Calf Strains: Causes, Rehab Exercises, and Recovery Tips | Physical Therapy Orlando

Understanding Calf Strains: Causes, Rehab, and Returning to Sport

Calf strains are a common injury, especially among athletes and active individuals. Whether you're a runner, a weekend warrior, or someone getting back into exercise after a long break, understanding how your calf muscles work and how to properly rehabilitate them can make a big difference in your recovery and performance.

‍Anatomy of the Calf

Your calf is primarily made up of two muscles:

• Gastrocnemius – The larger, more visible muscle that crosses both the knee and ankle joint. It helps you point your foot downward (plantar flexion) and also assists in bending the knee.
• Soleus – A deeper muscle that also contributes to plantar flexion but does not cross the knee joint.

Both muscles connect to the heel bone via the Achilles tendon. When they experience excessive strain, they can become injured.

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Types of Calf Strains and How They Happen

A calf strain can occur in either or both muscles. Here’s how to differentiate between the two:

• Gastrocnemius strain: This typically happens suddenly during explosive movements like sprinting, jumping, or quick direction changes. It often feels like a sharp, sudden pain.
• Soleus strain: This tends to develop gradually, often feeling like tightness or cramping. It’s more common in endurance activities like long-distance running.

Why Do Calf Strains Happen?

Most calf injuries occur due to overloading the muscle without adequate preparation. Examples include:

• Suddenly increasing activity levels (e.g., picking up pickleball three times a week after months of being sedentary).
• Increasing running mileage too quickly before a race.
• Insufficient recovery, including poor sleep, lack of rest, or previous injury history.

Rehabbing a Calf Strain

The goal of rehab is to gradually increase your calf's capacity (ability) so it can handle the demands of your sport or activity. Rehab focuses on strength, endurance, and power through progressive loading exercises.

Calf Raise Progression (knee straight progression)

1. Double-Leg Heel Raises – Start with both feet on the ground. Aim for 3 sets of 25 reps through a full range of motion (going all the way up and down) without pain or compensation

1. Single-Leg Heel Raises – Once you can do the above pain-free, progress to 3 sets of 15 reps on each leg.

1. Elevated Heel Raises – Perform the same as above but on an elevated surface for greater range of motion.

1. Weighted Heel Raises – Add weight and perform 3-4 sets of 6-10 reps.

Knee-Bent Heel Raise Progression (Targets the Soleus More)

1. Seated Heel Raises (Feet Flat on the Ground) – Can be performed with added weight. Same reps and sets as above.

1. Seated Heel Raises (Feet Elevated) – Adds more range of motion.

1. Standing Knee-Bent Heel Raises – Progress similarly to the straight-leg variations.

Knee Position Matters: Lateral & Horizontal Options

When doing exercises like heel raises, keeping your other knee straight can be done in different ways—either to the side (lateral) or straight in front (horizontal). This small change can make a big difference, especially if you play sports that involve running, quick changes in direction, and sprinting.

A lateral position (knee out to the side) helps with balance and side-to-side movement, which is key for sports like basketball, soccer, or tennis. A horizontal position (knee straight ahead) focuses more on forward power and speed, helping with sprinting and jumping

To maximize benefits, exercises should be done with controlled tempo to avoid common mistakes like:

• Rolling off the big toe or letting the ankle move outward.
• Clawing toes into the ground.
• Dropping the heel too fast without control.

If You Still Have Pain…

‍If exercises cause discomfort, regress to:

• If weight-bearing is too painful, try banded plantar flexion (3 sets of 25 reps) before progressing.
• Hold a knee-bent and knee-straight calf raise for 20-60 seconds.

‍Returning to Sport & RunningBefore returning to full activity, you should:

• Pass strength tests like adequate single-leg calf raises.
• Tolerate single-leg hopping for at least 3 sets of 60 seconds.
• Tolerate weight bearing without pain: squats, lunges, step downs from steps

Running Progressions (Based on Expert Guidelines)

• Start by running on alternate days.
• Avoid prolonged slow running in the early stages.
• Do not increase volume and intensity on consecutive days.
• Run before strength exercises to minimize fatigue.
• Match running progressions to your sport’s demands.
• Avoid sudden changes in footwear or surface conditions.

Additional Key Exercises

• Balance and proprioception (e.g., single-leg RDLs, ankle control drills).

• Compound movements (e.g., squats, deadlifts, lunges, hip thrusts).
• Other ankle-specific movements with resistance bands.

Final Tips

• Stretching is okay, but shouldn’t be painful.
• Avoid stretching before strengthening exercises, as strains occur due to overstretching.
• Always consult a healthcare provider (physician or physical therapist) before starting rehab exercises.

By following these guidelines, you can recover effectively and safely return to your sport stronger than before!

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