Torn calf muscle? One of the key factors that increases your risk of injury like a torn calf muscle, is a shortened Gastrocnemius and Soleus muscle. Runners are more likely to tear one of the calf muscles, due to the high intensity of the muscle contraction that is needed to push off between every stride. Jumpers, like long jump athletes, are even more prone to tear their calf muscles. The most common places where the muscles tends to tear are at the joining point between muscle, tendon and bone.

What is the calf made up of?

The calf is made up of 2 large muscles – gastrocnemius and soleus muscles. Gastrocnemius is the one on top (giving you that curved look) with Soleus just beneath it. The Gastrocnemius muscle has two heads (medial – on the inside and lateral – on the outside) and it crosses both the ankle and knee joints which makes it vulnerable to injury. The two muscles run closely together, joining to form the Achilles tendon, which anchors the two muscles to the back of the heel bone. These muscles can become injured or even tear due to overstretching or overuse.

Both the calf muscles are attached to tendons on both sides called the Musculo-tendinous junction. One at the top (called the proximal) and one at the bottom (called distal). The most common places where the muscles tends to tear are at theses joining point between two structures.

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What do the calf muscles do?

The superficial Gastrocnemius muscle, crosses both the knee and ankle joints. When a muscle crosses two joints it is already more vulnerable to injury, because of active insufficiency. This means that when a muscle is lengthened over two joints, it cannot exert maximum force. Contracting the Gastrocnemius muscle causes the ankle to plantarflex (the position that the ankle goes into when you point your toes).

It works hardest during high impact forward propulsion, like in a sprint, running up a hill or jumping. The deeper Soleus muscle only crosses the ankle joint, also causing plantar flexion at the ankle. Soleus works hardest during lower impact endurance use, think marathons.

How does a Calf muscle tear happen?

When a muscle needs to contract at a very high rate and force, this overload of ‘pulling’ on the muscle causes small microscopic tears in the muscle fibers. Our bodies react to these micro tears by activating the nervous system to tell the muscle it has been injured.

Your nervous system will react by contracting that muscle and increasing the muscle tension (to protect itself). This results a temporary shortening of the muscle to allow healing to take place.

After you’ve torn your calf muscles, when you push off your heels like jumping, you will feel a sharp stinging feeling. This is because the more you stretch it, the more you will damage the scar which is trying to heal the muscle fibers. Its like ripping the wound wide open again.

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Where the calf muscle tears

Types of calf muscle tears

Longitudinal tears inside the muscle belly are the most frequent that we see. This is a tear along the direction of the fibers meaning a split of the muscle sideways tearing from top to bottom. Mostly between the two heads of the Gastrocnemius muscle (the two heads split apart) or in the medial head of the Gastrocnemius due to it taking much more load compared to the outside (lateral) head.

Transverse tears are tears that rip across the fibers from the inside to the outside. This type of tear is very dangerous because the chances of tearing more fibers are very high or even a complete rupture. We see this usually between the attachment of the Gastrocnemius and Soleus muscle onto the Achilles tendon.

Soleus Muscle tear

The Soleus muscle tends to rip off its deep attachment on the back of the tibia. This presents more like a shin pain (Traction Periostitis) and is less common to tear from a single forceful contraction.

With a traumatic tear, the Soleus muscle will tear when the knee is bent. It needs to absorbs a lot more force when the covering Gastrocnemius muscle is less active. Then it tends to tear at the distal musculotendinous junction, where the Soleus attaches to the Achilles tendon.

Lateral and Medial Head of the Calf

What causes the calf muscle to tear?

