Calf muscle tear

Calf muscle tear: what causes it?

The calf consists of two large muscles: the superficial gastrocnemius with an inner and outer head, and the deeper soleus. Together they merge into the Achilles tendon. The gastrocnemius crosses both the knee and the ankle. As a result, it is under extra tension when your knee is straight and your foot is pulled up, for example during a sprint start or a quick lunge forwards. If the muscle has to contract forcefully at that moment, the fibres can tear. This usually happens in the inner head, at the junction between muscle and tendon.

Tennis leg is common in tennis, padel, squash, football and running, especially in athletes from around the age of 35. Risk factors are an insufficient warm-up, fatigue at the end of a match, cold weather, a previous calf injury, reduced calf strength and a sudden increase in sprinting or jumping.

Grades of calf muscle injury

Muscle injuries are graded by the amount of damaged fibres. A calf muscle tear is grade II or III:

• Grade I, strain: the fibres are overstretched and there is only microscopic damage. You can usually still walk. This is not a tear.
• Grade II, partial tear: some of the muscle fibres are torn. You have clear pain, loss of strength, swelling and often bruising.
• Grade III, complete tear: the muscle is torn across its full width or has come away from the tendon. Sometimes you can feel a dent and you can no longer stand on your toes.
• Soleus tear: a tear in the deep calf muscle often develops more gradually, for example in runners, and mainly hurts with the knee bent.

How to tell your calf muscle is torn

A calf muscle tear often feels very obvious. Typical features are:

• A sudden, sharp pain in the middle of a movement, as if you have been kicked or hit.
• Limping straight away and being barely able, or unable, to stand on your toes.
• Swelling and a tight feeling in the calf.
• A bruise that moves down towards the ankle after a few days.
• Tenderness at a clear spot, usually on the inside of the calf.
• Pain when stretching the calf and when pushing off.
• With a large tear, a palpable dent in the muscle.

If you heard a bang low down near the heel and cannot stand on your toes at all, your Achilles tendon may be ruptured and you should see your GP or go to A&E the same day. If your calf is swollen, warm and red without a clear cause, for example after a flight or surgery, it may be thrombosis and you should call your GP. If you also become short of breath or have chest pain, or if the calf becomes extremely tense and painful, call 112.

When should you see a physiotherapist for a calf muscle tear?

With a partial or complete tear, guidance from the first week is useful. Research shows that early, measured movement leads to better recovery than prolonged rest. The scar tissue that forms becomes stronger and more supple when it is loaded gradually. If we suspect a complete tear or an Achilles tendon rupture, we consult your GP or have you assessed by an orthopaedic surgeon.

Recovering from tennis leg in phases

We follow the natural healing of the muscle and increase the load as soon as the tissue is ready.

From the first days to sprinting

• In the first days: protecting the calf with a heel raise, compression and short, low-pain walks.
• Gentle movement exercises for the ankle and calf to prevent stiffness.
• Static tension exercises, followed by heel raises with a straight and a bent knee.
• Connective tissue massage to keep the scar tissue supple in the later phase.
• A running schedule that builds up from walking to jogging and running.
• Sprint, jump and change-of-direction exercises that suit your sport.

Back to your sport safely

You only return to matches once the strength of the injured calf is comparable to the other side and you can sprint and jump without pain. We test this with a number of strength and hop tests. This reduces the risk of the muscle tearing again at the same spot.

A calf muscle tear, a calf strain and cramp

Not every sudden pain in the calf is a tear. With a calf strain, the fibres are overstretched but intact; the pain is less sharp and walking is usually still reasonably possible. A calf cramp can also strike suddenly, but it fades within a few minutes without swelling or bruising. If a tear does not heal well, chronic calf pain from overuse can develop. You can read more about the causes of calf pain on the page about calf complaints.

Preventing another calf muscle tear

The risk of a new tear is greatest in the first months after returning to sport. So keep doing strength exercises for your calf twice a week, even when you no longer have symptoms. Do a warm-up with running drills and short accelerations. Take extra care at the end of a match and in cold weather, when your muscles are more tired and stiffer.

How we work at De Fysio Man

1. Intake and assessment

We ask how the injury happened and assess the location and size of the tear, the strength of your calf and the function of your Achilles tendon. This lets us determine the grade of the injury.

2. Tailored treatment plan

You receive a phased rehabilitation plan with clear milestones, matched to your sport and the date on which you want to play again.

3. Back on the pitch

We guide you all the way through sport-specific training, so you return to matches with confidence and a strong calf.