Calf strains are very common muscle injuries that occur in sport. The calf complex (also known as triceps surae) consists of the gastrocnemius (upper calf) which has a medial (inside) and lateral (outside) head at the back of our lower leg.
Underneath the gastrocnemius we have the soleus muscle (lower calf). Although gastrocnemius strains are most common, soleus strains do occur and can often be confused with a typical gastrocnemius strain.
The medial (inside head of the gastrocnemius) is most commonly strained, and is 3x more likely to occur compared to the lateral (outside) head.
Although not very common, the plantaris is another muscle that can be considered with calf strains, but important to note is that this muscle is missing in 7-20% of the population!²
How does a calf strain injury occur?
In professional sport, calf injuries occur within the team approx 1.8-2.9 times per season in football (soccer) and 1.8-2.9 times per season in AFL. Strains are most common in 22-28 year olds, and more frequent in men than women.³
There is a high recurrence rate of 19-31%!³
Mechanism of Calf Strain Injury
Activities where calf strain are commonly seen include accelerating/decelerating and jumping. Injuries are commonly seen when the knee and ankle rapidly go into an extended position (think of an explosive jump into the air).³
The risk factors for calf strains
Fatigue – This is always a consideration with muscle injuries as they generally tend to happen more frequently in those that are fatigued, sore, or both.
Weakness – lack of strength/endurance in the area may increase your risk of a calf a strain
Workload – Excessive workload in a short period of time puts the body under stress, which may increase the risk of muscle injury occurring
Previous calf strain – This is a huge factor, and as mentioned previously, recurrence rate tends to be approximately 19-31%.
The severity and duration of a calf strain injury
The time you will be out of sport will ultimately depend on the severity of the strain. Muscle injuries are normally graded from 0-3.
Grade 0 – There is mild tenderness on palpation but you will still have full range of movement. This injury can last anywhere from a few days to 2 weeks.
Grade 1 – Normally associated with a micro tear of the fibers which would mean you will need approx 2-4 weeks realistically before returning to sport.
Grade 2 – This is associated with a partial tear of the muscle fibres. Expect to be out of action for approximately 3-5 weeks.
Grade 3 – Associated with significant tearing, and may require 5-10+ weeks off. There would be significant pain, swelling, and loss of movement. Most calf injuries are managed conservatively, but a surgical opinion may be warranted in rare circumstances. In the case of an operation, recovery may take upto 6 months.
Medical imaging is normally unnecessary, as a thorough assessment from a physiotherapist should be able to determine the grade of injury. Referrals for Imaging however, are still quite regularly given to patients.
An ultrasound is a quick and easy imaging modality that can approximate the length/width of the muscle strain.
(Magnetic Resonance Imaging) MRI is gold standard when it comes to diagnosing the grade of muscle injuries, and gives a much clearer detailed image. However, these can be quite costly, and tend to be more so done for professional athletes.
Management of calf strains
Management will ultimately be determined by the type of activities you do, what the grade of your injury is and what your function is. From here, a graduated return to activity can be formulated to build back your strength, range of movement, and confidence in movement, while respecting the necessary time needed for the body to promote healing of the muscle tissue.
Below, are examples of 1 exercise option for each stage of your rehabilitation journey:
Early Stage Calf Strain Rehabilitation Exercises
Heel Raise Holds (Complete 5-10 sets of 10 second holds, 1-2x a day)
- Ensure you push up through your first two toes, and that your feet are pointing forwards to work the calf muscles evenly.
- If you want to target the soleus (lower calf), try doing this with slightly bent knees
- Ensure pain is under 2-3/10 when doing this exercise
- This exercise can normally be started 2 days following your injury
Mid-Stage Calf Strain Rehabilitation Exercises
Here is an example of more progressive strength exercises, that begins to incorporate unilateral (single leg) work, with added balance/mobility:
Single Leg Calf Raises (Complete 3 sets of 6-10 reps, once a day).
- Carry weight in hand if it becomes too easy
- Try doing it on a step, if doing it on the floor is too easy
Single Leg Squats (Complete 3 sets of 5-6 reps each leg, once a day) :
- Avoid collapsing onto the box. If it is too low, place a pillow on the box or use a higher box or chair.
- Ensure foot stays flat on ground and is pointing forwards)
- Carry weights in hands if too easy
Late-Stage Calf Strain Rehabilitation Exercises
Exercises by this stage should incorporate plyometric based movements that are required in your sport. This may include jumping, hopping and change of directions. This should be progressive in nature, and should only be completed once you are jogging/straight line running with no pain:
Hurdle Jump/Hop Variations (4-5 sets of 3-5 reps for each pattern , complete once every 2nd day):
- This can be done with a variety of patterns. The photo on the left indicates A basic forward jump sequence that can be done over mini hurdles and can be progressed to a hop.
- Hops can also be done side to side as seen in the middle photo.
- In the final photo, is a jump sequence where you jump forwards and back into the space between the hurdles, side to side, and back to forwards.
Numbered Square Reaction Drill (3×20-30 seconds, and incorporate your sports equipment or ball):
- Label each cone with a number. When you shout that number, the athlete has to quickly accelerate to that cone and touch it. You can include a ball pass in between each sprint.
How a physiotherapist can help with a calf strain injury
If you have suffered an injury to your calf, or have pain in and around that area and aren’t sure what it is, a physiotherapist can help! At Optimise, our detailed physiotherapy assessment, and comprehensive rehabilitation programs will cater for your sport specific needs, to get you back doing what you love as soon as possible. To find out more, get in touch via email or give us a ring to see how we can help you!
Do you need assistance managing or treating a calf strain injury?
Sports physiotherapist Chris El-Hayek has extensive expertise in offering physiotherapy services to athletes in a range of high-performance sports. He has been able to assess and treat multiple athletes with a wide range of sport related injuries. He can successfully implement programs that will minimise injury rates and enhance your athletic qualities.
- Hsu D, Chang KV. Gastrocnemius Strain. [Updated 2022 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534766/
- Spina AA. The plantaris muscle: anatomy, injury, imaging, and treatment. J Can Chiropr Assoc. 2007;51(3):158-65. PMID: 17885678; PMCID: PMC1978447.
- Meek, Wendy M. BBA1,a; Kucharik, Michael P. BS1; Eberlin, Christopher T. BS1; Naessig, Sara A. BS1; Rudisill, Samuel S. BS1; Martin, Scott D. MD1. Calf Strain in Athletes. JBJS Reviews: March 2022 – Volume 10 – Issue 3 – e21.00183 doi; 10.2106/JBJS.RVW.21.00183