8 Recovery Exercises for a Strained Calf Muscle

What are the Calf Muscles?

There are three calf muscles located in the lower leg.

1. Gastrocnemius
   • The Gastrocnemius is a large muscle group that originates from just above the backside of your knee. It is separated at the top as two muscular heads that come together in a “Y” formation near the bottom. It bends both the knee and ankle when it contracts. It also works hardest when the knee is in a straight position.
2. Soleus
   • The Soleus is a wide and flat muscle that lies underneath the Gastrocnemius towards the lower leg to the ankle. It is a strong muscle that helps to flex the ankle joint. It works hardest when the knee is in a bent position.
3. Plantaris
   • The Plantaris is a skinny, rope-like muscle that runs from behind the knee down to the inside of the Calcaneus (heel bone). It assists to flex both the knee and ankle joints.

These three calf muscles (collectively known as the triceps surae) work together to perform knee flexion and ankle plantarflexion. Knee flexion is when you bend your knee. Ankle plantarflexion occurs when you point your toes down away from you or when you raise up onto your tippy toes.

The fibers from the Gastrocnemius and Soleus muscles combine together to form the thick Achilles Tendon located at the back of the ankle.

What is a Calf Strain?

A calf muscle strain, or pulled muscle, is an injury to the muscle or tendon when there is an overloading force that is placed through the muscle. This can result in a calf strain (damage to tissue) or even partial tearing or complete tearing of the muscle/tendon.

Calf muscle strains typically occur suddenly, but it is possible to suffer a strain with repetitive load over a sustained amount of time (i.e. repetitive lifting/pushing of an object).

Symptoms of a Calf Strain

Diagnosing a calf strain is relatively easy as there will be pain and tenderness to the touch at the injury site on the calf muscle. There will likely be some swelling near the injury site as well.

Depending on the severity of the calf strain, the individual may be limping or afraid to place weight on the foot in fear of increasing the calf pain.

Within the first few hours, the calf muscles will begin to tighten up as the healing process begins.

Other Potential Lower Leg Injuries to Rule Out

Since calf injuries are fairly easy to identify, there are really only two other potential lower leg injuries that you want to rule out. The first and most severe one is an Achilles Tendon rupture. Most people that suffer an Achilles Tendon rupture report the sensation that someone kicked the back of their ankle or stepped on the back of their ankle when the injury occurred.

This did not actually occur, however the Achilles Rupture injury causes a similar sensation. If someone had an Achilles Tendon rupture, there would be a definitive divot within the tendon that would be quite noticeable. Additionally, the person would be unable to walk normally and they would need to seek out medical care immediately. Achilles Tendon reconstruction surgery is typically required in these cases.

Lastly, another injury that could be mistaken for a calf strain is Achilles Tendonitis. Again, this injury would be located within the tendon itself at the back of the ankle. This location is much further down the leg than where a calf strain would occur. Achilles Tendonitis is simply an overuse inflammatory injury to the Achilles Tendon that can be treated with physical therapy exercises.

First Steps to Take After a Calf Strain

You should treat an acute calf strain by following these initial steps:

1. Rest
2. Ice
   • Use a gel cold pack to wrap around the lower leg. Cold therapy (cryotherapy) can help to reduce localized swelling and pain. Combine the cold pack with elevation several times per day for the first few days after the injury for 10-15 minutes at a time.
   

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3. Compression
   • Gently wrap a compression bandage around the lower leg to help prevent excessive swelling.
   

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4. Elevation
   • Elevate the leg above the heart level. Combine with a cold pack. Remember “toes above the nose.”
5. Non-Steroidal Anti-Inflammatory Medications (NSAIDs)
   • These are over-the-counter oral medications that can reduce pain and inflammation (Aleve, Advil, Ibuprofen). Be sure to find out if these are safe for you to take by first speaking with your doctor or medical provider.
6. TENS Unit
   • A TENS Unit is a hand-held electrical device that can help provide immediate pain relief. It uses the “gate theory,” which temporarily blocks the pain pathways from reaching the brain when the device is on. TENS can be very helpful in reducing pain during the first few weeks after the injury.

