If you have ever suffered from a “pulled” or strained calf muscle, you know that running is difficult to near impossible and even walking can be an issue.
Calf injuries are common and occur in both competitive and recreational athletes of all kinds (such as runners, soccer players, basketball players, gymnasts, and dancers) and are frequently seen in weekend warriors as well as active individuals.
The major posterior calf muscles include the gastrocnemius, soleus, popliteal, and plantaris muscles. These muscles primarily perform plantarflexion of the ankle (pointing the toes) and are active during any type of upright ballistic activity. The gastrocnemius and soleus make up what most people call the “calf” and connect into the Achilles tendon.
Calf muscle strains usually occur when the muscles are not warmed up properly or have fatigued significantly during exercise. Often, clients report symptoms including soreness or tightness in their calf muscle prior to the injury.
There are many risk factors that may cause a calf strain. Environmental factors that could result in an accident and injury should also be considered when trying to prevent any form of injury. Even weather conditions (cold or inclement) can cause you to slip and then strain the muscle.
Risk Factors for Calf Strain/Pull include:
- Age. Older age increases your risk, but ages 40-60 seem to be at the highest risk.
- Prior injury.
- Prior lower leg injury. A history of other lower leg injuries (such as a hamstring pull or Achilles tendinitis) puts you at a greater risk.
- Increased (large) body mass.
- Poor general conditioning.
- Decreased calf muscle strength.
- Training errors including tapering up volume and intensity too quickly. For runners, this could be a sudden increase in mileage, an increase in intensity, returning from a layoff or a combination of these factors.
- Possible biomechanical factors.
- Environmental factors Such as slick surfaces due to cold weather that can lead to an accident and injury.
Those with posterior calf injuries often present with limping, swelling of the posterior calf, and significant pain at the time of injury. A calf strain can consist of an injury to the gastrocnemius or soleus (or both).
Gastrocnemius is the largest muscle on the outside of the calf. You’ll feel pain, soreness, and tightness deep within the muscles along the back of your lower leg. Performing a classic “calf stretch” will often provoke pain as will calf raises or vertical hops. Any motion that requires you to push off with your toes quickly and with any amount of force is likely to elicit pain
This is the muscle under the gastrocnemius which is smaller and only partially palpable on the sides of the calf area, are a little more difficult to diagnose because they can sometimes masquerade as Achilles tendon problems if they occur low enough along the muscle.
Like a gastrocnemius strain, you’ll have soreness, tightness, and pain in the soleus muscle. Soleus strains can be distinguished from a gastrocnemius strain by comparing the pain elicited from a traditional straight-legged calf stretch versus the pain from a bent-knee calf stretch.
The gastrocnemius muscles cross the knee joint, but the soleus does not. A “gastroc” strain will not be as painful with the knee bent while a soleus strain will often be more painful.
With any type of calf strain, you might be able to feel an area of muscle tissue that is especially tight or tender either by palpitating with your fingers or rolling on a stiff foam roller or PVC pipe. In larger tears, there may actually be a bump or divot that is present.
On average, the gastrocnemius (gastroc) is more prone to injury for two reasons:
- The gastroc crosses two joints (the ankle and the knee).
- The gastroc has a higher proportion of fast-twitch type muscle fibers.
Due to these factors, there is an increased mechanical load on the muscle which predisposes it to injury.
In contrast, the soleus only crosses one joint and has slower twitch muscle fibers. Due to the difference in muscles and fiber types, it means both muscles must be trained in a different matter, both pre-injury, and if necessary, post injury.
Unfortunately, about 10% of calf injuries involve strains to both the gastrocnemius and soleus. If you’re having trouble isolating your calf injury to one specific muscle, this might explain why.
The course of treatment is dependent on the intensity of the pain and the location of the injury. Please seek competent advice from a medical doctor, physical therapist or athletic trainer if you’re experiencing severe pain and/or significant loss of function. A professional can assess the severity of the strain and address how to handle the injury.
For the purpose of this discussion, I will address a Grade I or minor Grade II injury. The initial course of treatment following the sprain includes PRICE, which stands for Protection, Rest, Ice, Compression, and Elevation.
- Protect. Initially, you may choose to “protect” the injury site. The most common mistake is to over stretch. In this phase, avoid aggressive stretching and at most, only perform a gentle range of motion.
- Rest. Depending on the severity of the injury, you will need to significantly reduce your training volume or possibly stop training for a period of time. More severe pain or prolonged pain over many weeks means that you may need to discontinue your activity for 2-4 weeks or longer (depending on the intensity and duration of symptoms). Keep all activities relatively pain free.
