Calf Tear: How to Recognise and Treat
A calf tear is a common muscle injury among runners. Learn how to treat it and how to prevent it from happening again.
What is a Calf Tear?
A calf tear occurs when one of the calf muscles is overloaded, leading to a tear in some of its fibers. It's a very common injury among runners, first mentioned in medical literature in 1883 as "tennis leg." Although it can happen in any sport and to any runner, a 2022 study published in the Journal of Bone and Joint Surgery found that calf injuries are more common among elite athletes aged 22 to 28, particularly in men, and these injuries tend to recur in about 19% to 31% of cases. Among amateur runners, the most at-risk group is older runners, especially older men. However, a calf tear can affect anyone, with its severity varying significantly.
What does a Calf Tear feel like?
A calf tear usually presents as a sharp, sudden pain, often accompanied by a sensation of "snapping" or "crackling." It's typically not a pain you can run through, and even if you can, you shouldn’t, as it could worsen the injury. Other symptoms might include tightness in the calf, a particularly tender and painful area, swelling, and an inability to push off the affected leg properly. These symptoms usually subside with rest.
What should I do if I experience one?
If you think you've torn a calf muscle, stop running immediately. It is advisable to ice it as soon as possible. You can use a Compex Hot & Cold Gel Pack for example. Some claim that it slows healing, but this is thought to be negligible.
If you experience pain, I recommend that you add a little extra heel height to your shoe - or wear shoes with a higher heel - to relieve the calf muscle when moving around.
You might be familiar with the RICE approach (Rest, Ice, Compression, Elevation), but there’s a new acronym: PEACE and LOVE. This is the best treatment to apply after a soft tissue injury.
- P = Protection – Avoid running and use a heel lift if it helps.
- E = Elevation – Raise the leg above the heart.
- A = Avoid anti-inflammatories – They can slow healing in the first few days (although the effect is minor).
- C = Compression – Use a support, such as the Compex Activ' Calf Sleeves or Compex Recovery Socks.
- E = Education – The injury is likely to heal with time if you listen to your body.
- L = Load – Let pain guide you in rehabilitation as you slowly increase activity.
- O = Optimism - Be confident in your recovery.
- V = Vascularisation – Do low-impact cardio to increase blood flow, like cycling or swimming.
- E = Exercise – Actively engage in your recovery with the exercises listed below.
Which muscles are involved in a Calf Tear?
Gastrocnemius and Soleus
The calf comprises three distinct muscles, with the gastrocnemius and soleus being the most significant. The gastrocnemius is the larger muscle, typically visible when you look at your leg. It extends from the femur to the Achilles tendon, connecting the knee to the ankle joint.
The soleus is wider and flatter, located deeper in the leg, starting just below the knee and running down to connect with the Achilles tendon just above the heel. Because these two muscles converge at the same point, some consider the calf as a single large muscle with two sections. Together, these muscles help you walk, run, and jump.
Plantaris
There’s also a third muscle, the plantaris, a long, thin structure next to the Achilles tendon. It works with the Achilles tendon during ankle or knee joint flexion, aiding in standing on tiptoes or pointing the foot.
The most commonly involved muscle in calf tears is the gastrocnemius, with the pain usually felt in the inner, central part of the leg, midway up. A strain in the soleus or plantaris is less common and typically occurs lower in the leg, near the Achilles tendon. A soleus strain might develop more gradually than a sudden gastrocnemius tear, but the pain usually increases, and it shouldn’t be treated lightly.
What are the other possible causes?
While a gastrocnemius tear is usually easy to identify, the other muscles can be harder to pinpoint. Many runners don’t realize that the Achilles tendon, which surrounds the back of the heel, extends up to the mid-calf, so sudden pain in this area could be associated with the Achilles tendon. An Achilles tendon tear can feel like a sudden mid-calf pain and a sharp sensation.
It’s crucial to see a physical therapist for a proper diagnosis, as Achilles tendon tears can be more severe. Complete tendon tears require immobilization in a walking boot and may even need surgery in extreme cases.
How severe is the injury and how long will I need to rest?
