Calf Strain
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Description
The calf complex plays an essential component during locomotion and weight-bearing, especially for explosive movements.[2][3] Injuries to this area impact various sporting disciplines and athletic populations.[2] Calf muscle strain injuries (CMSI) occur commonly in sports involving high-speed running or increased volumes of running load, acceleration and deceleration as well as during fatiguing conditions of play or performance.[2][4]
Calf strain is a common muscle injury, with a strain of the medial gastrocnemius being the most common cause of mid-calf pain.[5] If not managed appropriately, there is a risk of re-injury and prolonged recovery. Muscle strains commonly occur in the medial head of the gastrocnemius or close to the musculotendinous junction. The gastrocnemius muscle is more susceptible to injury than the soleus as it is a triarticular muscle extending over the knee, the ankle, and the subtalar joint.[6] Sudden bursts of acceleration can precipitate injury as well as a sudden eccentric overstretch of the muscle involved.[7]
Clinically Relevant Anatomy
The "calf" refers to the three muscles on the posterior aspect of the lower leg:
- gastrocnemius - Along with soleus, it is a primary plantarflexor of the ankle joint. Unlike soleus, it aids in flexion at the knee joint.[8][9] Plantarflexion provides the propelling force during gait. Although it spans over two joints, gastrocnemius is not able to exert its maximum power on both joints simultaneously. If the knee is flexed, gastrocnemius cannot produce maximum power at the ankle joint and vice versa.[8]
- soleus - located deep to the gastrocnemius muscle in the superficial posterior compartment of the lower leg. Its main function is plantar flexion of the ankle and stabilising the tibia on the calcaneus limiting forward sway.[9]
- plantaris - located in the posterosuperficial compartment of the calf. Functionally, plantaris is not a major contributor and acts with gastrocnemius as both a flexor of the knee and a plantarflexor of the ankle[10]
These muscles come together to form the achilles tendon which inserts onto the calcaneus.
Epidemiology/Etiology
Muscle strains most commonly occur in bi-articular muscles such as the hamstrings, rectus femoris and gastrocnemius. Other factors also predispose the gastrocnemius muscle to muscle strains, including having a relatively higher proportion of type 2 fibres at around 50% (compared to soleus at 30%), as well as being involved in explosive movements.[11][12] Therefore a "calf strain" often refers to a gastrocnemius strain. The medial head of the gastrocnemius is also more likely to be strained as it is more active, especially in the toe out position,[13] and has a longer muscle length.[14]
During sporting activities such as sprinting, these long, bi-articular muscles have to cope with high internal forces and rapid changes in muscle length and mode of contraction leading to a higher risk of strain. Gastrocnemius strains usually happen in a position of maximal stretch i.e. when the knee is in full extension and the ankle in full dorsiflexion, especially during eccentric contractions.[5] The most common mechanism of injury is during push-off phase of running and jumping, where the muscle transitions from an eccentric phase to an isometric contraction phase.[15][16] Calf muscle strains have also been reported to occur during slow-lengthening muscle actions such as those performed by ballet dancers, and also during common daily activities.[17]
Various sports such as rugby, football, tennis, athletics and dancing are impacted by calf muscle strain injuries. In football, 92% of injuries are muscular injuries, 13% of these are calf injuries.[4] In Australian rules football CMSI represented one of the highest soft tissue injury incidences (3.00 per club per year) and there was a 16% recurrence rate.[2]
Risk Factors
The most significant risk factors for Medial Gastrocnemius Strain are as follows:[18]
- Age
- History of calf injury
Other risk factors with limited evidence include:[18]
- History of lower limb injuries (other than calf)
- High BMI
- Inadequate warm up
- L5 radiculopathy
In as much as 20% of patients, some early warning signs are present. Common prodromal symptoms include a dull muscle ache as well as cramps.[15][19]
Characteristics/Clinical Presentation
