Is Your Calf Muscle Pain Just a Strain or Something Else?

 Is Your Calf Muscle Pain Just a Strain or Something Else?

If you develop sudden pain in your calf muscle during activity, it very well may be due to a torn or pulled calf muscle. This is called a calf strain, or a calf pull, and it's a common injury, especially in athletes

However, your calf pain may also be something else (or something more serious), like a blood clot.1

 It's important to get it properly checked out by a doctor, so you can move forward with treatment promptly.
What Is a Calf Strain?

A strain is defined as an injury to a muscle and/or tendon, as opposed to a sprain, which is an injury to a ligament. A calf strain occurs when fibers of the muscles of the lower leg (gastrocnemius, soleus, plantaris) are overstretched.

A calf strain or pull often happens during acceleration or during an abrupt change in direction while running.2 Calf strains (which most commonly occur in the gastrocnemius muscle) may be minor or very severe.

They are graded as follows:3

​​​Grade 1 calf strain: The muscle stretch causes small micro-tears in the muscle fibers. You would have pain, but you can usually continue the activity. Full recovery takes approximately two weeks.
Grade 2 calf strain: There is a partial tear of the affected muscle fibers, so you can't continue the activity. Full recovery takes approximately five to eight weeks.
Grade 3 calf strain: This is the most severe calf strain, with a complete tear or rupture of the affected muscle fibers. Full recovery can take three to four months and, in some instances, surgery may be needed.

Tennis Leg

This is usually a sports-related injury, and it most commonly affects people who are middle-aged. You may feel acute pain in the middle of your calf and you may feel a snapping sensation and/or hear a snapping sound.

It is usually a rupture of the medial head of the gastrocnemius, and it can also occur due to a fluid collection between the gastrocnemius and soleus.4

About 10% of people who experience tennis leg symptoms actually have a blood clot, not a calf strain—this is why it's so important to have an accurate diagnosis.4
Calf Strain Treatment

The initial treatment for a calf strain is R.I.C.E. (rest, ice, compression, elevation), used in the first three to five days after the injury:5

Rest: It's important to rest your injured muscle, which means avoiding any activities that cause pain, as well as any impact activity or excessive stretching—like running, jumping, or weightlifting. It's also important to not return to sports until you are pain-free. Your doctor may recommend crutches so you can avoid placing unnecessary weight on the injured calf.
Ice: Applying ice to your calf for 20-minute intervals, several times a day is recommended to reduce swelling. Avoid directly placing ice on your skin by placing a thin towel between the ice and your calf or using a cold pack.
Compression: It's a good idea to wrap your injured calf with an elastic compression bandage (like an ACE wrap or kinesiology tape) to prevent blood from pooling in your foot. Some athletes find that taping the calf can reduce pain and help protect from further injury.
Elevation: Keeping the foot elevated (at or above the level of your heart) can help reduce swelling.

Your doctor may also recommend an anti-inflammatory medication like a non-steroidal anti-inflammatory (NSAID), such as ibuprofen, to reduce pain and swelling for up to three days.5

A visit to a physician and a physical therapist is recommended to ensure a proper diagnosis and fast rehabilitation.
Physical Therapy

In addition to the R.I.C.E. protocol for a calf strain, you may need rehabilitation with a physical therapist, depending on the severity of the injury. Examples of exercises or interventions a physical therapist may recommend include:6

Range of motion stretching exercises: When the acute pain is gone, begin stretching the muscle moderately with passive range of motion stretching. Gently pull your foot and toes up, with your legs straight, if possible, to stretch your calf muscle. Hold for 10 seconds and repeat five to 10 times.
Progressive calf stretching exercises: As your calf heals, you can begin using a regular stretching and flexibility program to gain range of motion and prevent future calf injury.
​​​Use of a foam roller: Performing gentle self-massage with a foam roller as your calf injury heals may help reduce scar tissue formation and improve blood flow to the area.
Muscle strengthening: Your physical therapist may recommend exercises to help build muscle strength and coordination, which may help you avoid future strain injuries.

Be sure to follow the advice of your therapist when beginning these exercises.

The goal of rehabilitation is to return to normal activity as quickly as possible without long-term effects. If you return too soon, you risk developing a chronic injury. Keep in mind that everyone recovers at a different rate—and your rehab needs to be tailored to your needs and your progress—not the calendar.
Other Causes of Acute Calf Pain

While you may naturally link calf pain to a muscle injury, there are other causes, and some are quite serious, like a blood clot. Potential causes include:
Calf Muscle Cramp

A far less severe, but often painful cause of calf pain is a muscle cramp or spasm.1 This involuntary contraction of a muscle is short-lived, but it may be so strong that it causes a bruise.
Muscle cramp causes, prevention, and treatment
Calf Muscle Contusion

Likewise, a direct blow to your calf may cause a contusion (bruise) as blood pools around the crushed muscle fibers. Most contusions are mild and can be treated with the R.I.C.E protocol.7
Blood Clot

Acute calf pain may also be the result of a deep vein thrombosis (DVT), which is a blood clot in a vein.8 Along with acute pain, a DVT can cause swelling, warmth, and/or redness. And the clot can dislodge and travel to the lungs—a potentially fatal complication.

If your doctor suspects a DVT in your leg, they will order an ultrasound of your leg to confirm the diagnosis. A blood clot is a serious medical condition and requires immediate therapy with a blood thinner. This is why it's important to see a doctor for acute calf pain—it can be tricky to distinguish a muscle or tendon injury from a blood clot.
Baker's Cyst

A Baker's cyst is a fluid-filled sac that usually forms as a result of arthritis in the knee joint. It may cause swelling or achiness, or it might not cause any symptoms at all. You can also experience calf pain or swelling, although this is usually seen with large or ruptured Baker's cysts.

Usually, Baker's cysts resolve on their own, but sometimes a steroid injection in the joint can reduce the swelling and discomfort associated with it.9 Rarely, surgery is needed.
Achilles Tendon Tear or Rupture

The Achilles tendon is the largest tendon in the human body, and it connects two calf muscles (the gastrocnemius and the soleus) to the heel. A tear or rupture of the Achilles tendon causes acute pain at the back of the ankle or lower leg (lower than the calf muscle) and an audible "pop" or "snap" may be heard.10

If this occurs, it's important to apply ice and elevate your leg right away—you will need to see a doctor promptly to determine whether or not the tendon is intact, and surgery may be indicated.
A Word From Verywell

There are many potential causes of calf pain, and it's best to get a medical evaluation. If you have been diagnosed with a calf strain, be kind to yourself and give your muscle the appropriate time and therapy it needs to heal. Then you can get back to your active life.

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