Remember! Our guides are to be used following an assessment with a qualified medical professional. Do not attempt these exercises if you have not been given a formal diagnosis, or given consent to complete these exercises by a Physiotherapist.

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Calf Strain Physical Therapy Guide

What Is A Calf Strain?

Acute strain of the Gastrocnemius (large calf muscle) occurs typically when the individual attempts to accelerate by extending the knee from a stationary position with the ankle flexed in dorsiflexion, or when lunging forward. It is commonly injured in racquet sports like squash or tennis when quick sprints are required. The medial (inner) head of the Gastrocnemius muscle is the largest and has a greater capacity for force generating, because of this the medial head is more susceptible to injury compared with the lateral head. Small calf strains are very common, and often resolve following a course of rehabilitation, this can take either a few days or up to multiple months depending on the type of strain. Muscle strains are graded into 3 different categories:

  1. Grade 1: a strain or damage of up to 25% of the muscle fibres. This is the most common type of strain and normally resolves within a couple of weeks with rest, ice and exercise.
  2. Grade 2: a strain or damage of up to 50% of the muscle fibres, normally accompanied by swelling and bruising. They normally resolves within 3-5 weeks with a more intensive Physical Therapy programme.
  3. Grade 3: a strain or damage of up to 75% of the muscle fibres, with severe swelling and bruising. These injuries typically take up to 6 months to make a full recovery with or without surgery.

What Causes A Calf Strain?

Strains and sprains are most commonly the result of excessive over-stretching of tissues, strenuous contractions and/or repetitive micro-trauma. Calf strains normally occur when running and sprinting, or in sports that require rapid acceleration / deceleration changes. The pain is felt immediately in the back of the lower leg and you’ll often have to stop what sport / activity you are performing immediately as you will be unable to continue. The main cause of any muscular injury is muscular overload. Muscle overload is the main cause of a calf muscle strain. This happens when the muscle is stretched beyond its capacity or challenged with a sudden load.

Calf Strain Risk Factors

  • Age: a number of studies have shown that older sportspeople are at an increased risk of an acute calf strain. Individuals aged 30-50 are at the highest risk of developing a calf strain injury.
  • Previous achilles injury: A prior history of calf strain or achilles injury is a huge risk factor for future injury, likely caused by the scar tissue in the muscle fibres. This is why it is imperative to complete a full rehab programme.
  • calf weakness: Reduced gastrocnemius strength increases the risk of the muscle being susceptible to an overload injury.
  • Fatigue: Performing or competing whilst your muscles have been overworked and have not fully recovered increases your risk of injury.

What Are The Symptoms?

  • Sudden and severe pain during exercise, occasionally with a snapping or popping feeling/sound.
  • Pain in the back of the lower leg and sometimes achilles when walking, bending the leg, or going up stairs.
  • Tenderness in the back of the lower leg.
  • Bruising and swelling.
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Foam Rolling Calf Strains!

Deep massage of the affected gastrocnemius is a painful treatment intended to speed up the recovery process of smaller strains, which is often used by Physical Therapists, but can be performed by the patients themselves. The purpose of deep massage is to improve the mobility of the muscular tissue and prevent adherent scars forming. The massage is deep and can be very sore for people suffering from a calf strain, however the movement encourages realignment and lengthening of the muscle fibres and will improve your recovery time.

You can buy our favourite roller here!

What Are My Treatment Options?

There are many treatment options available to people who suffer from a strained calf muscle! Your rehabilitation programme and recovery time depend entirely on how severe the calf strain is. Make sure you get a full assessment from your health care professional before starting any programme.

Rest & Time

Initially, you need to stop doing the activities that caused the calf injury in the first place and prevent agitating it further. Immediately following the calf strain you can commence the RICE protocols:

  • Rest. Rest, relax and protect your gastrocnemius and achilles. Stop, change, or take a break from any activity that may be increasing your pain.
  • Ice. Cold packs will reduce pain and swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. Do no place ice directly on to skin, wrap it in a towel first to avoid ice burn! You can find our favourite ice pack here!
  • Compression. Wrapping the lower leg with a compression sleeve will help decrease swelling and improve recovery time. You can find our favourite calf compression sleeve here!
  • Elevation. Elevate your feet to reduce swelling and bruising in your calves.

