Conditioning: Phase 1

The following is the first of four phases that will guide you from calf strain toward healthy running. Progress from each phase as instructed, applying rehabilitation modalities such as taping where needed.

Duration: 1 Week (at least)
Goal: Reduce pain through unloading.
Frequency of Exercises: Daily (Phase 1a & 1b: twice per day; Phase 1c: once per day). All should be done without pain.

a. HIGH PAIN

START HERE if pain is >7/10 with walking and/or double leg calf raises
Goal: Reduce inflammation. Do not run or exercise into pain.

Taping/Heel Lift: Taping the calf may assist in offloading. If you need to put less pressure on the calf, you can also insert a heel lift in the back of your shoe to reduce tension. Purpose: offload calf.
Ankle Pumps: 2 x 20 reps. On your back or sitting, bring your ankle slowly up and down without going into significant pain. The principle is to reduce inflammation and fluid buildup, and to help with fluid exchange in the calf. Purpose: reduce swelling and improve circulation.
Biking (Light Resistance): Walking may be too painful at this point, though if it feels okay then walk. Light stationary biking can be a good alternative as it places less stress on the recovering calf.
Soft Tissue Massage: 3-5 minutes. Lying down or sitting, gently massage/stroke the calf. Pretend that it is a sponge, and you are gently squeezing some of the fluid out to reduce inflammation build up. It should not be painful, and the motion should be up the leg. Purpose: reduce swelling and improve circulation in order to reduce pain and improve healing.
Ice: 10 minutes on calf muscle to reduce pain and inflammation.

b. MODERATE PAIN

START HERE if pain is 4-6/10 with walking and/or with double leg calf raise
Goal: continue to reduce pain. Do not run.

Taping/Heel Lift: (see video above) Taping the calf may assist in offloading. If you need to put less pressure on the calf, you can also insert a heel lift in the back of your shoe to reduce tension. Purpose: offload calf.
Double Leg Glute Bridges: 3 x 10 reps. Place your legs shoulder width apart with knees bent. Bring your hips up and down. You should feel your hip and thigh muscles working. Purpose: increase hip strength to reduce pressure on calves and prevent knee caving in.
Ankle Pumps (With Band): 2 x 20 reps (lying down). On your back or sitting, bring your ankle slowly up and down without going into significant pain. Use a towel or a Resistance Band to increase resistance. Purpose: reduce swelling, pain, and improve circulation.

Clamshells: 3 x 16 reps. Lying on your side with your knees bent (hips to 45 degree angle), bring your top knee up and hold for 3 seconds, and then back down. Repeat until 16 reps or fatigue. You should feel your hip muscles working. To make it more difficult, if needed, you can add a Resistance Band around your knees. Purpose: increase strength in glutes to reduce knee caving in and calf stress.
Walking and/or Biking (Light Resistance): Walk on flat surfaces as tolerated.
Soft Tissue Massage: 3-5 minutes. Lying down or sitting, gently massage/stroke the calf. Pretend that it is a sponge, and you are gently squeezing some of the fluid out to reduce inflammation build up. It should not be painful, and the motion should be up the leg. Purpose: reduce swelling and improve circulation in order to reduce pain and improve healing.
Ice: 10 minutes to calf muscles to reduce pain and inflammation.

c. MILD PAIN

START HERE if pain is <3/10 with double leg calf raises and/or walking)
Goal: Continue to reduce pain. No running.

Single Leg Glute Bridges: 3 x 10 reps. On your back with one knee up, bring your hips up and down slowly. You should feel your thigh and hip muscles working. Purpose: increase demand on the hip to reduce knee from caving in and stressing the calves.
Squats (With Band): 3 x 8-10. With knees shoulder width apart, slowly come down into mild pain and come back up. If able, place a resistance band around your knees to recruit your glutes with the squat. Purpose: increase the load on your calves, while also increasing hip/leg strength.
Double Leg Calf Raises: 3 x 12-16 reps. Standing on the ground, come up on your toes. Mild pain is okay (<3/10). Start by putting more pressure on the uninvolved side; and if it feels comfortable, gradually add more load to the tendon. Purpose: increase tensile load on your calves, improving resilience.

Rose Hips: 3 x 12-16 reps. On your side with your body straight, bring your lower leg up for stability. Your top leg, with toes biased downward, goes up and down slowly to recruit muscles on the side of your hip. Be careful not to let your top hip come forward (easiest to do this along a wall to prevent compensation). Purpose: improve hip strength to reduce knee from caving in and stressing the calves.
Single Leg Balance: 3 x 30 seconds (each leg). Ideally, complete this in front of a mirror. Stand with both hands on your hips while your feet are directly under you. Keeping your pelvis as stable as possible, bring one leg up without causing your pelvis to tilt or rotate. Hold that position. Purpose: improve hip, knee, and ankle joints stability.
Walking and/or Biking (Light Resistance): Slight discomfort is okay, but if pain is too much after exercise or lingers for a while, then you have done too much.
Soft Tissue Massage: 3-5 minutes. Lying down or sitting, gently massage/stroke the calf. Pretend that it is a sponge, and you are gently squeezing some of the fluid out to reduce inflammation build up. It should not be painful, and the motion should be up the leg. Purpose: reduce swelling and improve circulation in order to reduce pain and improve healing.
Ice: 10 minutes to calf muscles to reduce pain and inflammation.

TO GRADUATE TO PHASE 2

Required: Pain is < 3/10; and when aggravated, pain does not linger for more than 1 minute
Required: Able to perform 3×12 double leg calf raises with pain <3/10 for three consecutive exercise sessions
Required: No noticeable redness and very minimal swelling, if at all
Note: If you began at Phase 1.a., before graduating to Phase 2, be sure to progress in turn through Phases 1.b. and 1.c

Principles of Calf Strain: A Review

CAUSE – overloading of the calf muscle
NEED – reduce pain
PLAN – once pain is managed, progressively load the tissue to increase strength while also improving flexibility

Still Need Help?

You are welcome to meet virtually with our PT for additional feedback and assessment. Otherwise, continue to the next step to learn how best to manage the pain from your injury.