Are you struggling to make a comeback after a calf muscle strain?

At SIP we are often consulted by runners who have pulled their calf muscles once and then find that they reinjure it every few weeks or months – usually just as they’re getting back into their natural training rhythm. In our experience this is usually either due to a lack of a proper rehab/strength training programme or they may have increased neural tension in their legs.

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In this article:

• Why you have to do a specific strength training programme when you’ve torn a muscle

• What a rehab programme for a torn calf muscle should include

• How increased neural tension can lead to calf muscle strains

Here's a video of a livestream I did about this topic:

Why you have to do a specific strength training programme when you’ve torn a muscle

When you tear a calf muscle, you literally tear some of the muscle fibres or cells. In order for you to get back full function of that muscle, it has to go through a three-stage healing process.

Stage 1: The body first has to get rid of the injured cells. It does this through inflammation – during which the torn muscle fibres are absorbed by the inflammatory cells. Inflammation is a very important part of the initial healing process and that’s why it’s not a good idea to take anti-inflammatory drugs (like ibuprofen) during the first five days of a muscle injury.

Stage 2: You body now has to create new muscle cells to replace the damaged ones. This takes roughly 3 weeks BUT the new cells aren’t strong yet. You have to gradually strengthen them to the level they were before you pulled your calf muscle.

Stage 3: During this stage, your body will strengthen the new muscles cells, but only if you do the right exercises to signal to it that they need to be stronger. Think about it: you can’t build strong muscles by just resting them – you have to exercise them. The same goes for when you’ve injured your muscles. How long this part of the process takes will depend on how badly you’ve injured your calf.

As a rough guide we find that:

• Mild calf strains take about 4 weeks to heal.

• Moderate tears take between 6 to 12 weeks before they are back to normal.

• Severe calf tears can take more than 12 weeks before you can do your regular training.

What a rehab programme for a torn calf muscle should include

We hope that, from the discussion above, it’s clear why you can’t just sit and wait for the pain in your calf to disappear and then think that it’s fully recovered! You have to use a carefully graded exercise programme that strains the muscle at the right level.

None of the exercises should cause any pain while you’re doing them or after you’ve done them. There’s no one-size-fits-all and what exercises you start with will depend on your specific injury.

The exercises that you choose to do should be at the right level for you, but you usually want to start with something that works the calf muscle in isolation. Going up and down on your toes is a good example of an exercise that isolates the calf muscles.

You would normally start calf specific strength training with double leg heel raises and then progress to doing them on one leg and even adding extra weight to it. These exercises should also be done slightly differently depending on what part of the calf muscle you've strained. Doing the heel raises with your knees straight targets the Gastrocnemius (upper calf) more, while doing them with your knees bent works the Soleus (lower calf) harder.

The important thing is that you should build up the strength to the level that you need for your specific sport. When you run, forces as high as 3 to 6 times your bodyweight can go through your calf muscles. So you can see why it won’t be enough to just do easy double leg heel raises and then expect your calf to be strong enough to cope with the forces from running.

Some options on Amazon for adding extra weight to your exercises:

Make sure that you also strengthen all the muscles in your legs and around your core as they all help to spread the load during sport. If your sport involves jumping, you’ll also have to include plyometric exercises, that trains the muscle to contract forcefully, during the later stages of your recovery.

And lastly make sure that you do a slow return to running or sport. Start with slow short runs and gradually increase the distance and speed.

In summary – Your calf muscle tear programme should include:

• exercises that work the calf muscle in isolation, starting light and increasing the weight over time,

• exercises that strengthen the muscles in the rest of your body,

• exercises that prepare your calf for your specific type of sport e.g. plyometrics if you play jumping sports like volleyball,

• and a slow return to running/sport programme.

How increased neural tension can lead to calf muscle strains

Your nervous system is continuous from your head to the tips of your fingers and toes. It has the brain at the top that is connected to the spinal cord and from there you’ve got loads of nerves that run into your arms and legs.

As you move, the nerves are meant to slide freely. Sometimes something may prevent the nerves to slide, causing them to stretch and pull tight = increasing the tension in the nerve.

When this happens to the sciatic nerve it can lead to hamstring and calf muscle injuries. If you have increased neural tension in your sciatic nerve, you may reinjure your calf muscles frequently despite following the correct rehab programme.

This sounds quite sinister but in most cases it’s quite easy to improve. It’s something that we can easily test for via a video call consultation – check out the demo I did in the video above to understand how it works. Nine times out of ten we find that working on flexibility around the lower back and glutes as well as changing some daily habits are all that’s needed.

Neural Tension Slump Test

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn, ResearchGate.

References:

1. Brukner, P, et al. Brukner & Khan's Clinical Sports Medicine. (5th ed.) Vol 1: Injuries. (2017) McGraw-Hill Education.

2. Bryan Dixon J. Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Current Reviews in Musculoskeletal Medicine 2009;2(2):74-77. doi: 10.1007/s12178-009-9045-8

3. Orchard JW, Farhart P, Leopold C. Lumbar spine region pathology and hamstring and calf injuries in athletes: is there a connection? British Journal of Sports Medicine 2004;38(4):502-04. doi: 10.1136/bjsm.2003.011346