  • Overuse – Increasing your running distance too fast or sudden high repetition of calf raises and jumps.
  • Overload – Increasing the weight on a calf raise machine too fast. You can just imagine if you jump from 40kg to 60kg in one week. The muscle won’t be able to keep up.
  • Overstretch – Running hills or on a incline will force the muscles to contract from its stretched position. Muscles are very weak in their outer range.
  • Weakness – Muscle fatigue can play a role in runners who are not strong enough to run the distance (muscle endurance)
  • Poor technique – During training (Wrong movement pattern), overpronation of the ankle can cause forces to focus over the inside of the calf, that can load the medial Gastroc head significantly more.
  • Inadequate warm-up – A fast sudden contraction like a jump or start sprinting while the muscle is not prepared for it can put you at risk of tearing the calf muscles
  • Excessive stretching – of the muscle against a force, for example during calf rises, when the load is applied on both sides of the tendon, while it needs to contract and lengthen at the same time.
  • Wrong shoes – Poor support for your foot will cause muscle forces to concentrate along the inside of your calf, which loads those muscle fibers more that the outer part. These abnormal forces on the inside of your calf will cause the fibers to fatigue faster and tear first.
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Calf Muscle tear, Torn Calf muscle
  • Hear a pop or snap when it happens.

  • Pain when standing on toes.

  • Sudden sharp pain at the back of the lower leg.

  • Swelling or bruising along the calf.

  • Pain when the muscle is contracted against resistance (Calf raise)

  • Pain when the muscle is stretched.

  • Unable to continue play (sport), have to stop moving.

  • Pain through movement (When pointing your toes or pulling your upwards)

  • Loss of muscle strength (Unable to put weight on your leg)

Calf muscle tears have jokingly been baptized “tennis leg” among sport care practitioners, because of the high incidence of patients sustaining a tear during a tennis match, when they propel to get to the ball faster.

They describe the sensation as feeling like the ball hit them very hard on the back of the calf. This can cause some confusion as to where the ball is, or even lead to some quarreling among team mates.

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How we Test

  • Stand with your feet slightly apart, weight equally distributed, holding onto something solid for balance if you need it, keep the knees straight.
  • Rise up onto your toes, lifting your heels as high as possible. Keep your body upright (don’t bend forwards).
  • Ensure that your knee stays straight as you rise.

If you feel pain with this test it may indicate that you have a Gastrocnemius muscle strain/tear.

  • Stand with your feet slightly apart, weight equally distributed, holding onto something solid for balance if needed
  • Bend your knees to about 60 degrees.
  • Rise up onto your toes lifting your heels as high as possible. Keep your body upright (don’t bend forwards).
  • Ensure that your knees stay bent as you rise.

If you feel pain during this test, it may indicate that you have a Soleus muscle strain/tear.

  • Stand with the balls of your feet slightly apart on the edge of a stair, weight equally distributed, holding onto something solid for balance if you need it, keep the knees straight.
  • Drop the heels downs, so that your toes are higher than your heels, when looking from the side. Keep your body upright (don’t bend forwards).
  • Ensure that your knee stays straight as you lower.

If you feel pain with this test it may indicate that you have a Gastrocnemius muscle strain/tear.

  • Stand with the balls of your feet slightly apart on a stair, weight equally distributed, holding onto something solid for balance if you need it, bend the knees to about 60 degrees.
  • Drop the heels downs, so that your toes are higher than your heels, when looking from the side. Keep your body upright (don’t bend forwards).
  • Ensure that your knees stays bent.

If you feel pain with this test it may indicate that you have a Soleus muscle strain/tear.

  • Lay down on your back, with your knees bent at 60 degrees.
  • Lift your buttocks up (like doing a bridge)
  • Raise your heels off the floor to do a full rise., to load the Soleus even more alternate to lift the legs off the floor while holding the position. Rise and lower your calf to the floor 10 times on each leg.

If you feel pain during this test, it may indicate that you have a Soleus muscle strain/tear.

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Test how bad it is

We use a scale from 1 to 3 to determine how bad the tear is.
Here’s a short breakdown of how the different grades will look like, but for more detailed analysis click here

1st Degree (Mild)

Less than 20% of the muscle fibers are torn. This can also be referred to as a pulled muscle.
When the calf muscle is stretched by standing on the edge of a step and allowing the heel to hang over the edge of the step, the Gastrocnemius muscle will stretch when the knee is kept straight. The Soleus muscle will stretch when the knee is bent.