Calf strains are most commonly found in the medial head of the gastrocnemius.[9] The strain often happens during a sudden push-off, such as for sprinting or jumping.[5] Pain presentation can be varying: from sudden, sharp pain to latent (up to 24 hours[20]) and dull pain, felt in the posteromedial calf.[5] The patient often reports an audible or palpable "pop" in the medial aspect of the posterior calf, or they have a feeling as though someone has kicked/struck them in the back of the leg.[5] Pain may not present immediately, but may develop after taking a few steps.[21]
Pain may be present during rest, but may also only be provoked upon standing, walking, passive dorsiflexion, or active plantarflexion of the foot. Substantial pain and swelling usually develop during the following 24 hours.[22] Strains in the gastrocnemius are sometimes referred to as a “tennis leg” as the classic presentation was a middle-aged tennis player who suddenly extended the knee. [9]
Local tenderness may be evoked upon palpation. A palpable gap may also be present in higher grade ruptures.[20] More severe tears may cause a large hematoma, which in turn may compress the sural nerve and cause sensation loss in the lateral calf.[21] Less provocative tests can indicate a more severe strain, such as passive dorsiflexion of the ankle and resisted plantarflexion.[5] More provocative tests such as running and jumping may provoke pain for less severe strains.[5]
Gastrocnemius strain
Gastrocnemius is considered at high risk for strains because it crosses three joints (the knee, the ankle and the subtalar joint) and has a high density of type two fast-twitch muscle fibres.[6][9] A tear of the medial head of the gastrocnemius muscle is due to an eccentric force being applied to the muscle when the knee is extended and the ankle is dorsiflexed. The gastrocnemius muscle attempts to contract in the already lengthened state leading to tear of the muscle.[23]
Symptoms of gastrocnemius strain can include subjective reports of sudden sharp pain or tearing sensation at the back of the lower leg, often in the medial belly of the gastrocnemius or at the musculotendinous junction.[7]
On objective assessment there will be:[7]
- Tenderness to touch at the point of injury
- Swelling
- Bruising may appear within hours or days
- Stretching of the muscle will reproduce pain
- Pain on resisted plantarflexion
Soleus strain
The soleus muscle is injured while the knee is in flexion. Strains of the proximal medial musculotendinous junction are the most common type of soleus muscle injuries. Unlike gastrocnemius, soleus is considered low risk for injury. It crosses only one joint (ankle) and is largely comprised of type one slow-twitch muscle fibres. Soleus strains also tend to be less severe in clinical presentation and more subacute when compared to injuries of gastrocnemius.[9] This condition frequently occurs in the middle-aged, poorly conditioned and/or physically active patient.[24]
The presentation will likely be similar to gastrocnemuis strain however the pain may be slightly more distal and feel deeper subjectively. Pain in a soleus strain should present posterolaterally, unlike posteromedially for a medial gastrocnemius strain. Injury of the soleus muscle may be under-reported due to a misdiagnosis of thrombophlebitis or lumping of soleus strains with strains of the gastrocnemius.[9] A soleus strain causes pain when activating the calf muscle or when applying pressure on the Achilles tendon approximately 4 cm above the insertion point on the heel bone or higher up in the calf muscle. Stretching the tendon and walking on tip-toe will also aggravate pain.[25]
Plantaris strains
Plantaris is considered largely vestigial and rarely involved in calf strains, although it crosses both the knee and the ankle joint as well.[9] Rupture of the plantaris muscle may occur at the myotendinous junction with or without an associated hematoma or partial tear of the medial head of the gastrocnemius muscle or soleus.[10] Injury to the plantaris muscle can present with similar clinical features as those of the gastrocnemius and soleus muscle.[26]
Depending on the extent of the injury, the individual may be able to continue exercising although they will have some discomfort and/or tightness during or after activity. Where injuries are more severe, the exact mechanism of injury is easier to recall and/or the individual may be unable to walk due to severe pain.
