The optimal exercises for treating calf pain depends on the underlying cause of the pain. However, the most common causes of calf pain includes persistent/ repetitive or acute calf muscle strains and tears. Due to the common nature of these injuries which can occur in sporting individuals as well as inactive individuals there is a wealth of research concerning treatment.

When suffering from a calf muscle strain the initial line of treatment will be to limit the degree of inflammation and swelling present at the time of injury. Circle Health physiotherapists are able to advise regarding strategies to achieve this including:

  • Compression (normally using tubigrip or other support)
  • Icing
  • Elevation and circulation exercises
  • Gentle movement as pain and injury level dictate

Key to achieving success in treatment is when to start exercising the calf muscles after this initial acute management. If this is done too early in the process further inflammation may result, increasing pain levels and prolonging rehabilitation timeframes. Our expert lower limb physiotherapy team have great experience in dealing with calf muscle injuries and will be able to guide the appropriate level of activity by listening to your symptoms and from the clinical examination findings.

Once the majority of the acute pain and inflammation have dissipated, it is generally advised to exercise in to mild to moderate pain in line with research that has demonstrated that doing so may bring about more rapid benefits. In cases of persistent calf muscle pain rather than acute injury, your physiotherapist may ask you to push in to slightly more discomfort throughout the rehabilitation process.

Strengthening exercises, also commonly termed loading exercises have been demonstrated to be the most important form of rehabilitation exercise when treating calf muscle injuries. The calf comprises of two main muscles both of which attach to the heel by way of the achilles tendon. The gastrocnemius is a powerful muscle which attaches at it’s top end above behind the knee and is accentuated when the knee is extended. The soleus muscle on the other hand attaches below the knee at it’s top end and it’s use is accentuated when the knee is flexed or with lower load activities. For this reason a calf muscle strengthening program will often involve several exercises which may be repeated with the knee extended and the knee flexed.

Common early stage exercises may include pointing the foot away from the body against resistance tubing or static contractions of the calf muscle by pushing the forefoot in to a cushion. These may be slowly progressed to include heel raise exercises from the floor and in later stages off the edge of a step. Progressions for heel raises often include performing the exercise on a single leg with help from the other leg on the way up (eccentric heel raises) to single leg heel raises with no assistance at all. Weight is often added in a rucksack to further increase the load.

Once base strength has almost returned and pain levels are under control during and following rehabilitation exercises, our expert physiotherapists will plan a return to sport program if needed. During this phase there will be an emphasis on ballistic movements such as jumping, landing, accelerating and sprinting. Again the load will be closely monitored so as to build gradual strength in the calf muscles. In some cases our physiotherapists will use evidenced based return to sport physical tests to help gage when a full return to play may be appropriate.

The evidence concerning stretching to reduce calf muscle injuries has demonstrated that it may not be helpful. However, in certain cases where our expert lower limb physiotherapists identify significant calf muscle stiffness or stiffness in other muscles such as the hamstrings (which may lead to increased work on the calf muscles) it may be appropriate. In some cases of persistent calf muscle strains our expert orthotists may conduct a gait and or running analysis as part of a calf overload assessment. This may demonstrate some patterns of movement which may be helped with an ongoing flexibility program to reduce calf muscle injury risk.

Following an acute calf muscle injury the swelling and resultant immobility will always result in a stiff calf muscle for several weeks or months following injury. A combination of stretches and soft tissue work from our lower limb physiotherapists will be required to restore normal range of motion.

Rehabilitation of other calf pain conditions typically varies considerably and some of these conditions include potentially serious medical problems including compartment syndrome or DVT (deep vein thrombosis). These conditions require an urgent medical assessment and investigation and following diagnosis, exercise based treatment may not be appropriate for significant periods of time.

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Circle Health Group, 1st Floor, 30 Cannon Street, London, EC4M 6XH