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Calf Strain - Gastrocnemius

What is a Gastrocnemius calf strain?

Typically referred to as a "pulled muscle", a calf strain is an injury to the large muscles, or tendons, in the lower portion of the leg. These muscles are used to propel us forward when we are walking and running.

 

There are three grades of muscle strain to be aware of:

  • Grade 1 – this is a mild strain causing small tears in the muscle fibres. This is often an overstretch of the muscle or rapid stretch of a cold/fatigued muscle. There is no decrease in strength but you will experience pain and tenderness the next day,
  • Grade 2 – this is a moderate where half of the muscle fibres have torn in some capacity. This is often sharp and sudden with a loss in power, some swelling and pockets of bruising.
  • Grade 3 – this is a severe strain and involves the tendon detaching from the muscle or the muscle earing in two places. Rapid swelling and bruising as well as pain and loss of function of some foot movements. In some cases, you can get a bunching up of the muscle making it look like a round ball.
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What are the symptoms of a calf strain?

You will most likely experience the pain in one of two places. In the belly of one of the Gastrocnemius muscles, in the centre of the large meaty part of the calf, or calf muscle attaches to the Achilles tendon.

With a Gastrocnemius strain, you will be able to place your finger directly on the area that hurts.

 

What the pain feels like.

A repetitive strain will be a gradual build-up over time, starting as a bit of stiffness in the morning, easing with a light warm-up and some exercise then becoming increasingly painful towards the end of your training and through the night.

 

A sudden muscle strain will often present as:

  • A sharp and sudden pain.
  • Tender to palpate the area
  • Reduced power or range of movement.
  • Muscle spasm or the muscle feeling firm to touch
  • Bruising and swelling in the more severe cases.

 

What makes the pain worse?

  • Heel raises.
  • Walking or running when you are pushing off through the ball of the foot.

 

What causes a calf strain?

Sudden calf strain

  • Sudden change in training. Specifically the introduction of sprinting or running uphill. This will put a tremendous amount of force through the calf muscles and without adequate strength training you will be susceptible to a calf strain.
  • Fatigue or poor conditioning increases the risk of a muscle strain. This can also be linked to someone returning from injury or a period of rest where the body has deconditioned over time. As a muscle fatigues it experiences an increase in tension becoming tight and less reactive to changes in speed, direction and gradient when you are exercising.
  • Dehydration makes the muscle less pliable and elastic putting you at an increased risk of a calf strain.

 

Repetitive strains

This is often a lot more subtle and the pain will build up over time. Repetitive strains to the calf muscles have been linked to:

  • New footwear. A change in footwear or the level of support can change your gait placing more stress on the calf muscles. Such as a shift from a standard running shoe to a more maximal cushioning.
  • Old footwear. Tired, old or worn-out footwear can contribute to repetitive strains of the calf muscles. As the material degrades over time it will change the mechanics of the foot altering your gait pattern and changing the loading through the calf muscles.
  • Altered biomechanics. Conditions such as can increase the risk of a calf strain due to the mechanics of the foot changing the correction of force through the lower leg. Equally, if you have a strength imbalance or are returning from injury you are at an increased risk of a calf strain due to fatigue and the loading of the muscle.

 

Conditions that present like a calf strain. 

Something to be aware of is a blood clot in the calf or DVT (Deep vein thrombosis) as these can present similarly. There is one main difference that makes it stand out:

  • Severe pain without the presence of bruising.

A test you can do is sitting down on a chair with your leg out straight in front of you, pointing your toes towards you (toes towards the nose) then squeezing the calf. If you experience intense pain, you should seek medical advice immediately.

Treatment for a calf strain.

  • First 24 hours you will want to apply compression only to the area. This will provide support to the muscle whilst allowing the tissue to start repairing itself. The compression will limit any excessive swelling and help to minimise secondary tissue damage.
  • After 24 hours you should start applying the POLICE protocol:

 

    • P: Protect the area. This can be changing footwear or wearing a supporting knee brace
    • OL: Optimal Loading. Take as much weight as you can without making things worse. You may need rest or crutches.
    • I: Ice the area for 20 minutes at a time to relieve inflammation.
    • C: Compress the area to help reduce any swelling.
    • E: Elevate the area by putting your leg on a few pillows

 

  • Heat
  • Avoid stretching
  • Avoid impact-based exercise
  • Bike and swimming are good
  • Gradual strengthening exercise program

 

For grade 3 tears you may require surgery

Single-Leg Standing

This exercise helps with neuromuscular control by strengthening the small intrinsic muscles that help with balance, joint stability and movement feedback to the brain.

  • Place a folded towel or pillow on the floor.
  • Stand with one foot on the object.
  • Lift one foot off the ground keeping your hands by your side and a slight bend in the knee.

Frequency and duration 

  • Stand for 30 seconds for each leg
  • Complete this frequently throughout the day or for a more structured approach, 3 sets of 30 seconds on each leg 4 times a day.

Alternatives

  • Easier - Do this on a hard floor
  • Harder - close your eyes

Plantar Flexion Against Resistance

This exercise is designed to help strengthen the calf muscles as well as improve ankle mobility.

  • Sit on the ground with one foot planted for support and the other slightly out in front.
  • Place a resistance band or towel around the ball of the foot
  • Gripping the band/towel in both hands, push the foot down whilst still keeping the heel in place.
  • Return the foot back to the neutral position in a controlled manner.

Frequency and duration

  • Push down for a count of 2 seconds
  • Hold for a count of 2 seconds
  • Raise back up for a count of 2 seconds
  • Complete 3 sets of 12 on each leg

Alternatives

  • Easier - Apply less resistance
  • Harder - Apply more resistance

 

Isometric calf raises

This exercise is will help to strengthen the calf muscles in a controlled manner using your body weight.

  • Stand with both feet on a step and your heels over the edge.
  • Raise yourself up and then remove one leg so you are standing on one foot.
  • Lower yourself down in a controlled manner until your heel is lower than the step.

Frequency and duration

  • Raise up with both feet
  • Lower for a count of 3 seconds
  • Hold for a count of 1 second
  • Complete 3 sets of 12 on each leg

Single leg heel raises

This exercise uses your body weight to strengthen the calf muscles.

  • Stand with one foot on a step and your heel over the edge. Hold on to the wall for support.
  • Raise yourself up onto the ball of your foot.
  • Lower yourself down until your heel is lower than the edge of the step.
  • Repeat this movement to raise yourself back up.
  • Frequency and durationStarting from the centre:
    • Lower for a count of 3 seconds
    • Hold for a count of 1 second
    • Raise yourself back up for a count of 3 seconds.
    • 3x sets of 12 on each leg

    Alternatives 

    • Easier - do this exercise on a flat surface
    • Harder - hold a weight in each hand

     

Ski squats

This exercise is designed to improve single-leg strength.

  • Start with your back against the wall and your knees slightly bent in a half squat position.
  • Lower into a deeper squat and at the same time shift your weight over to the right leg.
  • Return to the centre in the half squat position
  • Lower into a deeper squat this time shift your weight over to the left leg.

Frequency and duration

Starting from the centre:

  • Lower for a count of 3 seconds
  • Hold for a count of 2 seconds
  • Return to the centre for a count of 3 seconds.
  • 3x sets of 12 on each leg

Alternatives 

  • Easier - reduce how far you slide over to the left/right
  • Harder - Make the squat deeper and hold for a count of 4 seconds.

 

The information on this site is intended for educational purposes.

You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.

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