Calf Strains: Common and Recurrent Without Good Rehab

Calf strains are extremely common -- particularly in recreational athletes in their 30s-50s (earning the colloquial name "tennis leg"). They occur most commonly during sudden acceleration, jumping, or push-off activities. The gastrocnemius (two-headed superficial calf muscle) is more commonly strained than the soleus, particularly at the medial head. Without adequate rehabilitation, re-injury rates are high.

Distinguishing Gastrocnemius from Soleus Strain

Gastrocnemius strain: pain with sudden onset during activity, tenderness in the upper-middle calf, pain aggravated by straight-knee calf stretching. Soleus strain: more insidious onset, deeper central calf pain, pain aggravated by bent-knee calf stretching. The Thompson test differentiates calf strain from Achilles rupture (squeeze the calf -- no foot plantarflexion = Achilles rupture).

Physiotherapy Rehabilitation

Acute Phase (Days 0-3)

Ice, compression, elevation, gentle pain-free range of motion. A small heel raise in footwear reduces tension on the calf while walking. Avoid aggressive stretching of the acutely torn muscle.

Subacute Phase (Days 3-14)

Progressive weight-bearing and gentle active stretching as tolerated. Double-leg calf raises progressing to single-leg. Stationary cycling as aerobic maintenance.

Strengthening Phase (Weeks 2-6)

Progressive eccentric calf loading (heel drops) -- the most evidence-based intervention for calf muscle rehabilitation. Single-leg calf raises through full range on a step.

Running Rehabilitation

Criteria-based return-to-running programme: walking -- power walking -- jogging -- running -- sprinting. Criteria: pain-free single-leg calf raises x 25 before starting to run.