Calf tear (calf strain): symptoms, recovery and when to worry

The calf is the bulk of muscle at the back of the leg between the knee and the ankle. Physio.co.uk, a physiotherapy provider, explains that it is made up of two muscles, the gastrocnemius on the surface and the soleus underneath, and that a calf strain is a tear in one of them. An NHS GP practice page on first contact physiotherapy adds that most strains are partial tears, graded I, II or III depending on severity, and that a severe injury can produce a complete tear known as a muscle rupture.

The NHS defines a strain as an overstretched or torn muscle, also called a pulled muscle, and says strains are most common in the feet, legs and back. A tear is therefore not a separate condition from a strain, just a description of how much of the muscle is damaged.

Physio.co.uk says a calf strain can occur when the muscle is forcibly contracted while it is stretched, for example when accelerating from standing still or lunging forward. It lists factors that may contribute: an inadequate warm-up, muscle stiffness or tightness, fatigue or overuse, too little recovery between training sessions, reduced muscle strength and faulty biomechanics. The practice page notes that any sport involving running leaves people most susceptible.

The NHS gives common causes of strains as not warming up before exercising, tired muscles and playing sport.

Physio.co.uk says the first sensation is sudden pain in the calf, which may feel like a stabbing or tearing sensation. With a minor tear you may be able to keep walking or running with little hindrance, but as you rest and the muscle cools the pain may gradually worsen as bleeding and swelling develop around the injured muscle. Stiffness, reduced range of movement and changes to the way you walk can follow.

The NHS lists signs of a strain more generally: pain, tenderness or weakness, swelling or bruising, difficulty putting weight on the injury or using it normally, and muscle spasms or cramping. If you cannot put any weight on the leg or walk more than a few steps, the NHS says to get help from NHS 111.

Not all calf pain is muscular. The NHS describes deep vein thrombosis (DVT) as a blood clot in a vein, usually in the leg, with throbbing pain in one leg, usually in the calf or thigh, swelling in one leg, red, blue or darkened skin around the painful area, and swollen veins. If you think you have a DVT the NHS says to ask for an urgent GP appointment or get help from NHS 111.

Call 999 or go to A&E if you have symptoms of DVT and feel short of breath or have chest pain, because a clot can travel to the lungs. The NHS says a DVT is more likely after surgery, a stay in hospital, long journeys of more than 4 hours, and with factors such as HRT, the combined contraceptive pill, pregnancy, cancer or previous DVT. A calf that is swollen and painful without any clear injury deserves particular caution.

For the first 2 to 3 days after a strain the NHS recommends PRICE: protection, rest, ice, compression and elevation.

• Protection: support the injury, for example with shoes that support your foot or ankle.

• Rest: stop exercise and try not to put weight on the injury.

• Ice: an ice pack, or frozen vegetables wrapped in a tea towel, for up to 20 minutes every 2 to 3 hours.

• Compression: a bandage for support during the day.

• Elevation: keep the leg raised on a pillow as much as possible.

The NHS says to avoid heat such as hot baths and heat packs, alcohol and massage for the first couple of days to help prevent swelling. Physio.co.uk makes a similar point for calf strains, saying that in the first few days you should not do things that increase blood flow to the muscle, which can prolong bleeding and swelling, including hot showers, calf stretching, heat rubs, massage, alcohol and excessive weight bearing. A pharmacist can advise about suitable painkillers; the NHS suggests paracetamol for pain and ibuprofen gel, mousse or spray for swelling, with tablets if needed.

The NHS says that once you can move the area without pain stopping you, you should keep moving it so it does not become stiff. After 2 weeks most strains feel better, but it advises avoiding strenuous exercise such as running for up to 8 weeks because of the risk of further damage, and says severe strains can take months to recover. If a strain is taking longer than usual, physiotherapy may help.

A physiotherapist can assess how much of the muscle is damaged and give an idea of healing time. The first contact physiotherapy practice page describes hands-on treatment, stretching, exercise prescription for strengthening and later-stage functional exercises to return to sport, and suggests that a badly torn calf may need crutches for walking. Physio.co.uk lists electrotherapy, hydrotherapy, massage and exercise programmes as options. Evidence for adjuncts such as laser or ultrasound is not covered by the sources used for this page.

The NHS says to get help from NHS 111 if the injury is very painful or getting worse, there is a large amount of swelling or bruising, you cannot put weight on it, it is very stiff, or it is not improving after self-care. Call 999 or go to A&E if you heard a crack when the injury happened, the limb has changed shape, it is numb or tingling, or the skin has changed colour, because a bone may be broken.

In many areas you can refer yourself to NHS community musculoskeletal services without seeing a GP, though the NHS notes that waiting times can be long and physiotherapy can also be arranged privately through a chartered physiotherapist. Private sports medicine or orthopaedic review can add ultrasound or MRI if a complete rupture is suspected; ask what the result would change in your treatment before agreeing to imaging.