     

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If you were unfortunate enough to suffer a severe calf strain or calf muscle tear, then you will likely find it very painful to walk on your injured leg. This is due to the stretch that is naturally placed through the calf muscles when walking.

In this case, you would likely benefit from using a walking boot and crutches to help allow the calf muscles to rest and heal without continuing to aggravate the injured tissue.

If you do decide that a walking boot and crutches would help, you will need to use them for 2-6 weeks in most cases to allow for ample healing time.

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Modification of Sports Activities should be considered after even a mild calf strain. It is better to allow for complete healing of the injured calf muscles than to continue to participate in sports or other high-intensity activities and risk a full-blown muscle tear.

Seek medical attention if there is severe leg swelling present or if you still cannot put weight on your foot after the initial 1-2 days following the injury.

When Can I Start Calf Strain Rehabilitation Exercises?

The simple answer: IMMEDIATELY! After suffering a calf strain, you can immediately begin to perform gentle calf strain physical therapy exercises as long as they are active range of motion activities within pain-free ranges. You will actually help promote healing and prevent any excessive increase in myofascial tightness (muscles and fascia) if you perform active range of motion calf strain exercises throughout the healing process. Remember, “motion is lotion.”

Begin with ankle pumps and ankle circles within pain-free ranges. Never push through the pain with these!

1. Ankle Pumps
   • Perform: 2 sets x 15 reps multiple times per day
2. Ankle Circles
   • Perform: 2 sets x 15 reps (both counter-clockwise and clockwise) multiple times per day

Over time, as the swelling, pain, and tightness in the calf muscles decrease, you can slowly progress the intensity and difficulty of the calf strain exercises.

Activities to Avoid

There are a few activities that you will want to avoid within the first week after a calf strain injury.

1. Aggressive massage
   • Aggressive massage will only aggravate the injured muscle and delay the natural healing process.
2. Heat Therapy
   • Heat should not be used until after the acute inflammatory stage is over (after 1-2 weeks). Heat will cause vasodilation of the capillaries in the area of the injury leading to increased swelling.
3. Participation in high-stress/impact activities
   • Luckily, calf strain injuries are self-limiting, so restricting your participation in any activity that can cause further injury to the calf muscles should be fairly obvious.

Prognosis After a Calf Strain

The prognosis for a full recovery after a calf strain is excellent. I’ve successfully rehabilitated every single one of my patients with calf strains and calf muscle tears back to their pre-injury capacity. Expect your full rehabilitation program to take anywhere from 6-12 weeks depending on the severity of the initial calf strain. The sooner you get started with doing the proper calf strain exercises, the faster your recovery will be. You’ve got this!

How to Prevent Calf Strains in the Future

Prevention of potential calf strains in the future can be best achieved by doing a proper warm-up prior to participation in high-exertion activities that will challenge your calf muscles (i.e. lifting weights, hiking, running, jumping, etc.)

1. Active (Dynamic) Warm-Up
   • Perform dynamic warm-up activities prior to starting the activity. Dynamic warm-ups can include standing heel raises, leg swings, jumping jacks, walking lunges, downward dog (from yoga), etc.
2. Calf Stretching Cool-Down
   • Make sure you stretch out your calf muscles during your cool-down after completing a high-intensity activity. Cool-down calf stretches should include both a Gastrocnemius stretch (knee straight) and a Soleus stretch (knee bent). Hold each stretch for 30 seconds and perform 2-3 repetitions each.

     

     

3. Strengthening Exercises
   • Strengthening of the calf muscles will improve the overall tolerance and workload of this muscle group. This can help prevent injuries as the muscles won’t be as easily overloaded. Calf strengthening exercises should be performed weekly as a maintenance program and should include standing heel raises (both double and single), single-leg Romanian deadlift, single-leg balance, and seated heel raises.