Grading of calf strains[7]
Muscle strains are graded from I to III, with grade III being the most severe. Treatment and rehabilitation depends on the severity of the muscle strain.
| Grade | Symptoms | Signs | Average time to return to sport |
|---|---|---|---|
| I | Sharp pain at the time of activity or after
May have a feeling of tightness May be able to continue activity, without pain or with mild discomfort Post activity tightness and/or aching |
Pain on unilateral calf raise or hop | 10 - 12 days |
| II | Sharp pain at the time of activity in calf
Unable to continue activity Significant pain with walking afterwards May have swelling in muscle Mild to moderate bruising may be present |
Pain with active plantarflexion
Pain and weakness with resisted plantarflexion Loss of dorsiflexion Bilateral calf raise pain |
16 - 21 days |
| III | Severe and immediate pain in the calf, often at
musculotendinous junction Unable to continue with activity May present with considerable bruising and swelling within hours of injury |
Inability to contract calf muscle
May have palpable defect Thomson's test positive |
6 months after surgery |
Differential Diagnosis
The following are potential differentials for this condition:
- Deep Vein Thrombosis: Pain, heaviness, cramps in the lower extremity are the typical symptoms but many times it can be asymptomatic.[27] DVT can present by itself, or as a complication of calf strain, and hence should be checked in calf strain injuries.[7]
- Achilles tendon injury should be checked for when medial gastrocnemius strain is suspected.[28]
- Nerve entrapment (may be caused by hematoma)[29]
- Tibial nerve
- Sural nerve
- Medial tibial stress syndrome (shin splints)
- Plantar fasciopathy
- Muscles strains and/or joint sprains due to reduced ROM of the ankle. [30]
- Other lower leg injuries related to sports with the same symptoms and treatment as a calf strain are discussed below.
- Chronic exertional compartment syndrome (CECS).[31]CECS begins with mild pain during periods of training and can disappear after training. In the latter stages, pain presents earlier, becoming more painful and of a greater duration forcing a halt in activity. Common complaints are; cramps, paraesthesia, numbness and weakness in the lower leg. CECS is caused by the increased intramuscular blood flow during exercise so compartmental pressure arises, capillaries become compressed and ischemia develops.
- Popliteal Artery Entrapment Syndrome (PAES). An abnormal relationship between the popliteal artery and the surrounding myofascial structures. Functional PAES is caused by muscle contraction, often active plantarflexion of the ankle that compresses the artery between the muscle and underlying bone.[32]
- Baker's cyst
- Neurogenic claudication: Patients with calf strain may present the symptoms close to the neurogenic claudication such as discomfort, weakness in the legs and paresthesia. In most of the cases it is bilateral presentation. It can involve the entire leg or just one portion. Neurogenic claudication is commonly seen in the patients of lumbar canal stenosis and its key feature is that the pain in the back increases in extension of the vertebral column and it reduces on flexion which helps to differentiate it from calf strain.[33]
- Intermittent claudication: The typical feature is lower extremity pain with ambulation that is relieved on rest.[34] It occurs when the oxygen supply is insufficient to meet metabolic demands of the skeletal muscles. It is a common symptom of peripheral vascular disease which incudes atherosclerotic changes within the arteries of extremities. The pain is commonly localized to hip, buttocks, thigh and calf muscles.[35]
Assessment
- Subjective assessment and thorough history should be taken at the initial assessment point
- Objective assessment:[36][37]
- Observation of the foot and ankle in standing and supine
- Ankle AROM
- Ankle PROM
- Palpation of the calf and replication of symptoms
- Resisted strength testing of the foot and ankle complex
- Thompson test: to rule out Achilles tendon rupture
- Knee AROM and resisted testing
- EmbedVideo is missing a required parameter.[38]
- Imaging:
- Ultrasound (US) is considered to be the gold standard. It can also be used to evaluate the degree and extent of the muscular lesion and to exclude other pathologies such as ruptured Baker's cyst and deep vein thrombosis. [6]
Medical Management
Calf strains are usually treated conservatively. However, some early indications may suggest a need for surgery. These early indications include:[28][39]
- complete or severe rupture of the muscle
- large hematomas
- compartment syndrome
Conservative management includes:
- Soft tissue injury management
- Steroid injection[40]
- Physiotherapy
- If a hematoma is present, its removal as quickly as possible is essential, otherwise, complications may occur such as myositis ossificans.
