Soft Tissue Injury: Calf Strain

  • Reference Number: HEY-231/2016
  • Departments: Emergency Department, Physiotherapy


This leaflet has been produced to give you general information about your injury. Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion  If after reading it, you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is a calf strain?

There are two muscles that combine to form the calf. These are called the gastrocnemius, which is the big muscle at the back of the lower leg and the soleus muscle, which is a smaller muscle lower down in the leg. A calf strain occurs when fibres of either of these two muscles are torn. It is a common injury and is often caused by overstretching or by putting excess force through the calf muscle.

What are the symptoms?

Symptoms can vary depending on the severity of the muscle strain. However, it is common to experience the following symptoms:

  • A sudden sharp pain in the back of the leg.
  •  The calf muscle may be painful, swollen or bruised.
  • It is painful to stand on tip toes and push off from the foot.

What if I need pain relief?

To manage your pain it is advised that you regularly take simple pain relief which can be bought over the counter. If you have allergies or conditions which prevent the use of pain relieving or anti-inflammatory medication, please seek advice from your General Practitioner (GP) or a pharmacist.

What should I do in the first 72 hours after the injury?

The most important initial treatment is aimed at controlling the pain and swelling by following the principles of RICE:

R – Rest

Complete rest is not advisable but it is important that you prevent putting the calf under strain in the early stages of healing. The movements below should be practiced 10 times, within your limits of pain, 3 to 4 times every day:

1. While sitting, pull your toes and ankle up towards you.
To assist this movement, place a scarf or towel around your foot and gently pull your foot up, by pulling the scarf with your hands. Hold this position for five seconds. rest-1a
Now point your toes away from you and hold for five seconds. pointingToesAwayImage2
2. While lying or sitting gently bend and straighten your knee.

I – Ice

Ice will help reduce the pain in your ankle and should be applied for 10 to 15 minutes before performing the exercises above. This will in turn help to reduce the swelling.

There are many different ways in which ice can be applied, however crushed ice is thought to be the most effective. Whichever method you choose it is important that you wrap the ice in a damp towel to prevent it from ‘burning’ the skin.

Please Note:

Only use an ice pack on areas that have normal skin sensation i.e. where you can feel hot and cold.

Do not apply ice to an open wound.

Do not apply an ice pack to an area that has poor circulation.

When you apply ice to your skin, check the skin every five minutes and stop using it if:

  • The area becomes white, blue or blotchy.
  • The area becomes excessively painful, numb or tingles.

C – Compression

You may have been given a tubigrip to wear, it is important this is removed if you develop any signs of poor circulation such as pins and needles or numbness. In addition, the tubigrip should be removed when you go to bed at night.

E – Elevation

The ankle should be elevated above the level of the heart as much as possible, as this will reduce and prevent swelling.
.legElevated Carrying out the movements of the ankle described above, while the leg is elevated, may help to reduce any swelling further.

What not to do

Consuming alcohol, massaging the injured area and applying heat can all be detrimental in the early stages of healing and therefore should be avoided.

Rehabilitation and recovery

If you follow this basic advice your injury should take around six weeks to heal. However, everyone recovers from injuries at different rates and your recovery is dependant on the severity of the injury and the presence of any other medical problems.

Once your pain settles and you no longer require crutches it is important to add in the following exercises which will help you to regain full function, flexibility and strength. When doing these exercises you should stop when you are at the point when it becomes painful; if you ‘push into the pain’, by continuing with the exercise, it may cause the muscle to tear again.


1. Stand facing a wall and step backwards with your injured leg.
standingExercise Keep this leg straight with your toes pointing forward and the heel on the floor.

Now bend your other knee until you feel a stretch in the calf of your injured leg. Hold this for 30 seconds and repeat three times per day.

2. From the position above, move your injured leg forward but keep it slightly behind your other leg.
stretchingPosition Ensure that your toes point forward and bend both knees, keeping the heel of your injured leg on the floor.

You should feel a stretch in the calf of your injured leg. Hold for 30 seconds and repeat three times per day.

3. Once you are able to stand on your toes without pain you can start to strengthen the muscle.

Stand holding on to a chair, spread your weight equally over both feet and push up onto your toes as high as possible.

standAndPush Hold for 5 seconds and slowly lower. Repeat 10 times, twice per day.

Once this becomes easier you can increase the number of repetitions, or progress to repeating this stood on the injured leg on its own.

When can I return to normal activities?

If you participate in an active hobby then it is advisable that you do not return to this until you have full strength, full range of movement and you can walk briskly without experiencing pain and swelling.

If you play a sport, you can practice sports specific activities, like dribbling or jumping. Build up these exercises gradually, in order to help regain strength and flexibility, before returning to full training sessions and competition.

When to seek further help

You will normally be offered a referral for physiotherapy following this type of injury, unless your symptoms are minimal on your initial appointment. Your physiotherapy appointment could be at one of the various locations in the Hull and East Riding area.

If 10 days following your injury you are unable to weight bear and the calf remains very painful and swollen, despite following the advice in this leaflet, please contact your physiotherapist.

If at this stage you have not started your physiotherapy treatment please contact the Emergency Care Physiotherapy Team on telephone number (01482) 674880. If there is no answer, please leave a message by clearly stating that you were seen in the Emergency Care Department and leave your full name, address, telephone number and brief description of the problem. A member of the team will get back to you as soon as possible.

Please be aware it is very important that you see your GP immediately if, after following advice in this leaflet, your symptoms do not improve and you notice that the calf becomes increasingly tender, red and hot to touch.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

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