Question 1

Overview of the anatomy

Accepted Answer

Two main muscles make up the majority of your calf.

The gastrocnemius muscle is the most superficial. It makes up the bulkier part at the top of your calf and originates from behind your knee.

The soleus muscle lies deep to the gastrocnemius muscle. Its fibers run down into your lower leg, almost as far down as your heel.

These muscles join to form a thick fascia layer called the Achilles tendon, which inserts into your heel bone.

A calf strain injury involves either of these muscles and sometimes both.

Question 2

Symptoms of a calf strain

Accepted Answer

The severity of your symptoms in the first few days after straining your calf will depend on how badly you’ve injured your muscles. Things you may experience include:

You may have moderate to severe pain in the area of the tear.
With milder strains, you may be able to walk with a near-normal gait pattern. However, if yours is more severe, you may struggle to walk.
It’s likely to be painful to stretch your calf, and in severe cases, placing your heel flat on the floor may be challenging.
Running may hurt, but not all people report pain with running; some describe it as a crampy feeling or persistent stiffness.
You may feel pain when contracting your calf muscle against resistance.
You may see some swelling and bruising, but not always. And if it does appear, it may take a few days. Bruising also often shows up lower than the injured area, for example, in the foot and ankle, because gravity pulls the tissue fluids downward.

Question 3

When to see a doctor

Accepted Answer

Most calf strains can be treated at home using a conservative exercise-based treatment plan as outlined in the app. You should consider seeing a medical practitioner if you have any concerns about your injury, particularly if:

You heard or felt a pop when you injured your leg – or it felt like someone kicked you in the back of the heel – especially if it was in the area of your Achilles tendon. These may indicate a severe Achilles tendon tear, and you should have it investigated immediately. Delaying proper treatment or following the wrong advice can result in your tendon not healing correctly.
You think your injury is severe, with lots of swelling and bruising.
Your leg (thigh, calf, or foot) is very swollen, red, hot to touch, or throbs with pain. These signs can indicate a blood clot, and you should have it investigated immediately.
Night pain keeps you awake or interrupts your sleep.
You have pins and needles or tingling in your leg, which may indicate possible nerve injury, and our treatment plan may not be suitable for you.
Your symptoms are getting worse.
Your injury isn’t healing within the expected healing timeframes (mentioned in later sections).

Question 4

Causes of a calf strain

Accepted Answer

People often blame “tight” calf muscles for causing a strain, but weak calf muscles or over-training are the primary causes for calf strains. Some of the most common causes include:

Overtraining: Not allowing your body to fully recover after a high-intensity session causes an accumulation of micro-damage in your muscle, and you can strain it more easily.
Fatigue: You are much more likely to tear a calf muscle towards the end of a hard training or running session when your muscles are tired.
Sudden increases in running intensities and volume don’t allow your muscles enough time to adapt and grow stronger, making them vulnerable to injury.
Weak calf muscles are prone to strain under forceful contractions during sprinting, hill running, jumping, or kicking.
A previous calf strain makes you more at risk of re-injury, especially if you haven’t fully recovered from the initial injury.
Poor strength and control in your lower back and core muscles can also lead to injury. A weakness in these areas may cause overloading of the calves.
Insufficient warm-ups, especially before intense training sessions: “Cold” muscles have a higher risk of straining.
Older age also increases your calf strain risk. Therefore, regular strength training sessions are essential to mitigate muscle loss and strength reductions associated with aging.

Question 5

Treatment, recovery times & prevention

Accepted Answer

Treatment

When you strain or tear your calf, cells, and fibers in the muscle break apart. While some can heal, others need to be cleared away and replaced with new cells. For your muscle to recover, it needs to go through a natural three-stage healing process:

First, your body gets rid of the injured cells through an inflammatory process (Stage 1).
Next, your body creates new muscle cells to replace the damaged ones (Stage 2).
Finally, your body strengthens the new muscle cells, but only in response to the correct exercises which stimulate this process (Stage 3).

The app’s treatment plan aligns with this natural healing process. For example, the graduated strength exercises signal the body to build and strengthen new muscle cells. Because we all heal at different rates, it is critical to progress through the exercise levels and stages at your own pace.

Recovery time

To offer you some guidance on how quickly you might recover from your calf strain, consider the following recovery times:

A very mild calf strain usually heals within 15 to 21 days.
More severe strains can take between 20 and 60 days to recover fully.
If you have a very severe strain involving a large part of the muscle or the tendons, it can take 90 days or longer to recover fully.
If you’ve neglected your calf strain for a while, tried to train on it, and reinjured it a few times, it may take several months to heal.

Prevention

Do regular strength training for your calves.
Keep up good core strength and control – as well as in the rest of your muscles.
Allow sufficient recovery time after hard training sessions. If your calves are constantly tight and uncomfortable, it may be a sign that they are not getting enough time to recover.
Avoid sudden increases in running volumes or intensity. Your body needs time to adapt and grow stronger.
Incorporate a sufficient warm-up before you train, especially before intense training sessions.

Question 6

Research References

Accepted Answer

Bramah C, Preece SJ, Gill N, Herrington L. Kinematic Characteristics of Male Runners With a History of Recurrent Calf Muscle Strain Injury. Int J Sports Phys Ther. 2021;16(3):732-740.
Franchi MV, Reeves ND, Narici MV. Skeletal Muscle Remodeling in Response to Eccentric vs. Concentric Loading: Morphological, Molecular, and Metabolic Adaptations. Front Physiol. 2017;8:447. Published 2017 Jul 4. doi:10.3389/fphys.2017.00447
Franchi MV, Reeves ND, Narici MV. Skeletal Muscle Remodeling in Response to Eccentric vs. Concentric Loading: Morphological, Molecular, and Metabolic Adaptations. Front Physiol. 2017;8:447. Published 2017 Jul 4. doi:10.3389/fphys.2017.00447
Fields, Karl B.1; Sykes, Jeannie C.2; Walker, Katherine M.3; Jackson, Jonathan C.4 Prevention of Running Injuries, Current Sports Medicine Reports: May 2010 – Volume 9 – Issue 3 – p 176-182
Mahieu NN, McNair P, Cools A, D’Haen C, Vandermeulen K, Witvrouw E. Effect of eccentric training on the plantar flexor muscle-tendon tissue properties. Med Sci Sports Exerc. 2008;40(1):117-123. doi:10.1249/mss.0b013e3181599254
Thacker SB, Gilchrist J, Stroup DF, Kimsey CD Jr. The impact of stretching on sports injury risk: a systematic review of the literature. Med Sci Sports Exerc. 2004;36(3):371-378.
van der Worp MP, ten Haaf DS, van Cingel R, de Wijer A, Nijhuis-van der Sanden MW, Staal JB. Injuries in runners; a systematic review on risk factors and sex differences. PLoS One. 2015;10(2):e0114937.

Calf strain treatment plan