Calf Strain

Calf strain

A calf strain is a tear to one or more of the muscles at the back of the lower leg. Here we explain the symptoms, causes, treatment, and exercises for recovering from a torn calf muscle

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.

If you suspect a grade 2 or 3 injury, we advise seeking professional advice.

Anatomy

A Calf strain is simply a tear of one of the muscles which make up the calf muscle group at the back of the lower leg.

Calf strain 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 that 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 is often referred to as ‘Tennis leg’ because it was so common in Tennis players. In particular, the musculotendinous junction (MTJ), where the tendon joins the muscle belly is a very common point to be injured.

Causes

Calf muscle strains usually occur either as a result of a sudden, explosive movement or from excessive, forced over-stretching of the muscles.

However, there are factors that 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.
  • Tight calf muscles – over time your muscles may tighten up and parts of the muscle may go into spasm, either from congenital reasons (genetics), or poor footwear.
  • Wearing high heels. If you regularly wear high-heeled shoes this increases the risk of a number of injuries including calf strains. The muscles adaptively shorten over time and as a result, are strengthened in a contracted state. When you wear flat running shoes they over-stretch, increasing the risk of a torn muscle.

Treatment

Immediate first aid is to apply the P.R.I.C.E. principles of protection rest, ice, compression, and elevation as soon as possible.

Cold Therapy

Use a cold therapy and compression wrap to minimise any bleeding within the muscle.

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. A simple reuseable gel pack with an elastic wrap is ideal.

Rest

In the early acute stage complete rest is important at least until you can walk pain-free. Once the acute phase has passed then active rest may be more beneficial than complete rest. There is evidence to support the theory that muscles heal with some stress, but this must be controlled. If in any doubt, ‘less is best’.

Compression

Wear a compression bandage or calf support to support the muscle and reduce swelling. Compressing blood vessels in the muscle encourages swelling to drain away from the area.

In the later stages, 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.

A professional on-field first aider or therapist may apply a compression bandage immediately after injury. This will minimise bleeding and prevent swelling, but should only be applied for 10 minutes at a time to avoid tissue damage.

Medication

A doctor may prescribe anti-inflammatory medication e.g. ibuprofen. This can be beneficial in the first few days after the injury. However, there is some evidence that anti-inflammatory medication (such as ibuprofen) can impair muscle healing.

Therefore, it should not be taken for more than a few days after the injury occurred. Do not take ibuprofen if you have asthma and always speak to a pharmacist or doctor before taking medications.

Wear a heel lift

Wear a heel pad in your shoes. This shortens the muscle, reducing the load on it. Place them in both shoes otherwise one leg will be longer than the other.

Later, when you return to running, remove them to avoid your muscles adaptively shortening.

Massage

Calf muscle massage

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, longer for more severe injuries. Massage may damage newly formed blood vessels and increase bleeding.

Later on as your injury heals massage can be extremely beneficial in flushing away tissue fluids and swelling, stimulating blood flow and loosening tight knots, lumps and bumps in the muscle.

Foam roller

If you do not have access to massage then using a foam roller can have a similar effect. In the later stages of rehabilitation, it may be used to help mobilise the muscle and fascia (sheath) surrounding it.

Roll along the full length of the muscles for 1 to 2 minutes. Use with a partner/therapist, or on your own.

Electrotherapy

A professional therapist may use Ultrasound to treat your torn calf. It transmits 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.

Rehabilitation & exercises

Seated calf raise

Our Calf strain rehabilitation program has been designed by England & British Lions Rugby Sports Physiotherapist Phil Pask. It is based on what an elite athlete would do and adapted for people of all ages and abilities.

The program is based around 4 phases with an aditional 5th injury prevention/mitigation phase.

Phase 1

Phase 1 begins immediately after injury and can last from 48 hours to 2 weeks or more depending on how bad your injury is.

The aim of phase 1 is to reduce pain, inflammation, and swelling as well as protect the tissue from re-injury and delaying recovery.

Phase 2

The aim of phase two is to safely get to a stage where the injury site is strong enough to a single-leg heel raise, step up and downs, or cycling without the risk of re-injury.

Phase 3

The aim of phase 3 is to strengthen the injured muscle sufficiently to safely progress to more dynamic explosive movements such as hopping, jumping, and running.

Phase 4

This is the end stage where we focus more on sports-specific type exercises with higher, more unpredictable loads.

Phase 5

This is the injury prevention or ‘mitigation’ phase designed to help prevent your injury from recurring. Here we encourage you to incorporate exercises from previous phases into your normal training routine.

Exercises

The program includes the following exercises:

  • Stretching & mobility
  • Activation exercises
  • Specific strengthening
  • General strengthening
  • Motion control
  • Functional exercises

Similar injuries

The following injuries have similar symptoms to torn calf muscles:

Deep vein thrombosis

A DVT is a blood clot in a vein. It is most common in the calf muscle area, particularly following surgery and long-haul flights. It is very important this is not misdiagnosed as a calf strain because treating it as one can cause life-threatening complications.

Posterior compartment syndrome

A compartment syndrome occurs when swelling or bleeding is contained within the muscle sheath. Pressure gradually increases causing pain in the muscle. An acute compartment syndrome is a medical emergency so seek professional advice if you suspect this.

References & research


Calf Strain Rehabilitation Program

Our step by step Calf strain rehabilitation program takes you from initial injury to full fitness.

We recommend the following products for treating calf strains:

Cold wrap

Cold compresion wrap

A cold therapy and compression wrap is essential first aid. It reduces pain and swelling and can also be used to apply heat later in the rehabilitation program.

Calf support

Calf support

A neoprene calf support reduces pain and swelling in the early stages. Later in the rehabilitation program, they provide support and protection.

Foam roller

A foam roller is an excellent piece of kit that can be used in place of massage to treat calf injuries. They are also excellent when used regularly as part of your warm-up to help prevent future injury and improve performance.

Heel pad

Heel raise

A heel pad takes the strain off your injured calf muscle by reducing shock and raising your heel, therefore shortening the muscle as you walk.


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This article has been written with reference to the bibliography.
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