- Ice. Apply ice to the painful area. The rule for icing is to apply ice no more than twenty minutes per hour.
- Compression helps to prevent and decrease swelling.
- Elevation. Compression and elevation in combination is a great way to reduce swelling and edema. Just make sure to position the leg higher than the level of the heart for maximum effectiveness.
Once you have progressed from the acute phase of the injury and you are ready to start into the sub-acute phase and rehabilitation, be sure to follow the suggestions below. Please keep in mind that you still do not want to over stretch the injury. The old philosophy of “no pain, no gain” should not be followed. For a complete and speedy recovery, it’s best to slowly and incrementally progress through the rehabilitation phase so you don’t re-injure the area and cause a setback in your recovery.
Mobilize the fascia and muscle tissue.
Work on restoring normal pain free movement of the calf. Start with mobilization of the areas above and below the injury site by using a tool such as Thera-Band Standard Roller Massager or a foam roller. Be gentle, and initially do not mobilize over the site of injury. As pain decreases and you are tolerating mobilization over adjacent sites to the injury, you can gentle start mobilizing the injured area.
For a more aggressive mobilization well into your healing process, you may consider using a CTM Band. The CTM Band variations are more aggressive and combine the compression of the band using a tack and floss technique. (“CTM” stands for compression, tension, and movement.) CTM Band techniques are not typically performed during the acute phases of recovery. They are more for prevention or to be used during the sub-acute or chronic phases.
Please refer to Mobility Band Exercises.pdf. Use code MTA15 for a 15% discount. (If you suffer from any form of blood clotting disorder or are on blood thinning medications, I would advise against utilizing mobility bands for any type of deep compression.)
Initially the focus is on just maintaining as much pain free range of motion (ROM) possible. You do not want to start aggressively stretching this area as it will slow healing time and may lead to additional injury. Be gentle and focus on keeping your ROM. Don’t let the calf become too tight and restricted, but don’t be aggressive with your stretching either. Pain may initially limit the full motion, but over time, progress back into full range of motion.
Initiate a strengthening program.
Any area injured will be weak initially. Slowly start progressing into strengthening the injured area. Focus on active range of motion without resistance, and then progress to partial resistance followed by body weight exercise before returning to any weightlifting activities.
The human body is primarily made of water, which is critical for all body functions. Hydrate more frequently during recovery. Adequate water intake is critical as your body attempts to heal and flush out metabolic wastes. Dehydrated tissues are prone to injury as they struggle to gain needed nutrients to heal and repair. Dehydrated tissues are less flexible and tend to accumulate waste products.
Warm up prior to exercise.
This should always be a priority if you want to avoid injury and perform at a high level. Especially if you continue with your training during your recovery and rehabilitation, you must focus on a proper warm up. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also prepares the tissues for exercise.
Like a good warm up, a good cool down should be a priority for avoiding injury and insuring that you’re not over straining an injury as you rehabilitate. After performing your exercises, take extra time to cool down and stretch. Focus on calf stretching as well as general lower extremity mobility stretches. Take this extra time during the cool down to provide extra care and support to the injured area and to work on any potential causative areas (spot train as needed). This is when you can really work to rehabilitate and do “prehab” to avoid future injury.
Depending on severity of injury, it can take 4-8 weeks to fully recover from a calf strain. If you’re not experiencing relief after a week or two of aggressively managing the symptoms, contact your local physical therapist for an assessment and help in managing the condition.
The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area. You may need assistance in identifying the biomechanical cause of the condition in order to eliminate the pain. You may need additional hands on techniques or modalities to help address the injury. A custom orthotic may be necessary or modalities, such as iontophoresis or low-level laser therapy (LLLT), may be indicated.
Get More Help
More specific strategies to help you determine the cause of your calf strain/pull along with more thorough treatment and prevention strategies for those suffering from a calf strain/pull are covered in the Resilient Runner Programwhich is designed to help you meet your training goals by insuring you have the tools to avoid injury, recover quickly, and train at a peak level.
What’s Inside the Resilient Runner Program:
- Guidance on preventing and self-treating common running related injuries, including Hip Flexor Pain, Runner’s Knee, IT Band Syndrome, Piriformis Syndrome, and more!
- Specific guidelines on when and how to return to running after experiencing an injury.
- Rehabilitation guides with step-by-step photos demonstrating recommended exercises.
- Step-by-step instructions on how to apply Kinesiological tape.
- Downloadable podcasts, videos, and more!
If you’re tired of ongoing aches, pains, and injuries, learn how to become a resilient runner so that you can continue to train and compete in order to meet your goals!
Read more about the Resilient Runner here: