How to treat your injured calf

The calf is formed by the gastocnemius and deeper soleus muscles. Together they attach to the heel via the achilles tendon, providing the ‘push off’ power when walking and running.

A calf strain involves damage to some of the muscle fibres within the belly of the muscle or where the muscle fibres join the achilles tendon.

Your body’s first response to injury is inflammation, during which your calf may become hot, swollen and painful. This inflammatory phase may last from one to several days depending on the severity of your injury.

During the first 3 days

• Avoid walking on the injured leg, use crutches or a stick if provided.
• When resting elevate the leg to discourage swelling. 
• Frozen peas or crushed ice in a damp tea towel can be applied to the injured area. For maximum effect apply for 20 minutes every 2 hours.

Once the calf feels less hot and painful, it is important to start gently exercising the injured muscle. This may be uncomfortable at first, but is essential to prevent tightness and weakness and to encourage the natural healing process.

The following exercises should be performed slowly and thoroughly, moving into some discomfort but short of pain. They can be repeated 4 – 5 times daily.

Exercise 1

Move your foot up and down at the ankle stretching as far as possible in each direction. To start with you may find it easier to do this with your knee bent. As soon as you are able, do the exercise with the knee straight to increase the stretch.

Gentle circling of the ankle can be added in. Using a towel or elastic band to assist these movements can be helpful.

Repeat 10 times.

After 3 days

As soon as you are able to put weight through the injured leg, start to get up and about more. Short walks are good for the healing muscle, but avoid long distances and standing for long periods. You may find it more comfortable in shoes with a thicker or higher heel to start with, as this will lessen the stretch on the calf. Typically people tend to walk with their foot turned outwards and in front of them, but this should improve as each day goes by.

Try and discard your crutches as soon as possible and please remember to return them to the Emergency Department or to the recycling area at the main entrance to the Brunel building. 

Later exercises

The following exercises are helpful in getting full stretch and strength back in the healing muscle.

A degree of discomfort during exercise is acceptable, but never push through pain. The exercises can be repeated 3 – 4 times daily.

Exercise 2: deep calf stretch 

Stand leaning forward on a firm surface, placing your injured leg in front with the foot flat on the floor. Lean slowly forwards allowing the knee to stretch over the foot, but keeping the heel flat on the floor. Hold at the point of tightness for up to 15 seconds, repeat 4 times. 

Exercise 3: normal calf stretch

Stand facing and leaning with your hands on a wall. With feet facing forward, place the injured leg behind with the heel to the floor and the knee straight.

Stretch to the point of discomfort or tightness and hold for 15 seconds, repeat 4 times. 

Compare the stretch with your uninjured leg, they should eventually be the same.

Exercise 4: to improve strength

Stand facing and leaning with your hands on a firm surface with feet placed slightly apart. Taking as much weight as you need through your hands, rise up on to your toes and down again. Repeat for as many times as you feel reasonable.

As the exercise gets easier reduce the support through your hands.

Eventually you should be able to do the exercise on the injured leg alone. Test your good leg to see the maximum number of repetitions you can do. Work towards the same number on the injured leg.

It is important to continue exercises 3-5 until there is no difference between your two legs, to reduce the chance of a repeat injury.

For the first two weeks following injury avoid excessive discomfort during activity. Exercise such as cycling, swimming and walking are good for the healing muscle.
However do not return to any form of running sports until the calf has regained full stretch and strength.

You may be aware of tightness in the muscle after prolonged inactivity or first thing in the morning. This will gradually settle.

Depending on how severely your calf is injured, it may take up to 8 weeks to return to normal.

In future it is advisable to ‘warm’ up the calf before sporting activities, in order to prevent re-injury. Exercises 3 – 5 can be used for this purpose.

Remember

• 1-3 days, protect, rest, ice elevate.
• 3-14 days, exercises, build up activity avoiding excessive discomfort or strain.
• 14 days onwards, progress exercises, be less protective.
• By 8 weeks you should have returned to all your usual activities.

If you are concerned about your injury, please consult your GP.

© North Bristol NHS Trust.  This edition published April 2024. Review due April 2027. NBT002257.