Calf Muscle Strain Rehab
Calf muscle injuries are notoriously tricky to rehab, and there is currently no universally agreed recovery protocol, even amongst the world's leading sports injury specialists. If you have a calf muscle strain, it’s worth trying to get your rehab right, as calves are particularly prone to being re-injured.
Before starting any rehab, please see here for advice about what to do in the first 24-48 hours following your injury. In particular, seek medical advice if you are not sure that your problem is actually a muscle injury.
Initial Rehabilitation Exercises
You should start your rehab by doing non-weight bearing exercises.
The first exercise is just gently pointing and pulling back your toes on the injured leg. This gently lengthens and contracts the calf muscles. This can then progress to using a resistance band for the same movement. Start with using both feet (see video below) , and then switch to just the injured leg.
Another gentle introductory exercise for your injured calf is using isometric muscle contractions, where you gently work the muscle, but it doesn’t change length.
Once you can tolerate the non-weight bearing exercises, most rehab protocols focus on improving the strength of the calf muscle. This is done as soon as possible, with some rehab specialists starting on these as early as day 2 or 3 post injury.
The keystone strength exercise used is the calf raise. As a rule, you start with double calf-raises, then single, and then single with weight added.
Most leading injury specialists don’t recommend any aggressive stretching of the injured calf, the focus is always on strength.
The first video below shows the progression for calf raising exercises after a gastrocnemius injury. The second video shows the same exercises, but focussed on a soleus injury.
Calf Raise Exercises for a Gastrocnemius Strain
Calf Raise Exercises for a Soleus Strain
Please note, if you have a gastrocnemius strain the calf raises should be done with a straight leg, and for a soleus strain with a bent leg. If you’re not sure - just do both!
A quick note on heel raises.
Injury rehab specialists look for people to be able to perform at least 2 sets of 15 slow single calf raises before moving on to harder exercises. They also look for the injured leg to have at least 90% of the capacity of the uninjured leg. This means that if you can do 30 single leg calf raises on your good side, you should look to be doing at least 27 on your injured side before moving on to the dynamic exercises.
Dynamic Exercises
Once you can complete the calf raises, most protocols move onto hopping and jumping exercises.
Hopping
You should start with some gentle on the spot vertical hopping on both legs, then just using the injured leg and then progress to forward hopping.
Hopping exercises for calf muscle strain rehab
Jumping
You should start with some vertical jumping using both legs, then just the injured leg and then progress to forward jumping.
Jumping exercises for calf muscle strain rehab.
The exercises shown above can all be done with little or no equipment. For those people with access to gym equipment or weights, there are further exercises that can be attempted. For these, as well as other variations of the exercises shown, this 15 minute video is currently by far the best resource on the internet for rehab of calf muscle strains.
Re-introduction of Running
This is the final stage of rehab, and the stage where people are most likely to re-injure themselves by running too soon. Unfortunately, calf muscles are prone to tearing, often without much warning.
One expert looks for injured athletes to be able to do 20-25 single leg calf raises and do 20 vertical hops on the injured leg before any running is started. The idea is that if you can’t hop, you can’t run.
Some general advice about initially returning to running from injury experts;
Run on the flat - avoid downhill running.
Run on alternate days
Don’t do long plodding runs - use short distances (see protocols below).
Don’t increase intensity and volume each session.
Do any strength work after runs
One expert uses an 80 metre distance to re-introduce running, starting with no more than 60% effort/speed. They aim for 8 repetitions, with a rest between each run, building to 2 or 3 sets.
For those that want a more prescriptive approach, I previously covered a 9 stage progressive running protocol for recovering from hamstring injuries, which may also be suitable for calf muscle strains.
For further information about calf muscle injuries and the benefits of supplements, red light therapy and osteopathy, then see this article here. In particular, if you suffer from repeated calf strains you should have your bio-mechanics evaluated to see if something is predisposing you to injury.
Cliff Russell
Registered Osteopath
Forest Row and East Grinstead areas
