Article written by:

Rick Clingan

Senior Physiotherapist

Calf pain can come from numerous sources, the most common being muscle strains or tears.

However calf pain can also come from the following sources: referred from the lumbar spine or myofascial trigger points in the buttock, nerve entrapments, stress fractures, compartment type syndrome, cramp, vascular causes (varicose veins, DVT, artery insufficiency) and delayed onset muscle soreness are some of them.

There are two main muscles in the calf which are commonly strained. Gastrocnemius and Soleus. Correct diagnosis of a calf strain is crucial because the rehabilitation of these two muscles is significantly different. Also incorrect or incomplete rehabilitation often results in re-strains.

Gastrocnemius strains usually occur as a sharp pain that comes on instantaneously.

It is a ‘power’ muscle and the mechanism is typically one where the athlete is accelerating from a static position or lunging forward.

The gastroc muscle has two heads, medal and lateral and it is the muscle responsible for the bulbous shape of our calves. It runs from above the knee down to the Achilles tendon.

Gastroc strains are most commonly in the medial head of the muscle.
Rehabilitation: Initially rest, ice, compression and elevation (RICE). Gastroc stretching is then done with a straight leg/knee and progressed to strengthening. Return to jogging when pain allows is usually safe, and a little soreness is not usually a re-strain. Re-strain is likely to occur by progressing to sprinting too early.

Soleus strains on the other hand often present as a tightening over days or weeks. They can also feel like soreness that gets worse whilst running and eventually causes the athlete to stop running, either during that run or subsequent runs.

Unlike gastroc, soleus is very active during walking and jogging and is often strained this way. Once strained, walking can keep this muscle sore.

It is a broad flat muscle lying under gastroc. It runs from the top of the tibia down to the Achilles tendon. It can be palpated at each side of the calf.

Soleus strains occur more often in the lateral side of the muscle.
Rehabilitation: Initially RICE. Soleus stretching is then done with a bent knee, as is strengthening. Return to jogging is more problematic with a soleus strain. It can feel OK jogging initially, and then get sore later during that run, or even the next run. This is usually a re-strain requiring weeks more rest and rehab. Return to jogging therefore needs to be conservative and managed carefully.

Recurrent calf strains are even more problematic, due to the build up of scar tissue and the increased likelihood of further break downs. Seeing your Physiotherapist and getting an accurate diagnosis and rehab program could well save weeks (even months) of pain and frustration.