Physical Therapy

Although rest is a vital component of the recovery process, it doesn’t mean the affected leg has to be completely immobilised for long periods. In fact,  the muscle fibres need to be placed under tensile loads to grow and stay healthy.  The easiest way to grow your calf muscles? Exercise! 

Calf Strain Exercises

1) Towel Stretch

Your calf muscles are located in the back of your lower leg, and are responsible for movements in which your foot points downwards (such as applying the brakes in your car). The Calf is made up of two large muscles called the Gastrocnemius and the Soleus. Having a tight calf is one of the major reasons people develop strain, so get stretching!

How to do it:

  • Sit on the floor or on your chair with a towel or a resistance loop band wrapped around your injured foot.
  • Gentle pull the band towards you forcing your ankle into dorsiflexion (toes pointing towards you)
  • Pull until your feel a comfortable stretch in your calf muscle and hold for 15 seconds.

Repeat 5 times, three times throughout the day.

 2) Soleus Stretch

The Soleus stretch targets the Soleus muscle which is deeper, underneath the larger Gastrocnemius muscle. Bending the knee relaxes gastrocnemius, allowing Soleus to be stretched in isolation.

How to do it:

  • Standing with one leg in front of the other, have something in front of you to hold on to.
  • Bend both knees, focusing on the front knee.
  • Move your weight forwards onto your toes ensuring you don’t lift off your heel.
  • Hold for 15 seconds.

Repeat 5 times, three times throughout the day.

3) Toe Scrunches

Once you can feel your pain improving and you are better able to complete exercises that you weren’t previously able to do, then you can progress to strengthening exercises of the foot to prevent your arches from collapsing.

How to do it:

  • Sitting with a towel or piece of paper in front of you on the floor.
  • Place your foot on the towel.
  • Scrunch your toes and arch of your foot, squeezing the towel on the floor
  • Hold for 5-10 seconds. Repeat 5 times, three times throughout the day.

4) Deep Calf Massage

Deep massage is a treatment intended to speed up the recovery process of injuries like a calf strain, which is used by Physiotherapists, but can be performed by the patients themselves. The purpose of deep massage is to improve the mobility of the soft tissues and prevent adherent scars forming. The massage is deep (and quite painful) for people suffering from a calf strain, however the movement encourages realignment and lengthening of the muscles fibres and will improve your recovery time.

Many professionals find it preferable to prescribe foam rollers or Muscle Stick rollers, which can be found here!

5) Stair Stretch

* Note: This exercise places a lot of load through your calves and achilles tendon! It is a very high level exercises and if it increases pain then skip this exercise until you get to the point where it is no longer painful.

The stair stretch is both a stretching and strengthening exercise, and places a great amount of tensile load through the achilles tendon and belly of the calf muscle. This exercise is for people who are reaching the end of their rehab and aren’t suffering from pain whilst exercising.

How to do it:

  • Standing on a step or a block with the heels of your feet overhanging the edge.
  • Slowly allow your heels to continue going in a downwards direction until you feel a comfortable stretch in your calves.
  • Hold the stretch for 10-15 seconds, before slowly going back to neutral.

Repeat 5 times, three times throughout the day.

6) Peed Pants Walk

This is a novel exercise prescribed by Physical Therapists and personal trainers that will help ease you back into competitive sport. It places a great deal tensile load through the the calf muscles and strengthens them very quickly, as a result, this exercise should only be used at the end of your rehab or as a preventative exercise.

How to do it:

  • Tie your theraband into a loop or use a loop band! Step into the loop so that it is wrapped around your ankles.
  • Stand hip width apart, sit into a squatted position and raise up onto your tip toes.
  • Slowly step side to side like a crab whilst maintaining on your toes (5 steps each direction)
  • Try and step as slowly as possible to really activate the hip and ankle stabiliser muscles.

Repeat 5 lengths, 3 sets. Try to do this 3 times per day.

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