Both stretching and strengthening exercises are important for recovering from calf strain injuries and can begin once the initial acute phase has passed and pain allows.
This may be a couple of days or longer depending on the injury. Here we demonstrate and explain essential calf strain exercises. The following is for information purposes only. Always consult a professional before attempting self-treatment.
A good starting point is to assess the flexibility of the calf muscles. One method of assessing calf muscle flexibility is to apply gentle pressure to the forefoot with the patient sitting with the leg out straight in front.
There will be a point where the resistance noticeably increases as the muscle begins to stretch. It is likely the therapist will feel this before the patient feels a stretch on the calf muscles.
Active calf stretch
Active stretching is used in the early stages of a calf injury as it applies only a gentle stretch to the muscle. Muscles work in pairs and by contracting the muscles in the front of the lower leg, the muscles at the back must relax.
In order to stretch the gastrocnemius, sit on the floor or a chair with the leg straight out in front of you. Pull the toes and foot back towards you, hold for a couple of seconds and relax. Repeat this 10-20 times.
To stretch the soleus muscle, sit with the knees bent and feet on the floor. Raise the toes and foot up towards you, keeping the heel on the floor. Hold for a couple of seconds, relax and repeat 10-20 times.
To stretch the big gastrocnemius muscle the back leg must be kept straight. Stand with the leg to be stretched at the back and hands on a wall at shoulder height. Bend the front knee and lean forward, keeping the back knee straight and pushing the heel down into the floor.
When you can feel a stretch, hold for 20 seconds. If the stretch eases, lean further forwards until you can feel it again. But do not push too far in the early stages. Perform 3 repetitions and repeat this 3-5 times a day.
Soleus muscle stretch
To stretch the deeper soleus muscle the knee of the leg to be stretched needs to be bent. This is because the soleus muscle attaches below the knee and bending the knee allows the gastrocnemius muscle to relax leaving the soleus on stretch.
Lean against a wall with the leg to be stretched at the back. Bend the knee keeping the heel in contact with the ground until a stretch is felt. Hold for 15 to 20 seconds and repeat three times. If a stretch is not felt then another method is to place the ball of the foot against the wall and bend the front knee until a stretch is felt.
Stretching on a step
As flexibility increases or if you have particularly flexible calf muscles it may be better to stretch using a step. Lower the heel off the step dropping down until a stretch is felt.
Hold for 15 to 20 seconds for 3 repetitions and repeat 3 to 5 times a day. The soleus muscle can be stretched similarly but with the knee of the leg to be stretched kept bent.
Plantar flexion with band
This is a gentle exercise to start with using a rehab or rubber resistance band. It is more suitable in the very early stages of rehab as long as pain allows after a severe contusion. Hold a loop of resistance band and use it to apply resistance as you point the foot away or plantarflex the foot.
Start with just 2 sets of 10 once a day and build up to 3 sets of 20 twice a day. If it does not hurt the next day then increase the resistance by shortening the section of band. If there is any pain during, after or the next day then reduce the load or rest a bit longer.
Seated calf raise
This is a gentle exercise that will strengthen the soleus muscle which is the smaller muscle lower down. This is also an early stage rehab exercise as it can be done with no weight at all, to begin with, if necessary. Sit on a chair with the knees bent and lift your heels off the ground as high as possible. Resting a weight on the knees will increase the resistance. Start with 2 sets of 10 once a day and increase a little every two or three days when you are sure there has been no adverse reaction (pain).
Stand on a step with the heels off the back of the step making sure you have something to hold onto for balance. Lower the heels just below the step then raise up onto tiptoes. Start with 2 sets of 10 reps provided it is pain-free and gradually build up to 3 sets of 20 reps. If after a few days this feels easy, transfer more of your weight on to the injured leg and then go on to single leg calf raises. This exercise can also be done leaning against a wall if a suitable step is not available.
To isolate the soleus muscle the calf raise exercise can be done as above but with the knee bent to 45 degrees which puts more load onto the soleus muscle.
This exercise is more suitable for the later stages of rehabilitation when the athlete is attempting to return to more specific sports training. The athlete steps back and then in one movement steps back onto the step. This is a more explosive, plyometric exercise related to the specific demands of sport. It works the calf muscle eccentrically during the stepping back phase and plyometrically as they push off. The athlete should be capable of normal running before starting this exercise.
Alternate so both legs are exercised and do not do any more on the good leg than you can achieve with the injured leg.