It’s a common running injury, so learn all about how to treat it, rehabilitate it – and how to prevent it happening again.
What is a calf tear and how can you avoid overuse injuries? What does a calf tear feel like and you run through calf pain? What kind of cross-training is the most efficient? And, should you stretch or foam roll a torn calf? Here, we answer some of your most asked questions about training and injuries…
What is a calf tear?
When the muscles in your calf are overloaded, some of the fibres within it can tear. This is a very common injury in runners, though actually it first appears in medical literature in 1883 as ‘tennis leg’. Of course, we know now that a calf tear can occur in any sport – and to any runner.
A 2022 review in the Journal of Bone and Joint Surgery found that calf injury is most common in elite athletes of 22 to 28 years, more common in men, and presents as a recurring injury in approximately 19-31% of cases. Among amateurs, however, the highest risk group are older runners and older men in particular. Nevertheless, a calf tear can strike anyone and can vary considerably in severity from mild strain to very painful sudden pain.
What does a calf tear feel like?
A calf tear will usually present as a sudden sharp pain, accompanied by a feeling of something ‘popping’ or ‘snapping’. It is also not usually the type of pain that you can continue to run through. Even if you can, you should not, as you could cause further damage. Other symptoms may include a tightness in the calf, a particular area that is sensitive and painful to the touch, swelling and inability to properly ‘push off’ from that leg. All symptoms would normally ease when resting.
What should I do?
If you suspect you may have torn a calf muscle, stop running immediately. Jodie Breach, the Physiotherapy National Lead at Nuffield Health says it’s time to reach for the frozen peas. ‘Using ice is good,’ she explains. ‘Some argue that it slows down the healing rates, but this is thought to be negligible’
‘If in pain, I would advise adding a small heel raise into the shoe – or wear shoes with a higher drop/heel – to take the pressure off the calf muscle while moving around.’
You might already be familiar with the RICE approach -Rest, Ice, Compression, Elevation, but Breach has an expanded new acronym for you – PEACE and LOVE. ‘It’s the best general principle following any soft tissue injury.’
P = Protection – avoiding running and using a heel raise if it helps
E = Elevation
A = Avoid Anti-inflammatories – these are thought to slow down the healing process in the first few days (though again, it’s a negligible effect)
C = Compression
E = Education – it is likely it will heal in time if you listen to your body
L = Load – let pain guide when you can start rehabilitation with heel raises
O = Optimism – Be confident it will resolve
V = Vascularisation – Engage in pain-free cardio activity to increase blood flow – eg, can you cycle or swim?
E = Exercise – Be active in your recovery by completing the exercises shown below.
What are the muscles involved in a calf tear?
The muscles of the calf
Your calf is made up of three distinct muscles. The two largest are the gastrocnemius and the soleus. The gastrocnemius is the bulkiest – it’s the one you can usually see the outline of if you examine your leg. It runs down the back of your leg from the femur to the Achilles tendon, connecting the knee joint and the ankle joint. The soleus is wider and flatter, and sits a bit deeper in the leg than the gastrocnemius. It starts just below the knee, and runs down the lower leg to connect to the Achilles just above the heel. Because the two muscles both come together at this point, some people may refer to the calf as one large muscle with two sections. Together, these muscles help you to walk, run and jump.
There is in fact also a third muscle, the plantaris, a long thin structure which runs next to the Achilles tendon. Its function is to work with the Achilles when you flex your ankle or knee joint. It allows you to stand on your toes, or point your foot.
By far the most common muscle involved in calf tears is the gastrocnemius, and the most common place that you would feel the strain is the middle inside section, halfway up, on the inside of the leg. A soleus or plantaris strain, on the other hand, is less common and usually presents further down the leg, nearer the Achilles. A soleus strain can sometimes also appear more gradually than the sudden gastrocnemius tear, though the pain usually increases and again can not, or should not, be run through.
What else could it be?
While a gastrocnemius tear is usually quite easy to spot, the other two muscles can be harder to pinpoint. Many runners don’t realise that while the Achilles tendon wraps around the back of the heel, it extends as far up as mid-calf, so a sudden pain there could be associated with the Achilles. An Achilles tear may feel initially similar – a sudden mid-calf pain and popping sensation. It’s important to get a physiotherapist to properly diagnose your injury, as Achilles tears can be more serious. Complete tears in the tendon need to be immobilised in a walking boot, and in extreme cases may even require surgery.
How bad is the injury and how long will I have to rest for?
‘When the pain starts to settle, or at least become more manageable, I would then suggest adding in heel raises, initially on both feet together, and then progressing to the single leg variation,’ explains Breach. ‘However, if someone is not able to do a heel raise at all and it is not painful to try, they must be assessed by a medical professional as it may be a sign that they have ruptured the Achilles that would need either immobilising in a boot or in some cases, surgery.’
The recovery period for a calf tear will depend on the severity of the injury. Calf tears are usually described in grades. A grade 1 is the mildest and means that a small number of the muscle fibres are strained or torn. This can take as little as one to three weeks to recover from, but it’s nevertheless important to rest and let it heal or you risk making it worse. A grade 2 tear is a moderate strain – some more of the muscle fibres are torn, but it is not a complete rupture of the muscle. The usual period for recovery would be around four to eight weeks. You might get some significant pain from a grade 2 and not be able to use the calf muscle normally, for example, fully bear weight on it. A grade 3 tear is the most serious, and usually involves a tear in most if not all the muscle fibres, and can cause a complete rupture of the muscle. A grade 3 tear can take around three months to heal, but six months for full recovery is not unusual. In cases of a complete rupture, the runner might even require surgery. Grade 3 tears tend to be painful and often results in swelling in the area. You should also be careful to watch for a haematoma (a localised pooling of blood due to a torn blood vessel).
