Calf Muscle Injuries:  Exercises for Your Best Recovery

A calf strain is an injury to the muscles in the back of your leg, below the knee.  Two major muscles make up the calf.  The gastrocnemius muscle is the large outer muscle in the back of the lower leg.  The smaller soleus muscle lies deep underneath the gastrocnemius.  Both plantarflex the foot.  This occurs when the toes are pointed downward such as when stepping on the gas pedal of a car.  These muscles are also highly active when pushing off during walking, running, or jumping.   Calf muscle injuries occur as a result of normal daily activities such as walking or stepping down from a curb.  Calf muscle injuries are also very common in sports such as tennis, football, soccer, and basketball.

Common symptoms of calf muscle injuries include sharp pain in the lower leg when walking or attempting to push with the toes.   Older adults and athletes with a previous history of muscle strains are particularly susceptible to calf muscle injuries.  Larger individuals are also at an increased risk.  Calf muscle injuries can be very slow to heel with typical recovery taking 3 to 6 months.  They also tend to reoccur often, especially in athletes.  Thankfully, early rehabilitation can expedite recovery from these nagging injuries.

Proven Treatment for Calf Muscle Injuries

Traditionally, treatment for calf muscle injuries has included rest, ice, compression, and sometimes medications to control pain.  This approach may result in an initial decrease in pain.  However, a more aggressive approach is required to achieve the best long-term outcome.

A 2018 study from Denmark, investigated the effectiveness of early versus delayed physical therapy on recovery after muscle injuries.  Individuals receiving early physical therapy began treatment 2 days after their injury.  Compared to those who delayed treatment, the early physical therapy individuals made a pain-free recovery and return to sports 3 weeks sooner.  These findings suggest too much rest early after a muscle injury can result in a prolonged recovery.  The following exercises are components of this proven approach to recovery from calf muscle injuries.

Calf Stretch

It is important to maintain ankle range of motion and flexibility as the injured muscle heals.  Gentle stretching will help the injured muscle heal at its normal length.  Begin sitting with the knee straight and a towel or belt wrapped around the ball of the foot.  Gently pull the toes towards the shin and hold this stretch for 15 to 30 seconds.  Performing the exercise with the knee straight emphasizes the stretch to the gastrocnemius muscle.  Slightly bending the knee emphasizes the soleus muscle.   This stretch can be performed multiple times each day.

Calf Isometrics

It is important to begin muscle activation exercises early after injury.  This will help diminish pain and facilitate blood flow to the healing muscle.  Slight pain (<5/10) is acceptable during the exercise.  Sit with the knee extended and foot up against the wall or another immovable object.  Gently push the toes and foot down into the wall as if stepping on the gas pedal of a car.  You will feel the calf muscle contract slightly as you do this.  Hold the contraction for at least 10 seconds.  Performing the exercise with the knee straight emphasizes activation of the gastrocnemius muscle.  Slightly bending the knee emphasizes the soleus muscle.  These exercises can be performed multiple times daily.

Heel Raise Exercises

As pain diminishes, isometric exercises are progressed to heel raise exercises.  This involves rising up on to the toes from a standing position.  Performing the exercise with the toes turned out will emphasize the inside aspect of the calf muscles.  This is where most calf muscle injuries occur. Performing the exercise with toes turned in emphasizes the outer aspect of the calf muscles. Weights can be held in the hands or a bar can be placed over the shoulders to increase the load.  Typically, 10 to 20 repetitions are performed for multiple sets several days per week.

Final Thoughts on Calf Muscle Injuries

Other treatments, such as manual therapy, can expedite recovery from calf muscle injuries.  More challenging balance and sport-specific exercises are incorporated when pain decreases and strength improves.  Pain free function can take several months.  However, starting the right exercises early is a proven approach.  These 3 exercises are only a small sample of an effective physical therapy program.  Your physical therapist can perform an individual assessment and design an exercise program based on your unique problems and goals.  Contact us today if you have questions about which exercises are right for you.

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