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.
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.
What is a Calf strain?
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.
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 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.
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.
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 your wear flat running shoes they over-stretch, increasing the risk of a torn muscle.
If you suspect a grade 2 or 3 injury, we advise seeking professional advice.
Calf strain treatment
Immediate first aid is to apply the Apply the P.R.I.C.E. principles of protection rest, ice, compression and elevation as soon as possible. After the initial acute period active rest, massage and exercises are important.
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.
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 benefitial 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’.
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.
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.
Both stretching and strengthening exercises are important for calf injuries. Exercises should only begin after the acute stage of healing has passed and 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 both straight and bent to target both the gastrocnemius and soleus muscles.
- Strengthening exercises can also begin as soon as pain allows. Plantar flexion with a resistance band is a gentle exercise, to begin with, along with seated calf raises.
- Eventually, more dynamic, functional exercises bridge the gap between basic rehab exercises and full fitness.
More on calf strain exercises
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.
More on Calf massage
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.
Ultrasound may be used to treat your muscle injury. 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.
References & further reading
- Koulouris G, Ting AYI, Jhamb A et al. Magnetic resonance imaging findings of injuries to the calf muscle complex. Keletal Radiol 2007;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