Calf muscle tear: What it is and how to treat it

Calf muscle tears are unfortunately relatively common among runners and triathletes, and can result in a spell on the sidelines.

That can feel like a minor disaster if you’re training for an upcoming event, but ignoring the injury or rushing back too early can make matters worse, resulting in a longer period of recovery.

To help make sure you don’t make the same mistakes, here’s Rachel McCulloch, a rehab specialist at Six Physio, with all the key info you need to know about calf muscle tears, including symptoms, treatment and recovery times.

What is a calf muscle tear?

The calf muscles sit at the back of the lower leg. There are two main calf muscles: the soleus and the gastrocnemius. A tear can range from a few fibres being torn to full tear through the muscle.

A muscle tear happens when the fibres, which make up the muscle belly, are overloaded and can’t cope with the levels of stress, and so tear as a result. This typically occurs when exercising, due to either overstretching of the muscle or a powerful contraction.

Calf tears are a common injury and happen in sports where there are changes in load, be it accelerating or decelerating, or changes in volumes (like distances, frequency of training or intensities). This is why running is one of the most common causes of a calf injury.

The NHS explains the three grades of calf muscle tears as below:

Grade one is classed as a ‘mild’ strain. In this situation, only a small number of muscle fibres are affected. Strength output is unaffected and full range of motion is maintained.

Grade two is ‘moderate’ in terms of severity. In this situation, more muscle fibres are torn but there is not a complete rupture. There will be minor decreases in strength outputs and it’s usually accompanied with swelling and acute pain.

Grade three is characterised as a severe tear, which can cause a full rupture of the muscle. Bruising and swelling are typically present and there will usually be a complete loss in strength outputs and severe pain. Grade one and two muscle injuries are the most common in running, with grade three being the least.

How do you tear a calf muscle?

Muscle tears occur when you increase the load demands of the muscle to work in a way that outstrips its capacity to perform.

The demand (load) can be increased from multiple factors; technique, training programmes, environmental conditions, equipment, biomechanical compensations, and whether you warm up/cool down appropriately.

The capacity of the muscle is affected by your age, BMI, fitness levels, endurance, power, flexibility, gender, hormone cycle, medications, and where your body is sitting on the rest/ training continuum to name a few.

How do I know if my calf muscle is torn?

People describe tearing a calf like being kicked from behind. It can be sore to varying extents and can seem to come out of nowhere.

It often occurs when you try to push off the floor behind you to generate power as with walking, running or jumping.

Aside from that, the main symptoms of a torn calf muscle are pain, tenderness, discomfort with stretching or using the calf muscle, bruising and walking with a limp. You might also notice a lack of power in the muscle when you try to use it.

The grade or severity of injury will determine which symptoms are most prominent. For example, bruising tends to come out with the more severe tear and can take a few days to show its true colours.

The gold standard assessment would be some medical imaging, however, in practice this isn’t needed too often. A physio or sports physician can assess this for you.

• How do you tell the difference between a soft tissue injury and a stress fracture?

Can a calf muscle tear heal on its own?

Yes, in principle. However, calf muscles are quite susceptible to repeat injury as the capacity of the tissues will be reduced. By returning to training, the load is likely to be higher than the muscle’s ability to cope.

It’s worth seeking help with these injuries to get the best possible outcome, especially on the first injury. This will also help to prevent compensations and that nasty cycle of one injury leading to another.

How to treat a torn calf muscle

The first job is to establish the severity of the injury and discover which grade it falls into. The treatment needs to take the severity into account.

Protecting the muscle from further injury is the next priority and often involves some level of rest. For some, this will need drastic measures such as crutches, while for others it will be as simple as amending training programmes to remove explosive movement.

Controlling inflammation and swelling come next. The goal is not to remove inflammation completely, as this is the first step to our healing journey, but to make sure it’s in proportion to the level of injury and not increasing. Ice, compression, elevation and, sometimes, anti-inflammatories come in here.

