Is Your Calf Muscle Pain Just a Strain or Something Else?

Calf pain does not always indicate a muscle problem

Cramp in calf Typical pain in a jogger`s calf. XXL size image.
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If you have a sudden pain in the calf muscle during activity, it very well may be the result of a pulled or torn calf muscle. This is called a calf strain, and it's a common injury, especially in athletes

But, your calf pain may also be something else, (and something more serious) like a blood clot. This is why it's important to get it properly checked out by a doctor, so you can move forward with treatment promptly.

What Is a Calf Strain?

A calf strain occurs when part of the muscles of the lower leg (gastrocnemius, soleus, plantaris) are stretched beyond their ability to withstand the tension. This stretching can result in small micro-tears in the muscle fibers or, in a severe injury, a complete rupture of the muscle fibers.  

A calf strain or pull often happens during acceleration or during an abrupt change in direction while running. 

Calf strains (which most commonly occur in the gastrocnemius muscle) may be minor or very severe and are typically graded as follows:

  • ​​​Grade 1 Calf Strain: The muscle is stretched causing some small micro tears in the muscle fibers. A person will be able to continue the activity but will have pain. Full recovery takes approximately two weeks.
  • Grade 2 Calf Strain: There is partial tearing of muscle fibers, so a person will be unable to continue the activity. Full recovery takes approximately 5 weeks to 8 weeks.
  • Grade 3 Calf Strain: This is the most severe calf strain with a complete tearing or rupture of muscle fibers in the lower leg. Full recovery can take 3 months to 4 months and, in some instances, surgery may be needed.

How Are Calf Strains Treated?

The initial treatment for a calf strain is R.I.C.E. (rest, ice, compression, elevation), used in the first three to five days after injury:

  • Rest: It's important to rest the muscle, which means avoiding any activities that cause pain, as well as any impact activity or excessive stretching—so no running, jumping, or weightlifting. It's also important to not return to sports until you are pain-free. A doctor may recommend crutches to avoid placing unnecessary weight on the injured calf. 
  • Ice: Applying ice to the calf for 20-minute intervals, several times a day will reduce swelling. It's best to avoid direct contact of the ice on your skin by placing a thin towel between the ice and your calf or using a cold pack.
  • Compression: It's a good idea to wrap the injured calf with an elastic compression bandage (like an ACE wrap) to prevent blood from pooling in the foot. Some athletes find that taping the calf can reduce pain and help protect from further injury. Applying special physical therapy or kinesiology tape is one way to easily tape the calf muscle. 
  • Elevation: Keeping the foot elevated (above your heart) is also important and will reduce swelling.

A doctor may also recommend an anti-inflammatory medication like a NSAID (for example, ibuprofen) to reduce pain and swelling for up to three days.

In addition to the R.I.C.E. protocol for a calf strain, a person may need rehabilitation with a physical therapist depending on the severity of the injury.

Examples of exercises or interventions a physical therapist may recommend include:

  • Range of Motion Stretching Exercises: When the acute pain is gone, begin stretching the muscle moderately with passive range of motion stretching. Gently pull your foot and toes up with legs straight if possible to stretch the calf muscle. Hold for 10 seconds and repeat five to 10 times.
  • Progressive Calf Stretching Exercises: As the calf heals, you can begin using a regular stretching and flexibility program to gain range of motion and prevent future calf injury. Follow the advice of your therapist when beginning these exercises.
  • ​​​Use of a Foam Roller: Performing gentle self-massage with a foam roller as your calf injury heals may help reduce scar tissue formation and improve blood flow to the area.
  • Achilles Tendon Strengthening: Once you have healed and experience no pain with basic strengthening exercises, consider strengthening your Achilles tendon to prevent related lower leg injuries.

Remember, the goal of rehabilitation is to return to normal activity as quickly as possible without any long-term effects. If you return too soon, you risk developing a chronic injury. Keep in mind that everyone recovers at a different rate and your rehab needs to be tailored to your needs and your progress, not the calendar.

Again, a visit to a physician and a physical therapist is recommended to ensure a proper diagnosis and fast rehabilitation.

Other Causes of Acute Calf Pain

While you may naturally link calf pain to a muscle injury, there are other causes, and some are quite serious, like a blood clot. Potential causes include:

Calf Muscle Cramp or Contusion

A far less severe, but often painful cause of calf pain is a muscle cramp or spasm. This involuntary contraction of a muscle is short-lived, but it may be so strong that it causes a bruise.

Likewise, a direct blow to the calf may cause a bruise (called a contusion), as blood pools around the crushed muscle fibers. Most contusions are mild and can be treated with the R.I.C.E protocol

Blood Clot

Acute calf pain may also be the result of a blood clot (called a deep vein thrombosis). Along with acute pain, people also experience swelling, warmth, and/or redness. If a doctor suspects a blood clot, he or she will order an ultrasound of your leg to confirm the diagnosis. 

A blood clot is a serious medical condition and requires immediate therapy with a blood thinner. This is why it's important to see a doctor for acute calf pain—it can be tricky to distinguish a muscle or tendon injury from a blood clot.

Baker's Cyst

A Baker's cyst is a fluid-filled sac that usually forms as a result of arthritis in the knee joint. It may cause swelling or achiness, or no symptoms at all. A person may also experience calf pain or swelling, although this is usually seen with large Baker's cysts or ones that have ruptured.

Usually, Baker's cysts resolve on their own, but sometimes a steroid injection in the joint can reduce the swelling and discomfort associated with it. Rarely, surgery is needed.

Achilles Tendon Tear or Rupture

The Achilles tendon is the largest tendon in the human body, and it connects two calf muscles (the gastrocnemius and the soleus) to the heel. A tear or rupture of the Achilles tendon causes an acute pain at the back of the ankle or lower leg (so lower than the calf muscle) and an audible "pop" or "snap" may be heard. 

If this occurs, it's important to apply ice and elevate your leg right away—you will need to see a doctor promptly to determine whether or not the tendon is intact, as surgery may be indicated. 

A Word From Verywell

There are a plethora of potential diagnoses for calf pain, so it's best to let a healthcare provider tease it out. If you have been diagnosed with a calf strain, be kind to yourself and give your muscle the appropriate time and therapy it needs to heal. Then you can get back to your active life. 

Sources:

American Academy of Orthopaedic Surgeons.(May 2012).  Achilles Tendon Rupture (Tear).

American Academy of Orthopaedic Surgeons. (July 2015). Sprains, Strains, and Other Soft-Tissue Injuries.

Dixon JB. Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Curr Rev Musculoskelet Med. 2009 Jun;2(2):74-77.

Frush TJ, Noyes FR. Diagnostic and Surgical Considerations. Sports Health. 2015 Jul;7(4):359-65.

Wilbur J, Shian, B. Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism. Am Fam Physician. 2012 Nov 15;86(10):913-19.

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