How to choose what exercises you do for a pulled calf muscle and how to design a progressive treatment plan.
Kim van Deventer

Kim van Deventer

A runner’s guide to calf strain injury: Part 2 – Exercise plan

In Calf Strain Part 1, we promised you a step-by-step exercise guide to help you recover from your calf strain. And here it is!

How long does it take for a calf strain to heal?

One of the first questions every athlete asks when they get injured is how long the injury is going to set them back. Calf strain rehab usually takes around 4 -16 weeks depending on your grade of injury.

How do you treat a strained calf muscle?

Calf strains respond well to a balance of relative rest and progressive exercise. A program that builds the muscle up bit by bit is most effective.

Muscles are made up of different types of fibers. Slow-twitch fibres are better for endurance exercises and fast-twitch fibres are better for short powerful bursts of activities.

Types of muscles fibers: Fast twitch and slow twitch fibers.

Muscles contract in three different ways (concentric, eccentric and isometric).

  • Concentric: The muscle shortens while it contracts (going up onto tiptoes)
  • Eccentric: The muscle lengthens while it contracts (lowering back down from tiptoes)
  • Isometric: The muscle contracts, but remains the same length (staying on tiptoes)

A comprehensive treatment plan, should develop all of these aspects. The Exakt Health App maps the rehab process into 7 stages. In each stage, different exercises target the different fibers and train the different types of contractions, preparing your muscles for the next stage.

By the end of the program, you will have a powerful, resilient calf muscle, and you can get back to running without fear of injury. You can get an overview of the app’s calf strain treatment plan here but we’ve also discussed it in more detail below.

Do you have a calf strain? Join our Sports Injury Study and get a free online assessment of your injury from an experienced physiotherapist.

The 7 stages of calf strain rehabilitation

At this point your injury is pretty fragile. Your body uses inflammation to get rid of all the injured cells and to prepare the area for healing.

Rehab aims

  • Protect the muscle from further injury
  • Allow the injury to settle

Icing a torn calf muscle can help recovery as part of early treatment.Treatment consists of the PRICE regime

  • Protection: Protect your muscle, stop any activity that causes pain
  • Rest: Give your injury time to rest
  • Ice: Apply ice over the area for 10 mins at a time (no longer)
  • Compression: Use a compression bandage to control swelling
  • Elevation: Raise the injured area above the level of the heart

What to avoid

When to progress

Most people with calf strains should be able to move on to the next stage 48 hours after sustaining their injury.

During this period your body starts to form new cells, but these cells aren’t very strong yet.

Rehab aims

  • Help the body to align and strengthen the new cells through gentle exercises.
  • Main focus is on developing strength and endurance in the slow twitch fibers through low load, concentric and eccentric contractions.
  • Include exercises for both the Gastrocnemius and Soleus muscles.
  • Keep the other parts of your body fit, strong and flexible to reduce the load on your calf muscles while running.
  • Maintain your cardiovascular fitness through activities that does not load the calf e.g. swimming.
  • Limit your walking and other activities to what you can do pain free.

Seated heel raises (that work the soleus) and double leg standing heel raises (that work the gastrocnemius) are examples of stage 2 calf strain exercisesExamples of Stage 2 calf specific exercises

Seated heel raises (soleus) and double leg standing heel raises (gastrocnemius) that are progressed to single leg heel raises, but with bodyweight only.

What to avoid

  • Strong calf stretches
  • High load/force activities like jumping and running

When to progress

  • When you can walk short distances without pain
  • When you’ve built good endurance in both the soleus and gastrocnemius muscles with low load (bodyweight) exercises.

Your body has now replaced most of the injured cells, but they still lack the strength and endurance to handle all the running that you would like to do.

Rehab aims

  • Restore full flexibility in your calf muscles.
  • Further build the strength in both your slow and fast twitch muscle fibers through progressing to heavy strength training.
  • Include both concentric and eccentric contractions, but emphasise the eccentric component.
  • Continue building strength and control in your core and other leg muscles.
  • You can now introduce cardiovascular exercise that uses the calf muscles, but does not require forceful contractions e.g. cycling and the cross trainer.