You will be able to put your weight on the leg, but you will experience some pain when walking. No swelling or bruising will be visible. Tenderness over the tear can be felt and a slight hardness around the tear due to the muscle guarding. Calf muscle cramps and spasms are common.

Recovery Time: 2 to 4 Weeks if you follow the treatment advice we give you.

Medical treatment
A small strain should heal within a week without treatment. If the pain hasn’t subsided in 3 days, give us a call so we can have a look at it and determine the damage.

Symptoms of a 1st degree Calf muscle tear

  • Able to continue playing (sport), jogging, but with pain.
  • Pain only at the end of range (when you pull your toes toward your head)
  • No loss of muscle strength (Able to do a calf raise with pain)
  • Dull pain when standing on the edge of a step, drop your heel off the step
  • Little swelling
  • No bruising visible (blue)
  • Unable to pinpoint it to one specific spot in the calf

2nd Degree (Moderate)

20% – 80% of muscle fibers are torn.
You will be unable to put weight on the injured leg or feel more than 5/10 pain in the calf when walking (for those with higher pain threshold). Sharp stinging pain when walking up a hill or incline. This will cause a pull over the tear and produce more pain.

When stretched by just sitting and pulling your toes up will bring on the pain. Pointing your toes will also cause pain. Usually there will be bruising visible, but only after 24 hours (This is usually first noted along the ankle and on the inside of the heel or underneath the arch of the foot).

There will be sharp pain when applying pressure to the tear and in some cases a clear indent or ‘gap’ can be felt. After the swelling have disappeared (3 days) you should be able to feel a bump or dip where the most painful spot is.

Medical treatment

Contact us A.S.A.P. The faster we have a look at it before the swelling and bleeding gets too much, we can determine where the tear is and distinguish which of the calf muscles are torn: Gastrocnenius(top) or Soleus(deeper) muscle .

Recovery Time: 2 to 4 Weeks back to running.
Full Recovery: 4 to 8 weeks.

Symptoms of a 2nd degree Calf muscle tear

  • Hear a pop or snap when it happens.
  • Unable to continue play (sport), have to stop moving (running, jumping)
  • Pain through the range as you point and pull your toes upwards
  • Loss of muscle strength (Unable to perform a calf raise)
  • Sharp pain when stretched (Toes pulled to your head)
  • Little to severe swelling (Mainly around the ankle)
  • With or without bleeding under skin (bruising visible – blue)
  • Able to pinpoint it to one specific spot

3rd Degree (Severe)

Severe muscle tear, resulting in the muscle being torn to pieces. This is the most severe tear with a complete rupture of the muscle fibers, and will require surgical reattachment of the muscle.

The main sign will be minimal pain and severe loss of movement. When you try to point your toe, the calf muscle will contract, but there will be very little movement in your foot. If the muscle tears right through (100% of fibers affected), it will leave the muscle in two separate pieces.

Medical treatment

Contact us immediately! The faster we have a look at it before the swelling and bleeding gets too much, we can determine where the tear was and how many muscles were torn.

Depending on the muscles affected, surgery will be required to attach the separate muscle pieces.

Recovery Time: 3 to 4 Months depending on the site of the tear.

Symptoms

  • Hearing a loud pop, snap when it happens.
  • Unable to continue playing, have to stop moving
  • Minimal or No pain
  • Able to contract the muscle, but no movement occurs (The ankle just flops forward and backwards)
  • Severe pain when stretched
  • Always swelling
  • Always considerable amount of bleeding under skin
  • Able to pinpoint and see the two lose ends of the torn calf muscle
  • Gap visible
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Diagnosis

Our physiotherapists are experts at detecting a muscle tear because we spend 11 hours a day working on soft tissue. Forgive us to say “we just have the feeling for it”. We will test the range of movement of your knee and ankle, asking you to point and flex the foot in various positions, with and without weight.This also gives us an indication of the muscle length.

