Calf Strains In Runners: Everything You Need To Know
This week, we’re talking about calf strains. Similar to the last few posts, I (Jason) interviewed my wife (Dr. Maria Leibler, PT, DPT, MTC), who specializes in working with runners. Calf strains are a very common injury that she sees. In fact, she said she’s got a bunch of them right now that she’s treating.
I tried to put myself in the shoes of someone dealing with calf pain and ask all the questions that might be on their mind. Without further ado, here’s the interview:
What’s the difference between calf tightness and a calf strain?
Maria: The word “tightness” doesn’t really tell a clinician anything specific. You can have adaptively shortened calves, a sensation of tightness, or a strain. They all mean different things.
A strain is technically a tear. People don’t really like to hear that term, but that’s what it is. It’s basically going beyond the threshold of what the fibers were capable of holding onto, and they got injured. You can interchange the word strain and tear. They mean the same thing, but the severity is graded according to how extensive it is.
A sensation of tightness can come on for many reasons. It can be neural, muscular, or related to the tendon where the muscle attaches. But it doesn’t always give us the big picture. A sensation of tightness needs to be explored further.
Can you talk about calf injuries in general? What do people need to know about calf injuries?
Maria: If you have a calf injury in the muscle belly of the calf—the meaty part of the lower leg that most people think of—and it’s persisting, there’s a great chance that the more you continue to train without addressing it, the more likely it will worsen, especially for runners. It’s not something you should ignore.
Sometimes scaling back training and allowing time for recovery is all it takes. Other times there are different structures involved besides just the muscle fibers, such as the tendon or nerves in the lower leg, or sometimes even issues originating from the low back.
Males who are older, typically over 50, are a common population complaining of calf pain. But I see it in all populations. Right now I’m treating a young female, a middle-aged man, and an older gentleman.
What causes calf strains and how do they happen?
Maria: You can think of it as an overloading issue. If the demands you’re putting on your body are greater than what your tissue can recover from before you load it again, it’s not going to be able to keep up without adequate recovery time.
Are certain runners more prone to calf strains or tightness?
Maria: Men, generally older, as it relates to the entire calf muscle complex (CMC). The same is true of Achilles tendon issues—the older you are, the more it affects you, with males being most commonly affected.
Can running form contribute to calf tightness or strain risk?
Maria: Yes. There are times when people try to change their gait because they think they need to run on their forefoot or be a non-heel striker. When they adapt their running form, they shift more load to the calf muscle complex. If this adaptive period isn’t progressive and spread out enough for the body to handle that demand, it can be too much too fast and the tissues get angry.
What should a runner do if they feel calf tightness during or after a run?
Maria: It depends on the severity and behavior of the tightness. If they’re post-run, they can gently stretch their calf to see if it gives them relief. They should walk for a cool down to continue pumping blood rather than just stopping cold. They should sleep well and make sure they have adequate time between that session and their next session—ideally 24 hours.
If that’s not possible, they should ensure a thorough warm-up before their next session, which should be at least six to eight hours later if they’re having symptoms they’re unsure about.
Should runners stop running if they have calf tightness or a strain?
Maria: Generally, most runners can continue to run to some degree with considerations for decreasing intensity, which means reducing either speed or elevation. Often, going uphill is something they may need to scale back on, and definitely speed because it greatly increases the demand on the calf muscle complex.
If the area warms up the longer they run, they can generally keep going. But if the severity of their pain is causing them to change their gait mechanics or limp, then no, they shouldn’t run through a limp.
What are the biggest myths about calf tightness, strains, or calf injuries in general?
Maria: That runners should stretch their calf before a run. Or that they should stretch regardless of what’s going on, which isn’t true in the case of tendon issues, specifically insertional tendinopathy—meaning the fibers at the end of the tendon where they insert onto the heel bone. Often stretching just makes that problem worse.
People also assume that calf strains happen because they didn’t roll their calves on a foam roller enough, and that’s never the case. It’s usually an imbalance between recovery and the amount of load they’re putting on their bodies.
What home treatments actually work for calf strains and tightness other than rest? Is there something people can do at home for minor issues?
Maria: A strain to the muscle belly will generally tolerate gentle stretching. A strain happens when the muscle gets pulled too quickly or too far at a rapid rate, and the body’s reaction is to bind it down for protection because it knows injury could potentially happen again.
You can gently stretch the muscle fibers back out and massage them to help increase blood flow and relax the muscle. You can walk. Sometimes strength training is part of the remedy, but it depends on what exacerbates symptoms and what alleviates them.
