Nearly every week, I receive a call from an injured runner or triathlete riddled with calf pain. In most cases, the athlete has already attempted and failed self-management of their condition. Inevitably, they come to the realization that they need professional help. Despite the seemingly innocuous nature of calf muscle strains, they pose a serious threat to runners and triathletes. Sound decision making during the early stages of the injury process coupled with a thorough rehabilitation program, can help an athlete heal. Failure to properly manage calf strains will not only prolong an athlete’s recovery, but can also lead to more severe and recurring injury, which can ultimately end one’s career.

The calf muscle complex (CMC), which is also referred to as the triceps surae, is a superficial muscle group on the posterior aspect of the leg. It consists of the gastrocnemius, soleus, and plantaris, which is absent in seven to 20 percent of cases. Collectively, these muscles insert on the calcaneus (heel bone) by way of the Achilles tendon. They function to plantarflex the ankle (going up on the toes) and also act eccentrically control dorsiflexion as the tibia progresses over the foot with walking and running.

In 1883, Powell documented the first calf stain in the journal Lancet. He termed the condition “tennis leg” after he identified it in Dr. W.G. Grace, who was perhaps England’s best-known cricketer of the time. Calf strains typically occur in middle aged people and stem from non-contact injuries rather than direct trauma, and occur in muscles that work across two joints such as the rectus femoris, semitendinosus, and gastrocnemius. In the context of calf strains, athletes typically report a sudden, painful injury, as if struck by a ball, which makes walking difficult, causing the athlete to ambulate with their foot turned out. As it relates to triathlon, calf strains typically occur while running. Despite long attribution of this injury to a rupture of the plantaris tendon, most researchers attribute tennis leg to an isolated rupture of the medial head of the gastrocnemius at the musculotendinous junction.

Simply put, calf injuries occur when the gastrocnemius fails to withstand a certain force or strain. Muscle strains of the lower extremity pose a serious threat to runners and triathletes as they have a high recurrence rate, and account for a significant amount of convalescence time in both competitive and recreational athletes. Dissimilar to bone fractures, which heal by means of regeneration (identical tissue), muscle strains heal by repair (scar formation). When it comes to the severity of injury, muscle strains are usually categorized as follows:

Grade 1 (Mild) – tear of only a few muscle fibers with minor swelling and discomfort; minimal to no strength loss nor motion restriction

Grade 2 (Moderate) – greater damage with clear loss of the ability of the muscle to contract

Grade 3 (Severe) – tear extends across the entire cross section resulting in near complete loss of function

In the event an athlete sustains a calf strain, it’s important to seek attention from a licensed medical professional to rule out more serious, life-threatening conditions such as deep venous thrombosis, acute compartment syndrome, and cellulitis. Once these diagnoses have been excluded, conservative management generally ensues, as most calf strains don’t result in complete muscle disruption. Since each individual athlete requires a customized approach to properly manage their condition, here’s a short list of evidence-based guidelines to bring on optimal recovery.