Then we need to start giving the muscle some positive stimulus to recover. It needs that sweet spot of strengthening where we encourage the muscle to start building bridges over the torn areas so that it can repair and start laying down scar tissue. However, too much load or aggressive strengthening here could be detrimental.

It’s best to seek advice from a physio at this point. Too little load and healing will probably still occur, but the risk of repeat injury will be high.

The strengthening needs to be progressive and gradually start challenging the muscle through its range of movement, and then the different acceleration/deceleration demands that are muscle and sport specific. Strengthening starts to build your calf muscles’ load tolerance.

Along the way, some soft tissue input to increase blood flow, break down some of the scar tissues (yes, sounds counterintuitive, right?) and improve the quality of movement works a treat.

It’s worth noting that scar tissue is laid down initially in a very disorganised fashion, which is excellent in the short term as it helps to protect the muscle and starts the repair process.

However, this disorganised matrix of new tissue is inflexible, unable to withstand great forces and can be painful – put that all together and it’s a perfect storm for a repeat injury.

With some soft tissue treatment and then a progressive strengthening programme, the body starts to understand the variety of demands placed upon the muscle.

Our wonderful body responds to this information by constantly adjusting the scar tissue and repeating the repair process until it can do everything that is required of it – for example, where muscle tissue capacity is more than or equal to the load demands.

It’s important to note here that many people go straight to stretching with muscle tears as the muscle feels tight.

Stretching a vulnerable tissue while it’s trying to repair can be detrimental, especially in those tears where the muscle is already elongated.

If it feels stiff, talk to your physio and they will advise on the best way to get your range back to normal while improving the tissue quality and thus building your capacity to withstand forces.

How long does it take to recover from a torn calf muscle?

The healing time of a muscle tear is affected by its severity. Healing takes up to 12 weeks, but you may find you are back to your normal training before then.

It’s always worth getting seen by a physiotherapist to help determine the cause of your injury, as it may be different to other people’s experiences.

This will help prevent repeat injuries which are common in the calf.

How to start training again after a calf muscle injury

Some cross training can occur straight away in many circumstances; for example, getting in the pool, or going for a light (very light) cycle early on can be beneficial.

It’s key to make sure your calf muscle has the strength and flexibility to cope with the demands of your sport. Some baseline strengthening and making sure you have a normal range of movement are the first two goals to achieve.

Start with some static strengthening, then work through range, and finally change the load demands later on with weights/speed/change of direction.

Returning to the bike is pretty simple; train with light resistance and short rides, and gradually with time build duration and duration.

Listen to your body – it should not be painful. Some mild discomfort during the activity is acceptable but it shouldn’t feel worse afterwards.

Returning to running needs a more thorough rehab approach. When your physio gives you the green light, a tailored approach is needed taking into account duration, speed, terrain and your specific goals.

Often short and easy intervals are the way to go at the beginning, in time building interval intensity, duration and varying terrain.

• How to start running after a calf injury

How to prevent a calf muscle injury

The more resilience it has in the specific needs of your sport(s) the less likely it is to get injured again.

As a runner, for example, the calf will need to be able to cope with the acceleration and deceleration forces associated with running and also the repetitive nature of this. Therefore, take off, landing and endurance are key.

Take that resilience one step further and challenge your calf with a variety of tasks then we reduce its risk of injury during less predictable activities too – dashing for the train, running on wet mud or a kick around in the park. Aim for good power, endurance, range of movement and versatility.

Strengthening has been shown over and over again in well-designed studies to be beneficial in the prevention of injury in endurance sports.

When those miles build up, strengthening is the first thing that people tend to drop off their training regime.

Keep it high up there on the priority list and know that you’re giving your body the ability you need to achieve your goals.

In need of some treatment or additional advice? Six Physio has multiple clinics across London. Find out more here.

Top image credit: Getty Images