Calf strain

Calf strain: what causes it?

A calf strain is a grade I muscle injury. The muscle fibres of the gastrocnemius or the soleus are stretched further than they can handle while the muscle is producing tension at the same time. This causes small, microscopic damage in a limited number of fibres. There is no visible tear, no dent in the muscle and usually no bruising. The muscle largely keeps working, but responds with pain and protective increased tension.

A strain often occurs during intensive sport without a proper warm-up, when accelerating suddenly or running uphill and at the end of a training session when the muscle is tired. A rapid increase in training volume, new shoes, a different surface, stiff calf muscles and limited ankle mobility also increase the risk. People who have had a calf injury before are more likely to strain it again.

Which calf muscle is strained?

The location of the strain determines which movements hurt:

• Gastrocnemius: the superficial calf muscle. A strain often occurs during sprinting or jumping and mainly hurts with a straight knee.
• Soleus: the deep calf muscle beneath the gastrocnemius. Strains are common in distance runners, develop more gradually and hurt with a bent knee, for example when running downhill.
• Junction with the Achilles tendon: pain low in the calf, just above the tendon, often after a lot of running on the forefoot.
• Muscle soreness after exercise: not an injury, but stiff and tender calves on both sides, one to three days after a hard session. This fades by itself.

Symptoms of a calf strain

A strain is less severe than a tear, but it can still limit you considerably. You recognise it by:

• A pulling or nagging pain that develops during or after sport.
• Pain when pushing off, climbing stairs or standing on your toes.
• A tight, tender calf with increased muscle tension.
• Pain when stretching the calf.
• Walking is reasonably fine, but running or jumping is not.
• Little or no swelling and no bruise.
• A stiff calf during the first steps in the morning.

If you felt a snap with immediate sharp pain and a bruise appears, there is probably more going on than a strain. If your calf becomes swollen, warm and red without a clear cause, contact your GP the same day because of the risk of thrombosis. If you are also short of breath, call 112.

When should you see a physiotherapist for a calf strain?

A mild calf strain often recovers by itself within one to three weeks. Physiotherapy is useful if the pain has hardly decreased after a week, if you are unsure whether it is a strain or a tear, or if you want to return to your sport quickly and safely. If your calf keeps getting strained, it is also worth having the cause assessed.

Getting your calf ready for load again

With a strain, complete rest is not needed. We keep the muscle moving and build up the load quickly but responsibly.

Active recovery

• Explanation of the difference between a strain and a tear and how much pain is acceptable.
• Pain-free movement and stretching exercises from the first days.
• Trigger point therapy for the increased tension and tender points in the calf.
• Strength exercises with a straight and a bent knee to train both calf muscles.
• Mobilisation of the ankle if it is stiff.
• A build-up schedule for running or your own sport.

Finding the cause

A strain is often the result of a load that was just too high for your calf. We look at how you build up your training, your warm-up, your shoes and the mobility of your ankle. This way, you know what to watch out for to prevent another strain.

A calf strain, a calf muscle tear and cramp

Calf pain during sport can have different causes. With a calf muscle tear, muscle fibres are actually torn, with sharp pain, loss of strength and often bruising. With a calf cramp, the muscle contracts involuntarily and the pain usually disappears after a few minutes. If a strain keeps coming back, it can turn into chronic calf pain from overuse. You can find all causes listed on the page about calf complaints.

A calf strain that keeps coming back

If your calf strains again and again, the muscle is often not yet strong enough for the load you ask of it. A stiff ankle, building up training too quickly or a muscle that never fully recovered after a previous injury also play a part. Sometimes irritation of a nerve from the lower back contributes to a tense calf. We assess these factors and give you a strength programme that you keep doing after recovery too.

How we work at De Fysio Man

1. Intake and assessment

We ask how and when the pain started and assess which calf muscle is strained. With strength and stretch tests, we rule out a tear.

2. Tailored treatment plan

You receive a short, active recovery plan with exercises for home, supplemented with treatment of the increased muscle tension.

3. Moving again quickly

We build up your running and sports load until you can run, sprint and jump again without a pulling sensation.