Pain in Calf

Calf pain is usually due to a calf strain, cramp or tightness due to overuse of the calf muscle. So when someone presents in our clinic with calf pain we ask a number of questions and do a detailed assessment to determine the cause of the pain, the underlying reason why it occured and also to outrule any risk of clot which can occasionally occur .

What is calf strain ?

When an excessive load is applied to the calf muscle, the gastrocnemius or soleus muscles while they are contracting, or if these muscles over stretch as they lengthen the muscle may tear. This will most likely occur on acceleration or decceleration.

Grade 1 Calf Strain

When there is damage to a small number of muscle fibres – usually less than 5% of fibres  this is a considered to be a mild calf strain.

In this case the pain may be sudden onset pain or just tightness in the calf area, the player might be able to play on, the area will become painful and tender later on, there will probably be no visible bruising or swelling, and the player will be able to walk around without limping.

This could take 2 to 3 weeks rest, however sometimes this is more like a micro-tear with minimal damage, and with good early management the player may return to sport after a week.

Grade 2 Calf Strain

When there is more extensive damage, with a large number of muscle fibres involved, but the muscle is still in tact it is known as a grade 2 calf strain or calf tear.

In this case there will be a sudden onset of pain. The player will be unable to play on, there will be a tender mass at the site of injury, there may be bruising which may not appear until the following day, and may be lower than the area of pain. There will be weakness in the muscle and the player may be limping.

The rest period required is usually between 3 and 6 weeks. Good physiotherapy treatment and early management will reduce the recovery period.

Grade 3 Calf Strain

When there is a complete rupture of a muscle it is referred to as a grade 3 calf tear.  There will be a sudden severe onset of pain, and the player may not be able to walk off the pitch.

There will be severe pain in the muscle and severe pain and weakness on resistance. There may be a visible deformity in the muscle where the fibres have recoiled back into a lump. There will be swelling in the area and bruising will be extensive when it appears the following day.

In a sports person this may require surgery to repair the muscle if the fibres have severely recoiled. Even with good physiotherapy and management it may take 3 months to fully recover.

All muscle strains should be rested and allowed to heal. If the patient continues to play, the condition will worsen. If ignored, a grade one strain has the potential to become a grade two strain or even a complete rupture.

How to treat a calf strain?

As with any acute injury the early management of a calf strain is extremely important to aid recovery and prevent

Calf Strain

Calf Stretch 2

further trauma to the area.

PRICE for Calf Injury treatment

  • Protect the area
  • Rest – relative rest is advocated, no running, but move within normal painfree limits
  • Ice is extremely important. 20 minutes at a time every 2 hours, protect the skin to avoid ice burns
  • Compression – use an elastic bandage or support to apply firm light pressure to the are to limit swelling
  • Elevation – keeping the injured area higher than the hip aids swelling reabsorption

calf treatment

In our clinic we will use Laser therapy within the first 48 hours in conjunction with PRICE to accelerate the Inflammatory phase of healing.

Then we will offer you manual therapy as in soft tissue massage an deep transverse frictions, electrotherapy such as ultrasound an interferential, deep dry needling,  eccentric and concentric strengthening, stretching and rehabilitation including sports specific activities an pjyometrics for return to sport.

Also we will address any underlying issues which may have been causative factors for your calf strain. These may include biomechanical deviations

Why does it take so long for calf strain to heal?

There are four main stages of the healing process for a calf muscle strain or calf tear.


The body has a natural healing process which must occur when  a muscle is strained or torn.This  begins with an inflammatory response which occurs over the first 48 hours. This is a really important time where the inflammatory reaction the body produces chemicals and cells which remove dead muscle fibres and start the repair process. This must be allowed to happen, and that is why you should not take anti-inflamatory medication in the first 48 hours after an injury. It is also why protection of the area, rest, ice, compression and elevation is important


The damaged tissue must be replaced, so new muscle fibres grow from special cells within the muscle.


When an injury occurs there will be bleeding in the gap between the torn muscle ends, and this eventually lays down fibres called collagen which form a scar linking the 2 muscle fibre ends to help them heal.


As the scar develops the collagen fibres take on a permanent structure and physiotherapy is useful in this stage to help the new collagen fibres to be laid down inline with the original muscle fibres so improving the long term tensile strength and flexibility of the injured muscle enabling it to withstand more force.