We will test the Gastrocnemius and Soleus muscles’ strength individually by evaluating your ability to rise onto your toes with the knee at various angles, with and without bearing weight.

If we suspect a calf muscle tear , the best way to confirm the diagnosis r is to see it, measure the width, depth and length of the tear by using a Sonar or Ultrasound (Diagnostic Sonar).

Sonar (Diagnostic Ultrasound)

This will be the investigation of choice, as the soft tissue (muscles, ligaments and bleeding) can be visualised. A sonar would show the depth, length and direction of the muscle tear enabling us to treat you optimally.

X-Rays

In some cases we may refer you for an X-ray to exclude any knee or ankle pathology, but this is rare., as X-rays show only the bones and will therefore not give us an indication of what in happening in the muscle bellies. X rays will only be indicated if we suspect a stress fracture of the tibia, or on avulsion fracture of the Achilles tendon.

MRI:

A MRI will only be needed if we suspect the interosseous membrane, between the tibia and fibula is injured. The interosseous membrane of the leg (middle tibiofibular ligament) extends between the tibia and fibula, it helps stabilize the Tib-Fib relationship and distance between the two bones of the lower leg, furthermore it separates the muscles on the front from those on the back of the leg.

Calf muscle tear

What makes a torn calf muscle worse

  • Walking up a ramp or incline

  • Climbing stairs

  • Running uphill

  • Stair running drills

  • Sprint running drills

  • Single leg jumps

  • Giving a bigger stride in a jog or run

  • Walking on your toes or heels

  • Raising onto your toes, when dancing

  • Wearing high heels

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Loading the Calf muscle & tendon to stimulate healing

  • While rest may be helpful in the very short term, continued rest may lead to deconditioning of the tissues – joint stiffness, muscle weakness,tightness and reduced proprioception (control and balance).
  • Optimal loading will stimulate the healing process as bone, tendon, ligament and muscle all require some loading to stimulate healing
  • The right amount of activity can help manage swelling. For example in the ankle, contraction of the calf muscles helps to move swelling by stimulating a venous return of blood flow back to the heart (against gravity). The muscle functions as a pump,when the muscle contracts pressure is applied to the veins, which aids in circulation This will prevent the swelling from building up in your calf by improving blood supply around the injured tissue. Complete rest will prevent this.

I’m not suggesting you ditch your crutches and run off down the street! When it comes to managing an acute calf injury we recommend you seek medical advice, especially if there is noticeable swelling or any restriction of your ankle range of movement.

We have to adopt a policy of weight-bearing as tolerated. Meaning do as much as you feel comfortable to do and don’t push through pain. This usually fits within the idea of optimal loading, but if in doubt, call us. This also includes exercises, we encourage people to gently move the joints around the knee and ankle, again listening to the body and not pushing through pain. It’s better to do these small movements than to end up with a stiff knee or ankle joint. Do not overdo it, or you may just cause more pain. Offload taping is very useful to support an area when you load it.

Why my calf pain doesn’t go away

If you are asking yourself ‘why is it taking so long for the pain to go away’ then you might want to consider the following. When the muscle tears the body attempts to repair the injured fibers by sending cells to reattach the torn ends of the fibers.

It reacts similar to repairing an open wound. Like having a cut at the bottom of your foot. If you keep on walking on it, you will shear away the cells that are healing and closing the wound. The more you walk or run through the pain, the longer it will take to heal.If the pain returns every time you start running again, you have missed the most vital aspect of the cause of the muscle tear. The muscle length must return to normal before you return to participating.

If you take a few days off and the pain in the calf is gone (usually 3 days) when you try running again, the pain just returns. If the muscle length is not restored, you will rip the wound wide open and start from the beginning again. This is the most common reason why patients consult us.

If you are taking anti-inflammatory medication for the calf muscle tear, STOP taking them. Inflammation is the body’s natural way of healing the injured muscle fibers. The medication is preventing this process from taking place, not to mention, masking the effect of the trauma on the tissue if you return to running while still taking anti-inflammatory medications.

