A calf strain is a tear to one or more of the muscles at the back of the lower leg. Symptoms include a sudden sharp pain which can range from mild to severe.
On this page:
- Symptoms & diagnosis
- Causes & anatomy
- Treatment & Rehabilitation
- Sports massage
Calf strain symptoms
Symptoms of a calf strain vary significantly depending on how bad the injury is. A mild strain may feel more like an ache during or after exercise. Sometimes athletes may not even be aware they have an injury and continue to play making it worse.
With a more severe strain you will feel a sudden sharp pain at the back of the lower leg at the time of injury. Swelling may occur immediately or develop gradually over the next 24 hours or so.
Calf muscle strains are graded from 1 to 3, with grade 3 being the most severe. A grade 1 will not require professional treatment and will usually heal on its own within a couple of weeks.
A grade 2 or 3 injury will take significantly more time to heal and may require specialist treatment.
Read more on calf strain diagnosis and try our calf strain diagnosis tool.
Calf strain causes & anatomy
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) head of the gastrocnemius muscle. This injury often referred to as ‘Tennis Leg’ because the mechanism of injury is often seen whilst playing tennis.
The most common type of calf strain is a tear to the medial (inside) head of the gastrocnemius muscle. This injury often referred to as ‘Tennis Leg’ because the mechanism of injury is often seen in Tennis player.
The musculotendinous junction, where the tendon joins the muscle belly and is also a very common area to be injured.
What causes Calf strains?
Calf muscle strains usually occur as a result of a sudden pushing off movement. Or from excessive and forced over-stretching of the muscles. The is most likely when landing from jumping activities or during quick changes of direction. However, there are factors which increase the chances of sustaining a torn calf muscle.
- If the muscles are particularly tight before exercise begins, then they may be more susceptible to strains. Regular sports massage can help identify specific tight areas before they become strains.
- 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 exercses?
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 the patient moving the foot themselves to stretch the muscles. To stretch the gastrocnemius muscle, lie or sit with your legs out in front. Pull your toes up. You should feel a gentle stretch at the back of the lower leg. Hold the stretch for a couple of seconds then relax. Repeat for 10 to 20 repetitions.
The soleus muscle is stretched in the same way but with the knee bent. This relaxes the gastrocnemius muscle which attaches above the knee, enabling the soleus muscle to be stretched.
More advanced stretches are done against a wall. Keep the knee straight to target the gastrocnemius muscle and bent to isolate the soleus. If you are particularly flexible then stretch on a step to increase the stretch. Make sure that you ease slowly into the stretch, until you feel a tightness, but no pain. Hold for 20 seconds. Repeat three times and aim to stretch 3 to 5 times each day. Do not push too far, especially in the early stages.
Read more and watch video demonstrations of calf exercises.
Strengthening can begin as soon as pain allows.
Plantar flexion with band
Plantar flexion with a resistance band is a gentle exercise to begin with. Hold a loop of resistance band around your foot (as shown) and use it to apply resistance whilst you point the foot away (plantarflexion). Start with just 2 sets of 10, once a day, and then build up to 3 sets of 20 repetitions, twice a day.
If there is no reaction in the muscle and it does not hurt the next day, then make the exercise harder by either increasing the resistance of the band or performing more repetitions. However, if there is any pain whilst performing the exercises, or the following day then go back a step. Reduce the restistance, number of reps or recover time between sets.
Seated calf raise
Seated calf raise is another gentle exercise that will strengthen the Soleus muscle. To begin with, it can be performed with no weight at all. As the muscle gets stronger, use a weight on the thighs to increase resistance. Sit on a chair with your knees bent. Lift your heels off the ground as high as possible.
Standing calf raise
A standing calf raise is the most effective exercise to use in the long term. Stand on a step or against a wall and keeping your knees straight, raise your body up and down on the balls of the feet to strengthen the calf muscles. Start with 2 sets of 10 reps provided it is pain-free and then gradually build up to 3 sets of 20 reps. To bias, the Soleus muscle, repeat the same exercise with a bent knee.
During the later stages of rehabilitation, it is important to introduce more functional or sports specific exercises to bridge the gap between controlled indoor rehabilitation and returning to full sporting fitness and preparing the healing calf muscles ready to withstand the rigours of sport. Examples of these exercises include explosive jumps, hopping, stepping plyometric exercises, changes of direction, sprinting, long distance running and any other exercises that mimic the specific demands of the sport.
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