Gastrocnemius or soleus – two different injuries
The calf is made up mainly of two muscles. The gastrocnemius, which lies more superficially, crosses the knee and ankle joints, works during a fast push-off and is the one most often strained suddenly – usually in its medial part. This is the so-called “tennis leg”: sharp pain in the middle of the calf when setting off for the ball, jumping or sprinting, often with a feeling of being hit from behind.
The soleus lies deeper, crosses only the ankle joint and works particularly hard with the knee bent – among other things, with every running stride. Its injuries often develop gradually: the calf stiffens and hurts more and more during a run, without one clear moment of injury. Symptoms like these are sometimes played down, yet they can keep coming back if the return to running is too quick.
First we rule out anything urgent
Before we deal with the muscle, we check for two situations that need a doctor. The first is an Achilles tendon rupture – it has a similar moment of injury, but the main signs are a dip you can feel in the tendon above the heel and a positive Thompson test: if squeezing the calf does not make the foot point down, the tendon may be ruptured. Difficulty rising onto your toes occurs with both injuries, so on its own it does not tell them apart. With a muscle strain the pain and tenderness are in the belly of the calf muscle, and the tendon is intact. We describe chronic tendon problems separately on the Achilles tendon pain page.
The second is deep vein thrombosis. Swelling of the whole calf, warmth, redness and pain increasing without a clear injury – especially after a long journey, surgery or immobilisation of the leg – need an urgent medical consultation, not a massage.
Treatment: early, graded loading
In the first days after the injury the calf is usually swollen and painful when walking. Raising the leg, light compression and avoiding activities that cause sharp pain help, but without complete rest – short walks within a tolerable range are advisable. Over time the bruise may move down towards the ankle; that is usually just the bruising tracking down, not a sign of getting worse.
With a muscle strain we do not recommend long immobilisation. For the first few days we protect the calf – shorter steps, sometimes a heel raise in your shoe – but we quickly get back to walking and gentle isometric exercises. Then we introduce calf raises with the knee straight and bent, gradually increasing the weight, the number of repetitions and the speed. This kind of medical training is the foundation of rebuilding, just as with a hamstring strain.
Massage and soft tissue work help reduce tension and discomfort at a later stage, but they will not replace exercise. Healing time depends on the extent of the injury: with minor strains the return to training usually takes a few weeks, with more extensive ones – longer.
When you can return to running and sport
The return is decided not by the calendar but by what the calf can do. The condition for returning to running is being able to do a set of single-leg calf raises and hops comfortably and without pain, with a result close to the healthy side. Before sports with sharp changes of direction we add accelerations, braking and jumping exercises. It is also worth keeping calf strength exercises going for good, because a previous strain increases the risk of another one. Before a match or a hard session, a short warm-up with hops and accelerations works well to prepare the calf for explosive work.
It is worth coming in during the first days after the injury – exercise that is started early and well dosed makes the return to full function easier. If, however, the symptoms point to an Achilles tendon rupture or a blood clot, contact a doctor first. You can arrange an appointment via the Contact page.