Why isn’t my calf strain getting better?

Not all calves are torn equal. To understand these injuries, we need to first revisit some biomechanics and anatomy.

These injuries are normally sustained during running and jumping activities. During running, the calf (along with other muscles) has the challenging role of acting as shock absorber and assisting in propulsion. There are active structures and passive structures that facilitate this. The active structures are basically your muscles. They generate and absorb energy. The passive structures are comprised of your ligaments, fascia and tendons. Unlike muscles, these structures only transfer energy rather than create energy. Any deficiencies in these systems will result in tissue overload and injury.

Muscle strains: 
The typical calf injury involves a strain to the medial (inner) gastrocnemius. The athlete normally reports the sensation of being ‘shot’ in the back of the leg. The more sever ones will often see the athlete limping off the field/track/court. In the acute phase, we tell patients to rest, ice, compress and elevate (RICE) the injury. Once the acute phase settles, rehabilitation of the injury includes massage, stretching and strengthening of the affected tissue. 2 simple tests to monitor your progress are the knee to wall test (for flexibility) and the heel raise (for strength). Here are the respective links and At bare minimum, they should reach the level of your uninjured calf. Although very painful initially, pain settles and function returns steadily. Healing times can vary between 2-8 weeks depending on the severity of the strain.

Connective tissue strains:
This often involves a tear to the fascial component of the ‘passive’ system. The athlete often feels a minor pull at the time of incident or may cite gradual increasing tightness during a run. There are usually minimal symptoms at rest and with light activity. However, the athlete will experience pain/tightness when resuming higher level activity such as running. Healing time frame back to full function is in excess of 3 months! Rehabilitation is more complex compared to muscle strains and incorporates movements to enhance your ‘stretch shortening cycle’. The stretch shortening cycle utilizes elastic recoil to contribute to propulsion. Using hopping as an example, the muscle and passive restraints are actively stretches as you land, and rapidly followed by a quick contraction as you push off. The force is obviously much larger than a muscle contraction alone.

Often for both injuries, examination of other intrinsic and extrinsic factors are required.
Intrinsic factors include:
  • Inadequate force propulsion from other muscles such as glutes, hamstrings and quadriceps
  • Running technique
  • Balance and body control
  • Rest and recovery
Extrinsic factors include:
  • Type of training (eg. plyometric versus endurance training)
  • Amount/volume of training
  • Footwear
  • Running surface


One last thing to consider:

There can be vascular and neural sources of calf pain (eg compartment syndrome, deep vein thrombosis, nerve entrapment). Even the structures in the back can refer pain to the calf. Some of these require urgent medical attention. If you are unsure about your calf pain, speak to the team at Ascend at (08) 9387 2699 and we will get you back to your peak performance.