When the pain starts to subside or at least becomes more manageable, it’s recommended to add heel lifts, initially on both feet together, then progressing to the single-leg variation. However, if you’re unable to perform a heel raise without pain, it’s important to be examined by a healthcare professional, as this could indicate an Achilles tendon rupture requiring immobilization in a boot or, in some cases, surgery.
Recovery time for a calf tear depends on the severity of the injury. Calf tears are typically classified into grades:
- Grade 1 is the mildest, where only a few muscle fibers are strained or torn. Recovery may take between one and three weeks, but it’s still crucial to rest and let the injury heal to avoid worsening it.
- Grade 2 is a moderate strain, where more muscle fibers are torn, but it’s not a complete rupture. Recovery usually takes about four to eight weeks. A grade 2 tear can cause significant pain and prevent you from using the calf muscle normally, such as bearing full weight on it.
- Grade 3 is the most severe and usually involves a tear of most or all muscle fibers, potentially leading to a complete muscle rupture. Recovery from a grade 3 tear can take around three months, but it’s not uncommon for it to take up to six months for full recovery. In cases of complete rupture, surgery may be necessary. Grade 3 tears tend to be very painful and often cause swelling in the area. It’s also important to watch for the appearance of a hematoma (localized blood accumulation due to a torn blood vessel).
What’s the difference between a Calf Tear and a Rupture?
A tear and a rupture are essentially the same thing. However, a tear can be partial, meaning not all fibers are torn, or complete, meaning the ends are no longer attached. A grade 3 tear is equivalent to a rupture.
Should I stretch my injured calf and use massage rollers?
Though it may seem counterintuitive, it’s not advisable to stretch your torn calf while it’s still healing, as this could disrupt the healing fibers and prolong recovery. Generally, stretching should only begin when you can contract the muscle, which means being able to lift your heel without pain.
Similarly, using a massage roller on the injured area during the acute phase of recovery isn’t recommended. There’s no evidence that this technique speeds up healing, but it can be used on muscle groups other than the calf if they’re also tight, as it may help you stay mobile. Like stretching, only return to massage rolling - if it’s part of your training plan - once you can perform a single-leg heel raise without pain.
Why are some runners more at risk of Calf Tears?
Runners often suffer from calf tears when they change something in their routine—such as suddenly increasing mileage, changing shoes, or running on a different surface. But tears are overuse injuries, and the cause isn’t always obvious. That’s why it’s important to consult a physical therapist if possible, to determine the cause of the calf tear and prevent it from happening again. A physical therapist can examine your posture and ask you to perform single-leg exercises to identify weaknesses or imbalances that contributed to the injury.
One of the most common causes of calf tears is that other muscles aren’t working as efficiently as they should, putting more strain on the calves. For example, if your glutes aren’t working enough while running, a physical therapist can suggest exercises to engage them more when you return to running.
Unfortunately, calf tears seem to become more of a risk with age, though there isn’t much evidence yet to explain this. The group most at risk for calf tears is men aged 40 to 60, and in a study of over 2,000 running-related injuries, 70% of gastrocnemius injuries occurred in men.
How can I prevent a Calf Tear from happening again?
The best way to prevent injuries is to understand what led to the calf tear and make sure you correct any weaknesses under the supervision of a physical therapist.
It’s essential to strengthen the muscle-tendon unit with calf raises. This increases tendon stiffness because the muscle can handle the tension. It's also important to note that stretching doesn't reduce injury risk, which makes sense because it further reduces tendon stiffness.
One theory explaining the higher prevalence of calf tears among older runners is that overall leg stiffness decreases with age. The achilles tendon then becomes less stiff, meaning the impact absorbed by the calf muscle during the landing phase is greater, increasing the risk of injury. It might, therefore, be wise to work on this by doing exercises targeting the tendon.
The best way to properly rehabilitate a calf tear and ensure it doesn’t recur as much as possible is to follow a progressive loading and strengthening program. Do this program at home or in the gym. Below are some common exercises.
What should I do when I start running again?
Returning to running after a calf tear can be challenging at first, as it’s hard not to be afraid of re-injury. Remember, you use your calf muscles and Achilles tendons with each step, but you can still run. Before running again, make sure you can perform single-leg heel raises without pain and have good range of motion in your foot and ankle. Consult a physical therapist to develop a rehabilitation program to follow as you return to running, and make sure to build strength and follow a progressive loading plan.