Weighted heel raises are an example of an exercise you can use during the later stages of calf strain treatment.Examples of Stage 3 calf specific exercises

Heel raises using light weights that makes you tired around 15 repetitions (15 Rep Max). You have to increase the weights over time.

What to avoid

  • Activities that create strong, forceful contractions e.g. running, hopping and jumping.

When to progress

  • When you can walk 30 minutes at your normal comfortable pace; and
  • You can comfortably do your heel raise exercises with weights that equal about 10% of your bodyweight; and
  • You can hop pain free.

Use this stage to develop the explosive strength you need when running.

Rehab aims

  • Develop fast, explosive strength (type 2 muscle fibres) through plyometric exercises.
  • Continue building general calf strength through heavy resistance training.
  • Carry on with core and general body conditioning.
  • Include brisk walking as part of your cardiovascular exercise.

Example of Stage 4 calf specific exercise

You should include at least one session of plyometric exercises in your training week which can consist of a variety of hops and jumps. The treatment plan in the Exakt Health app includes a hop program that starts out easy but progresses in volume and intensity over several weeks.

It's important to include plyometric exercises, like box jumps, in the later stages of your calf strain rehab

What to avoid

 It may be tempting to run, but hold back until you’ve completed this stage.

When to progress

  • When you can walk 30 minutes at a brisk pace; and
  • You can comfortably do your heel raise exercises with weights that equal about 20% of your bodyweight; and
  • You can complete your plyometric sessions pain free.

The forces that your calf muscles have to produce and absorb during running, are much higher than those they have to tolerate when you walk. The best way to avoid reinjury is to slowly ease back into running by using a walk/run program.

Rehab aims

  • Help your calf muscles adapt to the increased forces by following a walk/run program.
  • Maintain your calf and general strength by doing at least 2 strength training sessions a week.

A run/walk program is a safe way to get back to running after injury and to prevent reinjury.Example of Stage 5 calf specific exercises

Once you start running, you can usually drop the plyometric sessions and just keep a maintenance dose of heel raises in your program. Although you may be excited to finally be able to run again, it’s crucial that you keep it slow, controlled, and pain free. The walk/run program that’s included in the app, starts with 1 minute intervals and gradually builds your endurance until you can run continuously for 20 minutes.

What to avoid

High intensity sessions like tempo runs, intervals, or hill sessions. Your muscles need a little bit more preparation before you can move onto those. (Not long to go, hang in there!)

When to progress

You’re ready to progress when you can run continuously for 20 minutes.

You should always build your slow running endurance when making a comeback from injury.Easy running places a lot less force on your calf muscles than fast running. That’s why you should always first build your slow running mileage to what you could do preinjury.

Rehab aims

  • Regain your calf’s previous slow running endurance.
  • To maintain the strength you’ve built in the previous stages.

Example of Stage 6 calf specific exercise

You can maintain your calf strength by doing two strength training sessions per week, using weights that fatigue your calves within about 10 repetitions (10 rep max).

What to avoid

No sprints, tempos, or hill sessions.

When to progress

You’re ready to progress to the final stage once you’re able to complete your preinjury weekly running volumes at an easy pace.

High intensity workouts place the most strain on your calves and should only be included once you’ve fully restored your easy running endurance.

Rehab aims

  • Develop your calf’s ability to withstand high intensity workouts e.g. hill sessions, tempo runs and sprinting.
  • Maintain the strength and control in the rest of your body.

High intensity running sessions should be left for the final stage of rehab.Example of Stage 7 calf specific exercise

You can continue with the same maintenance exercises as in stage 6. The main difference is that you will now add in some high intensity running session into your normal training week. It’s usually best to start with just one session per week, but what you can do will depend on a variety of factors.

We understand. We’ve been there. Finding convenient and reliable help for injuries online can be a tedious and demoralising process. Here’s our story and why we started Exakt Health.

The Exakt Health App provides a convenient, intuitive and science-based injury rehab experience for runners. 

All treatment advice is based on trusted medical evidence and reviewed by licenced sports physiotherapists, with each rehabilitation plan tailored to your unique grade of injury and phase of healing.  Download the Exakt Health App and start your recovery now.

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