate pain at the back of the lower leg.
- A ‘pop’ sensation might be felt at the time of injury.
- If you can walk at all, you will have a significant limp.
- Swelling will develop rapidly within an hour or so and bruising is also likely to be visible.
- A gap or deformity in your muscle may be visible as the torn fibres bunch up towards the knee.
What is a Calf strain?
A Calf strain is simply a tear to one of the muscles which make up the calf muscle group. The calf muscle group consists of the Gastrocnemius and Soleus muscles.
The gastrocnemius is the big muscle at the back of the lower leg. The soleus is the smaller of the two and is located lower down and lies underneath the gastrocnemius. Both muscles contract to produce ‘plantar flexion’ at the ankle joint. This is the same movement as standing up onto your tip-toes.
The Gastrocnemius is the more powerful muscle which produces propulsion during dynamic movements such as sprinting and jumping. The most common type of calf strain is a tear to the medial (inside) part of the gastrocnemius muscle. This injury often referred to as ‘Tennis Leg’ because the injury is often seen whilst playing tennis.
The musculotendinous junction, where the tendon joins the muscle belly and is a very common area to be injured.
What causes a torn calf muscle?
Calf muscle strains usually occur either as a result of a sudden, pushing off movement, or from excessive and forced over-stretching of the muscles. This is more likely to occur from a sudden explosive change of direction. However, there are factors which increase the chances of sustaining a torn calf muscle.
- Not warming up properly. If your muscles are particularly tight, then they may be more susceptible to injury.
- Athletes who have chronic shortening of the calf muscles, either from conjenital reasons (genetics), or poor footwear choices.
- Wearing high heels recularly increases the risk of a number of injuries including calf muscle injuries. The muscles adaptively shorted over time, then when the athlete wears flat running shoes they over-stretch.
Another consequence of wearing high heeled shoes regularly is that the muscle only works in a shortened position. As a result the muscle may switch off and weaken, particularly in a stretched position needed for running. This in itself may be another risk factor for developing an injury to the muscle.
Calf strain treatment
Treatment involves immediate first aid principles, followed by active rest and a gradual stretching and strengthening program.
Self Help Treatment
Apply the P.R.I.C.E. principles of protection rest, ice, compression and elevation as soon as possible. A cold therapy and compression wrap will help minimise any internal bleeding within the muscles. This reduces pain and swelling because it surpresses the bodies inflammatory response. Cold therapy can be applied for 10 to 15 minutes every hour initially, reducing frequency as symptoms allow. Do not apply ice directly to the skin as it can cause ice burns. Read more about P.R.I.C.E.
In most cases it is not advisable to rest completely. But it is important to allow the muscle fibres to heal as this enables them and form new scar tissue. Therefore stopping activities such as running and playing sport are advised until walking is pain-free.
There is significant evidence to support the theory that muscles heal with some stress, but this must be controlled. If in any doubt, ‘less is best’. The more you use the muscle when it is trying to heal, the longer it will take to heal.
In the early acute stages, wearing a compression bandage or calf support can help protect the muscle and reduce swelling. Compressing blood vessels in the muscle encourages swelling to drain away from the area. In the later stages of the rehabilitation, when running and agility exercises are introduced, a heat retainer type support can be worn. This will help keep the muscle warm and improve blood flow.
Wear a calf support
In order to encourage healing and protect the new muscle fibres in the early stages. Wearing a heel pad in shoes will raise the heel and shorten the muscle slightly. This reduces the strain on the muscle. Place heel pads in both shoes otherwise one leg will be longer than the other, causing further problems. As soon as running begins again the heel pads should be removed, to avoid adaptive shortening.
When can I start exercises?
When pain allows, begin gentle stretching and strengthening exercises. Stretching exercises can begin once the initial acute phase has passed. This is usually a couple of days after the injury occurred. It is very important not to force the stretching and strengthening exercises. This will interfere with the healing process and may damage the new muscle fibres and scar tissue.
In the later stages of rehabilitation, a foam roller may be used to help mobilise the muscle and fascia. The fascia is connective tissue which surrounds the muscle. This will help to keep the muscle supple and ready for action.
Performing ‘self’ myofascial release is a way of relieving tension in the fascia yourself, similar to sports massage. This is performed by rolling the foam roller up and down the muscle. Adjust the pressure accordingly depending on the tightness of the muscle or the pain felt whilst doing it. Roll the leg over the roller along the full length of the muscles and back. It is a good idea to continue using the foam roller regularly to prevent injury.
If you suspect a grade 2 or 3 injury, we advise seeking professional advice.
Read more detail with our calf strain rehabilitation program.
What can a professional do?
In more severe cases, a doctor or medical professional may prescribe anti-inflammatory medication e.g. ibuprofen. This can be beneficial in the first few days after the injury. Do not take ibuprofen if you have asthma and always speak to a pharmacist or doctor before taking medications. There is some strong evidence that anti-inflammatory medication (such as ibuprofen) can impair muscle healing. Therefore, they should not be taken for more than a few days after the injury occured.
An on-field first aider or sports injury therapist may apply a compression bandage immediately to the muscle following injury. This will minimise bleeding and prevent swelling, but should only be applied for 10 minutes at a time. Restricting blood flow completely will cause tissue damage. A normal calf support or sleeve can then be worn after this for longer periods as the compression is not so intense.
A professional therapist may use electrotherapy treatments, such as therapeutic ultrasound to treat your muscle injury. Therapeutic ultrasound is different from the diagnostic ultrasound which is used to look inside the body. However, it works in a similar way by transmitting high-frequency sound waves into the tissue. This encourages blood flow which facilitates healing of damaged muscle fibres. Ultrasound is particularly useful in the early stages of the injury.
Sports massage for calf strains can be used after the initial acute phase has finished. Do not massage in the first 5 days post-injury. This may damage newly formed blood vessels and increase bleeding.
After the acute stage of healing has passed, massage will help stimulate blood flow, mobilise the muscle fibres, and release areas of muscle spasm. Another major benefit of massage, particularly in the latter stages, is to soften newly formed scar tissue and help align new fibres. A skilled massage therapist may also to identify tight areas of the muscle at risk of future injury.
Exercises for calf strains
Both stretching and strengthening exercises are important for calf injuries. They should only begin after the acute stage of healing has been completed and should always be performed pain-free.
- Active calf stretches are recommended once the early stages of recovery have been completed. They involve moving your foot yourself to stretch the muscles.
- As your muscle heals, static stretches should be done with the leg straight and bent. This relaxes the gastrocnemius muscle which attaches above the knee, enabling the soleus muscle to be stretched.
- Strengthening can begin as soon as pain allows. Plantar flexion with a resistance band is a gentle exercise to begin with, along with seated calf raises.
Read more and watch video demonstrations of calf exercises.
- Koulouris G, Ting AYI, Jhamb A et al. Magnetic resonance imaging findings of injuries to the calf muscle complex. Keletal Radiol2007;36:921-7
- Orchard J, Alcott E, James T et al. Exact moment of a gastrocnemius muscle strain captured on video. Br Journal Sports Med 2002;36:222-3
- Kwak HS, Han YM, Lee SY et al. Diagnosis and follow up US evaluation of ruptures of the medial head of the gastrocnemius (‘tennis leg’). korean J radiol 2007;7(3):193-8