Most calf muscle injuries or strains occur in the largest two muscles in the area, although there are multiple muscles in this section of the leg. These two muscles are called Gastrocnemius and Soleus. The Gastrocnemius is involved in rapid movement (running, jumping, acceleration), whereas the Soleus is designed for power and postural control (Prakash et al, 2018). It is the Soleus muscle that is the most important in running.

Differences between the two types of calf muscle injuries

The Soleus is more commonly injured during steady-state running or long-distance running (Green et al, 2022) and has a more progressive onset (Green et al, 2022). This means that instead of feeling a sudden, intense pain, you are more likely to first experience a tightness in the calf that does not resolve and eventually becomes sore. There are five areas in the Soleus where most injuries occur (Pedret et al, 2015) and rehabilitation and return to sport will depend on where the injury occurred (Balius et al, 2014). Unfortunately Soleus injuries can only be accurately confirmed with an MRI (Balius et al, 2014) but your physiotherapist can help diagnose it by excluding a Gastrocnemius tear on ultrasound and by considering how it got injured, as well as checking the symptoms present.

Gastrocnemius calf muscle injuries most commonly occur in the lower, inner section of the muscle and are often referred to as “tennis leg” (Pedret et al, 2020), but the injury can occur in all sports. Injuries to the Gastrocnemius muscle are sudden and can feel like a gunshot to the leg and typically occur during higher intensity running (Green et al, 2022). Pain is felt immediately as the injury occurs. As with the Soleus muscle, there are various areas in the Gastrocnemius where the injury can occur (Pedret et al, 2020) and recovery and return to sport will vary based on the location (Pedret et al, 2020 and Green et al, 2022). If a part called the aponeurosis is hurt, recovery typically takes longer. Gastrocnemius injuries are easily diagnosed using ultrasound scans (Pedret etl al, 2020).

Some risk factors to consider

  • A previous calf injury
  • Being older
  • Calf weakness
  • A period of immobilisation

Physiotherapy after a calf injury is crucial, as this kind of trauma has a very high re-injury rate (Green et al, 2022). Your physiotherapist will be able to help you determine which muscle was injured and will then take you through a progressive rehabilitation programme. A short period of immobilisation (using crutches) may be needed in more severe injuries and rehabilitation time frames will vary depending on the severity of the injury and where the injury occurred. Your physiotherapist will also address any modifiable risk factors to help prevent the injury from occurring again. Correct strengthening is the cornerstone of calf injury prevention and also forms a large part of the rehabilitation process.

Exercises to strengthen the calf muscle

Below are two examples of calf strengthening. The standing exercise targets the Gastrocnemius and the seated exercise targets the Soleus.

standing calf muscle exercise

⬅ Watch this video on YouTube.


seated calf muscle strengthening exercise

Repeat this exercise for a count of ten and aim for three sets.




This article was written by Wendy Snyders who is the Practice Manager at the Cape Town branch in Tygervalley. If you would like to see her about a calf injury, you can make an appointment in Wendy’s diary, fill out a web appointment form if you’d like to make a comment, or else phone the Practice on (021) 140-1490 / 010 140 0005 and select 6.


  1. Prakash, A., Entwisle, T., Schneider, M., Brukner, P. and Connell, D., 2018. Connective tissue injury in calf muscle tears and return to play: MRI correlation. British journal of sports medicine, 52(14), pp.929-933.
  2. Green B, McClelland JA, Semciw AI, Schache AG, McCall A, Pizzari T. The Assessment, Management and Prevention of Calf Muscle Strain Injuries: A Qualitative Study of the Practices and Perspectives of 20 Expert Sports Clinicians. Sports Medicine-Open. 2022 Dec;8(1):1-28.
  3. Pedret, C., Rodas, G., Balius, R., Capdevila, L., Bossy, M., Vernooij, R.W. and Alomar, X., 2015. Return to play after soleus muscle injuries. Orthopaedic journal of sports medicine, 3(7), p.2325967115595802.
  4. Balius, R., Rodas, G., Pedret, C., Capdevila, L., Alomar, X. and Bong, D.A., 2014. Soleus muscle injury: sensitivity of ultrasound patterns. Skeletal radiology, 43(6), pp.805-812.
  5. Pedret, C., Balius, R., Blasi, M., Dávila, F., Aramendi, J.F., Masci, L. and de la Fuente, J., 2020. Ultrasound classification of medial gastrocnemious injuries. Scandinavian Journal of Medicine & Science in Sports, 30(12), pp.2456-2465.