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Fibrous tissue formation

Scar tissue needs to be formed after an injury or tear to heal the muscle. This scar tissue is like a scab forming over a wound on your skin. The scar tissue needs to form in the same direction as the muscle fibers, be of the same length and able to withstand the forces that will be loaded onto the muscle. Optimal, functional scarring will allow you to return to your sport, without re injuring it. If you keep running through the pain, you are ripping the wound tissue that forms every day expect your body to repair it again while you rest.

It will eventually lead to damage control, poorly placed, thick scar tissue to form that looks like a dense web of scattered fibers called a fibrous scar. This web of scar tissue can attach itself to arteries, veins and nerves in the area, apart from the fact that it will restrict the normal sliding of the muscle fibers, you may get nerve pain as well. You won’t fix the dent in your car without having it smoothed, polished and coloured, so why don’t you go through the same trouble for your calf?

Calf muscle tear

What NOT to do

  • Anti-inflammatory medications are not recommended, especially in the first 48 hours as they are thought to delay healing

  • Stretch your calf through the pain

  • Walk, run, jog through the pain

  • Do not ignore calf pain that gets worse (it could be an sign of a Deep venous Thrombus)

  • Leave it untreated, if you are uncertain of the diagnosis, rather call us and be safe

What you should do

  • Follow a POLICE or PRICE protocol.

  • Make an appointment to confirm the diagnosis and determine the severity of the tear.

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Physiotherapist treatment

A muscle tear can re-attach successfully if you guide and protect it throughout its healing phases.
We follow the 6 phase rehabilitation process where we guide you through each step.

Treatment and Rehabilitation

  • Physiotherapy treatment focuses on pain management and accelerating the healing process by using Ultrasound and Laser
  • Strapping and Taping to support and protect from further injury.
  • Acupuncture or Dry Needling of the Gastrocnemius and Soleus muscles.
  • Electrotherapy
  • Massage, Soft tissue mobilization and muscle Stretches to lengthen the shortened muscles.
  • Myofascial release of the calf muscles to guide the scar tissue formation.
  • Dynamic, static and ballistic stretches together with eccentric loading exercises to condition the muscle fibers.
  • Compression braces like compression socks or neoprene sleeve can promote blood flow through the site of injury and prevent the blood pooling in the lower leg.
  • Crutches to immobilize the calf for the first few days or weeks.
  • We will gradually progress your rehabilitation exercises to regain full function of the Gastrocnemius and Soleus muscles.
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PRICE protocol

1st Phase: Protection & initial Healing

Key Action
P Protect We have found that patients tend to continue walking on the injured leg with a limp. The muscle still contracts every time that your weight is put onto the leg. It’s better to get crutches and keep the load off the muscle. The main concern is to prevent the muscle from tearing even further.
R Rest No weight on the injured leg. Use crutches to take the load off the muscle.
I Ice Ice cubes warped in a towel, tied around the calf reduces pain & inflammation and speeds up the healing process. For at least the first 3 days or until the swelling goes down, apply an ice pack for 20 minutes every two hours. Always keep a towel between the ice and your skin (to prevent a clod burn), and press the ice pack firmly against all the curves of your calf.
C Compress Use strapping (Leukotake S) or elastic compression bandage to keep the muscle supported and prevent blood pooling in your calf. This can be done either with taping or tube grip bandage and helps to control swelling.
E Elevate Lying on your back with your foot on a chair (your calf must be higher than your heart to allow gravity to assist in draining the pooled blood in your leg.) Raise your calf for 15 minute intervals during the day.
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2nd Phase: Regain Full Range of Movement

The most important component of rehabilitation is to regain full range of movement of the muscle fibers. The scar tissue that form inside the site of the tear must be lengthened and orientated to allow the muscle to contract without any restrictions. We use massage, stretches and neurodynamic mobilizations to achieve full range of movement. This will also prevent future reoccurrence.