How can runners tell if they need professional help for a calf strain?
Maria: If it’s worsening despite what you’ve done or attempted to do, if there’s no relief or change when you unload your training or cross-train, or if there are neural symptoms like burning, zinging, numbness, or tingling.
What are the risks of a runner trying to push through a calf injury without treatment?
Maria: Further strain, meaning a greater degree or grade of tear. There’s always a consideration for deep vein thrombosis when we’re thinking of the big calf muscles of the lower leg. That’s something we would screen for during an evaluation of muscle pain, because the calf is a common area for DVT.
Also, pushing through can cause compensations up and down the kinetic chain. Avoidance movements trying to avoid pain can cause the body to start moving differently, which isn’t good.
Could you talk briefly about the connection between the calf and the Achilles? Is one a red flag for the other?
Maria: Yes, you always want to consider them together because they form a complex of tissues that make up the calf muscle complex. They can be separate injuries if the tendon isn’t involved or the muscle belly isn’t involved, but they’re directly connected. The Achilles is how the calf muscle attaches to the bone at the heel, so you always want to consider them together.
As a physical therapist, can you talk about your approach to treating calf injuries? What do PTs do or know that people can’t do on their own?
Maria: PTs have the ability to get a lens into somebody’s situation involving their training, recovery, fueling, stress, and how they approach any given training session. We can look at their overall thought process behind cross-training, strength training, and running training, and identify where the imbalance of overloading is occurring that’s manifesting as a strain.
What does treatment typically look like? Are you working on strength in the calf or supporting muscles?
Maria: First and foremost, it’s a matter of looking at whether this calf complex is overloaded. Adding calf strengthening to somebody who’s already overloaded with physical exercise and activities could be counterproductive. You need to peel back the things that are contributing to recovery imbalance.
There may be strength deficits up and down the kinetic chain, not just in the calf. The whole posterior chain as a unit working together—meaning the glutes, hamstrings, and calves—is important.
I’m looking at how overall movement patterns play into somebody’s life. For example, can the runner perform a hip hinge? Are they always just flexing their spine and falling forward, which puts their center of mass more in front? This shifts weight to the forefoot or toes, making the calf work harder to counteract that weight distribution. So I’m examining things up and down the entire kinetic chain.
Are calf strains one of those injuries that needs load to recover?
Maria: It’s different from tendon in that sense, where you want to be loading the tendon tissue to help it heal. But the same general concept applies—you don’t want to make an individual immobilized or sedentary. You want to keep them as active as possible, and with muscular pain, we can do that by keeping their symptoms low through appropriate modifications. You want them to work through as much beneficial activity without pushing over their threshold for exacerbating symptoms.
Are there any exercises that can prevent calf issues or that you would recommend most runners have in their strength training routine?
Maria: Strengthening the calves is important for overall fitness and health because the calf muscle complex deals with a lot of load during running. If you’re consistently targeting the four main muscle groups of the legs, you should have good balance and variability in movement, which is important.
Can you be a little more specific? Should they do calf raises? Plyometrics? Lifting to failure? What should a healthy runner do to keep their calves strong?
Maria: Yes to strength exercises, yes to plyometric exercises, and no to lifting until failure. Having one or two reps in reserve when you’re lifting for muscular strength is a good general approach for runners.
For strength exercises, runners should incorporate different variations of calf raises to target both the gastrocnemius and soleus muscles. This includes straight-leg calf raises for the gastrocnemius and bent-knee calf raises for the soleus. Start with bodyweight exercises, then progress to single-leg variations, and eventually add resistance with dumbbells or a calf raise machine.
For plyometrics, include exercises like skipping, hopping, and jumping rope to develop elastic strength and power in the calves. These exercises train the stretch-shortening cycle that’s crucial for running efficiency. Start with low volume—maybe 2-3 sets of 8-10 reps twice weekly—and gradually increase as tolerance builds.
Progressive overload is important, but runners should avoid training to complete failure, as this can impair recovery between running sessions. Focus on quality movements with good form, gradually increasing weight or repetitions over time. For most runners, 2-3 calf-strengthening sessions per week is sufficient, with at least 48 hours between intense sessions to allow for recovery.
Any closing advice on calf injuries in runners?
Maria: Even if calf pain is minimal, if it’s popping up chronically or repetitively, don’t ignore it. Have a physical therapist who knows about running look at your overall training. Consider how much energy you’re actually expending during any given day, week, month, and season, and evaluate whether you’re giving adequate recovery for your body to keep up with those demands.
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