What is the difference between a tear and a rupture?
‘A tear and a rupture are actually the same thing,’ explains Breach. ‘However, a tear can be either partial, meaning not all the fibres are torn, or complete, when the ends are no longer attached at all. So a grade 3 tear is the same as a rupture.’
Should I stretch and foam roll my injured calf?
‘Although it feels counterintuitive, it is not advised to stretch your torn calf while it is still healing, as it will likely disrupt the healing fibres and may mean it takes longer to recover,’ cautions Breach. ‘A general rule of thumb is to only start stretching once you can contract the muscle – so you should be able to complete a heel raise, pain-free.
‘Similarly, foam rolling is not advisable over the injured area in the acute phase of your recovery. There is no evidence that foam rolling will help you heal faster, however, it can be used in muscle groups away from the calf if they are also feeling tight, as it can help you keep mobile. Similar to stretching, only return to foam rolling – if it is part of your training routine – once you are able to do a single leg heel raise pain-free.’
Why are some runners more susceptible to calf tears?
Runners often pick up calf tears when they change something in their routine – this could be a sudden increase in kilometrage, a change in footwear or surface. But tears are an overuse injury, so the cause is not always obvious. That is why it is important to see a physio if possible, to help work out why the calf tear happened and to stop it happening again. A physiotherapist may look at your movement patterns and ask you to perform single-leg exercises to help identify any weaknesses or imbalances that have contributed to the injury.
One of the most common causes of calf tears may be that other muscles are not working as efficiently as they should, leading to the calves taking more of the strain. For instance, your glutes may not be firing properly, and a physio may give you exercises to help engage them more when you go back to running.
Unfortunately, calf tears do appear to become more of a risk as we get older, though there is not much evidence yet as to why this is. The highest risk group for calf tears has been found to be men of around 40-60, and in a study of over 2000 running-related injuries, 70% of gastrocnemius injuries occurred in men.
How can I prevent a calf tear from happening again?
‘Strengthening the muscle-tendon unit with calf raises is a must – this is thought to increase the stiffness of the tendon by the muscle being able to take the strain,’ explains Breach. ‘It is also important to note that stretching has not been associated with reduced injury risk, which makes sense as this would reduce the stiffness of the tendon further.’
One theory for the greater prevalence of calf tears in older runners is as we get older, we actually experience reduced overall leg stiffness. This in turn leads to a less stiff Achilles tendon, which means a greater impact absorbed by the calf muscle eccentrically on landing. That leads to a greater risk of injury. Working to improve this by exercises targeting the tendon can therefore be wise.
The best way to properly rehab a calf tear and make as sure as possible that it doesn’t return is a progressive loading and strength programme. This can be done at home or at the gym. Some of the most common exercises to help can be found below.
What should I do when I go back to running?
Returning to running from a calf tear can be nerve-wracking at first as it is hard not to worry about the tear and over-think your run. It’s important to go back gradually and not leap back into your previous routine.
A thorough warm-up is always a good idea for injury prevention, increasing blood flow and getting the muscles prepared for harder work. However, this can be as simple as just starting your run at a very gentle jogging pace, and doing some mobility drills before you do any faster running or hill work.
Regular strengthening of the calf muscle is often neglected. Simple calf strengthening exercises your muscle will gradually increase their ability to absorb mechanical load, increasing your resistance to calf tears.
Regime to strengthen calf muscles
Here’s a routine to strengthen your calf muscles. Try and add it – or elements of it – to your strength training routine twice a week. ‘As you improve, or if you are doing this for injury prevention, you should add extra weight to all the exercises by holding onto weights,’ says Breach. ‘Seven times your body weight goes through the Achilles and therefore calf on every step of a run, and we aim for achieving approximately 1 1/3rd body weight in total to get back to full fitness.’
1. Calf raises
- With a straight leg, squeeze quadriceps muscles and push up on your tiptoes
- Keep hips square onto the wall
- Push straight up
- Build up to a max of 30 repetitions
2. Soleus raises
- Bend knee 20-30 degrees and push up onto tiptoes
- Keep hips and shoulders square onto the wall
- Slowly lower
- Again build up to 30 repetitions
3. Deep knee calf raises
- Squat leaning against the wall
- Knees angle 90-120 degrees
- Lift up and down through the heels
- Aim for 15 repetitions.
4. Wall-supported lunge calf raise
- Place the back foot against the wall
- Adopt a lunge position, making sure that the front knee is behind the toes
- Narrow foot tracking to simulate running
- Push the back foot into the wall for support and glute activation
- Lift up through the heel of the front foot
- Aim for ten repetitions
A post-run calf regime to increase flexibility
1. Soleus Stretch
- Heel down and bend your bottom knee forwards
- You will feel the stretch low in the calf
2. Gastrocs stretch
- Tracking feet in a straight line, back heel pushing into the floor
- Lean body weight forward to feel the stretch in the back of the calf
- Hold for 40 seconds then switch sides
3. Downward Dog
- Push one heel into the floor, hips high, upper back extended
- Hold for 40 seconds then switch sides