3rd Phase: Eccentric Muscle Strength

A muscle contraction works in two directions: One where the muscle is contracted and it shortens like a heel rise (concentric), and controlling the descent going down from a heel rise (eccentric). This loads the muscle fibers while being lengthening. These type of exercises is vital at conditioning the muscle fibers to absorb a force.

4th Phase: Concentric Muscle Strength

Shortening of the muscle during a contraction involves strength and power exercises that will be progressed gradually as healing takes place. This will be tested frequently to determine if you can progress from non-weight bearing to full weight bearing (walking without crutches). The physiotherapist will guide and monitor the muscles reaction to normal forces like walking, climbing stairs and driving.

5th Phase: High Speed, Power, Proprioception

The calf muscles must be tested under high load and speed to ensure that the muscle will be able to keep up with the demand of your body. During this phase the physiotherapist will guide you to return to normal activities, as well challenges the muscle past its ‘normal’ boundaries to determine how it reacts to different forces and prepare you to return to participating in your sport.

6th Phase: Sport Specific Training

Depending on your sport, the physiotherapist will tailor specific exercises that will help strengthen the muscles pertaining to your sport. A successful outcome is when you have gained knowledge throughout the rehabilitation program and can participate at full power and speed, not to mention the benefits of minimizing your chance of future injury.

Signs of Calf pain that can be life threatening

Deep Venous Thrombosis (DVT)

Symptoms of DVT overlap with a calf injury, but the main distinguishing factors are:

  • Warmth over the skin of the calf
  • Redness or discoloration of the skin in the calf
  • Excessive pain from your injury

A DVT can develop after an injury post injury or not being able to move your leg for a few weeks after a prolonged period of immobilisation, like bedrest or a long haul flight. It can happen to anybody, regardless of your age.

General Practitioners tend to send patients for an Ultrasound (Diagnostic Sonar) investigation of a suspected DVT, where they can see the veins in the calf and determine if there is any obstruction in blood flow back to your heart.

If the thrombosis can be seen, the test is positive, and they will admit you to the hospital for observation and start you on a variety of anticoagulant medications. A DVT is a serious condition and can lead to pulmonary embolism (where the blood clot moves to the lungs, obstructing your ability to breath) which is potentially life threatening.

If the test is negative, your Sonographer will search for signs of a muscle tear.

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Surgery of a calf muscle tear

Surgery would only be considered for a Achilles tendon rupture. Normal sutures cannot hold muscle fibers together. Therefor a calf muscle tear would be treated conservatively with physiotherapy.

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What else could calf muscle pain be

Achilles tendinosis or tendinitis

Inflammation of the Achilles tendon itself will cause localised pain over the tendon at the back of the leg. It can be at the base of the Gastrocnemius and Soleus muscles, where the tendon starts, or where the tendon attaches to the heel. Tendinitis will normally be painful at rest, go away during activity and return after cooldown.

Flexor Digitorum Longus muscle tear

Injury to this muscle is common in ballet dancers, due to the repetitive plantar flexion needed at the ankle. This will cause pain more localised to the ankle and foot, especially bad when taking weight on the affected side, cramping of the foot or even clawing a deformity of the foot.

Posterior Tibial nerve entrapment

The posterior tibial nerve can become entrapped along the path it follows from below the knee, through the calf and entering the foot. Symptoms of entrapment may include cramping, pins and needles, burning sensation along the calf or ankle.

Gastrocnemius or Soleus muscle cramp

Cramps are sudden, painful, involuntary contractions of the muscles due to overexertion, dehydration, dietary insufficiency or decreased flexibility.

Posterior Compartment Syndrome

The muscles in the lower leg are surrounded by sheaths. When the pressure rises too much because of exertion or swelling pain may be experienced. This will be painful during a exercise and go away completely during rest, only to return with exercise again.

Deep Venous Thrombosis

DVT, as discussed above, is a dangerous condition and should be treated immediately.

Calf muscle tear – Also Known as

Calf muscle strains, pulled calf muscle, torn calf muscle.

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