Calf injuries are a common and sometimes serious setback in running progression, often occurring when tissue tolerance exceeds capacity in either repetitive relative overload or one-off absolute overload events such as sprinting.
No hard and fast rule exists as to when running should resume, but it is best not to leave it too late. A physio will help create an appropriate return-to-running program.
Rest is important
At first, calf muscle tears may cause sharp pain with some swelling or bruising/swelling; however, tears in soleus muscles (located at the lower 2/3 of posterior leg) often do not feel that noticeable and runners may offload their calf to prevent further injury; this delay may increase deconditioning of their muscle and decrease recovery timelines significantly.
Calf strains tend to heal faster and longer than stress fractures or tendon injuries; thus the length of rest after such injuries varies widely. To assess an athlete’s return safely to running after suffering a calf strain, physiotherapists will monitor factors like pain-free walking speed, palpation tenderness, single leg heel raise strength and plyometric function to guide safe return-to-running practices.
Ice it!
Gastrocnemius strains often occur gradually over time; runners experiencing them might recall no single incident wherein their injuries occurred; instead, a tightening sensation that worsens as they run or walk can eventually reach pain-inducing levels. Conversely, those with soleus injuries typically notice more acute onsets of pain during uphill running or nearing the end of long runs.
Common symptoms of back and lower leg injuries can include sharp or pulling sensations in the back leg, tenderness, difficulty contracting muscles or standing on tiptoe, as well as bruising. Sometimes there may also be swelling.
Similar to stress fractures or tendon injuries, there are no hard and fast guidelines as to when runners can return to running after experiencing injury. Instead, it is up to both the physiotherapist and runner themselves to create an individualised plan which gradually builds tolerance of running loads over time.
Moist Heat
During your rest period, try walking as often as possible without exerting pressure or sudden movements, as these will increase pain and swelling. When your swelling has subsided you may begin light cross training provided it does not put too much strain on your calf muscles and you are experiencing no additional discomfort.
The calf muscles consist of gastrocnemius and soleus muscles which run along the lower back of your leg. When injured suddenly through activities like running uphill or sprinting, they dorsiflex quickly inwards which puts undue strain on them both simultaneously, such as dorsiflexing ankle and knee joint simultaneously.
Moist heat increases blood flow to muscles, assists with cell removal and speeds healing by breaking down cellular by-products more effectively than dry heat can reach deep tissues more efficiently. It is particularly useful in cases of calf injuries as its soothing warmth reaches deeper tissues more effectively than dry heat can do.
Stretching
Calf pain and discomfort is common when returning to running after injury, as runners tend to avoid loading up injured muscles for fear of further injury. Unfortunately, this often leads to further deconditioning through disuse, which prolongs overall recovery timelines.
Early in the rehabilitation process, your Physical Therapist will prescribe gentle calf stretching exercises and start some light strengthening (usually isometric contractions that tighten muscle without moving joints). As your calf heals it’s recommended that gradually increase activity level including more aggressive dynamic stretching as well as strength training until there is no return of pain in that region.
As part of your stress reduction strategy, a gait analysis may also be beneficial in helping identify any mechanical issues with your feet/legs that could be contributing to increased tension on calf muscles and Achilles tendon.
Strengthening
Physiotherapists have discovered that many calf strains are the result of weakness in the calves, making strengthening exercises an integral component of recovery from running-related calf injuries. Strength training should therefore form part of any rehabilitation program for an injury sustained running.
The gastrocnemius and soleus muscles can both lead to calf strains. However, the gastrocnemius tends to be more susceptible due to it crossing two joints and possessing more fast-twitch muscle fibers than its counterpart.
As such, the gastrocnemius muscle bears more mechanical load than soleus; this increased load can quickly fatigue muscles and lead to calf strain. Therefore, runners experiencing calf pain should wait at least 24 hours until walking and single leg hop without pain before returning to running again.