For the first few runs, keep your pace slow and listen to your body. Allow time for warm-ups and recovery. Perform a few heel raises at home before starting your run. Then, during the first five to ten minutes of running, pause briefly and do a few more heel raises. This will get the calf muscles used to the running action and should reduce tension and pain.
For the first few weeks, it’s better to do several short runs to allow the calves to get used to running again. You might want to increase the frequency of your runs rather than their length. For example, instead of running twice a week for 60 minutes, run five times a week for 20 to 30 minutes, or every other day. This will allow your body to get used to running without putting too much stress on the calf.
How to Treat a Calf Muscle Tear?
Here’s the recommended electrostimulation protocol for treating a seriously diagnosed calf muscle tear.
During the first 3 days after the injury:
- Only Use a TENS Pain Relief Program (Avoid any other programs as they may worsen the hematoma).
- Electrode Placement: Cover the painful area with as many electrodes as needed.
- Intensity: Increase the intensity until you feel a pronounced tingling sensation.
- Frequency of Treatment: Depending on the pain level, multiple sessions per day if necessary.
From day 4 until full healing (theoretical duration: 21 days, confirmed by medical examination):
- Endorphin Program: Promotes healing by increasing local blood flow.
- Electrode Placement: Place a small positive electrode (red connection) on the most painful point upon palpation, and a large negative electrode (black connection) either above the calf or in the middle of the calf if the tear is high.
- Intensity: Gradually increase until you achieve a noticeable muscle vibration (muscle twitches).
- Frequency of Treatment: At least one session per day, preferably one in the morning and another in the evening.
From day 21 onward:
- Healing Achieved (healing time may vary; medical advice required).
- Atrophy Program: Use for 1 week, followed by muscle strengthening for 2 to 3 weeks.
- Intensity: Gradually increase until you see a visible contraction during the first session. Then, increase the intensity with each session to reach the maximum tolerable level. Stimulation should never cause the pain felt during the initial injury to resurface.
- Frequency of Treatment: One session per day.
Calf Muscle Strengthening Program
Here is a calf muscle strengthening program. Try to incorporate it—or elements of it—into your muscle-strengthening routine twice a week. As you improve or if you're doing this to prevent injuries, you should add weight to all exercises by holding dumbbells. Each running step puts seven times your body weight through the Achilles tendon and calf, so the goal is to reach one to one-third of your body weight in total to prevent tears.
1. Calf Raises
- With a straight leg, tighten the quadriceps and rise onto your toes.
- Keep your hips well-aligned with the wall.
- Push straight up.
- Increase repetitions to a maximum of 30.
2. Soleus Raises
- Bend the knee 20 to 30 degrees and rise onto your toes.
- Keep hips and shoulders well-aligned with the wall.
- Lower slowly.
- Repeat up to 30 times.
3. Knee Lifts for Calves
- Squat against the wall with a knee angle of 90 to 120 degrees.
- Lift and lower the heels.
- Aim for 15 repetitions.
4. Wall-Supported Lunge with Calf Raise
- Place your back foot against the wall.
- Take a lunge position, ensuring the front knee is behind the toes.
- Reduce the foot’s range of motion to simulate running.
- Push the back foot against the wall to support and activate the glutes.
- Lift the heel of the front foot.
- Aim for ten repetitions.
3 Post-Session Stretches to Increase Calf Flexibility
1. Soleus Stretch
- Place the heel down and bend the lower knee forward.
- You'll feel the stretch along the calf.
2. Gastrocnemius Stretch
- Follow a straight line with your feet, pushing the back heel into the ground.
- Lean your body weight forward to feel the stretch at the back of the calf.
- Hold for 40 seconds, then switch sides.
3. Downward-Facing Dog
- Push one heel into the ground, hips high, back straight.
- Hold for 40 seconds, then switch sides.
Proven Effectiveness
Backed by clinical studies proving their effectiveness, Compex stimulators also belong to the category of Class II medical devices. They also meet the needs of the European Medical Standard 93/42 EEC.
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