- In the case of a more severe injury, a temporary heel pad to shorten the calf muscle to reduce tension in the muscle whilst it heals may be useful. It may be advisable to put heel pads in both shoes, however, to avoid creating a gait imbalance.
Physical Therapy Management
Generally, physical therapy takes around 3 to 6 weeks, depending on injury severity.[20]Initial treatment aims:
- limit bleeding
- control pain
- prevent complications[9]
PEACE and LOVE principles should be applied, for approximately 24-48 hours post-injury.[41] Refer to the linked article for a guide on these principles.
- Effectiveness of Icing remains debatable as there is no high- quality evidence to support its benefits. Research suggests that ice can hinder the tissue repair process by interfering with inflammatory response, angiogenesis and revascularisation.[41]
- Compression (20 to 30 mmHg)[40] should be started initially and continued for at least 1 week until no swelling or hematoma can be detected
- NSAID use is not recommended for the first 48 hours as they may slow down healing.[5] If major bleeding has occurred, NSAID use may also have an anti-platelet effect which can increase bleeding, just as the premature application of heat and massage also can.[9]
- Therapists should provide early education to patients on the nature of condition, optimal load management strategies, and the importance of having an active approach throughout the recovery.
Activity modifications:
- Crutches during the first 1 to 2 weeks may be used. Weight bearing and walking can be initially assisted with crutches, progressing to without as tolerated.
- A walking boot with a heel lift on the injured side helps minimise stretch on the calf. A heel lift can be used for up to 12 weeks during walking. Some experts also recommend bilateral heel lifts (6 mm) for shorter periods
Exercises:
- Gentle active stretching exercises without pain to maintain range of motion eg. dorsiflexion, plantarflexion, inversion, eversion.[42] In the latter stages, once inflammation has resolved, applying superficial heat simultaneously with a low load static stretch improves the flexibility of muscles.[40]
- Isometric plantarflexion eg. against wall
- Isotonic exercises for the antagonists tibialis anterior, and the peronei are recommended as well as light exercises for the injured muscle. Gentle movements, within pain limitations, in the first few days following injury will help to promote healing,[40]
- When the calf muscles can be fully extended pain free, a switch can be made from gentle passive stretching to active stretches, in both a flexed knee position (soleus) and a straightened knee position (gastrocnemius).[40]
- Gradual loading/strengthening exercises of the calf muscles should be given in order to have a full recovery. The sooner loading exercises are commenced the more rapidly recovery will be.
- A 6 phase rehab program is recommended as an optimal management programme for Athletes, with the phases listed below.[43]
- Acute injury management
- Early Rehabilitation
- Intermediate Rehabilitation
- Return to full training
- Return to play
- Post return to play
Strains may cause long-lasting pain, despite adequate early treatment. Treatment outcome is successful when: pain is resolved, the calf muscle can be fully extended, strength is back to normal, knee and ankle ROM are normal and when excessive tenderness has disappeared.[40]
Outcome Measures
- LEFS: Lower Extremity Functional Scale
- VAS: Visual Analogue Scale
- NPRS: Numeric Pain Rating Scale
- Muscle Strength testing: Regarding muscle strength testing it's important to do it in the most objective way possible. An option for this is using a force platform for the isometric muscle assessment of gastrocnemius and soleus. The differentiation is if you assess strength seated or standing position. In this assessment, we can obtain Maximum Force and the rate of force development ( this last one can be at 150ms or 300 ms). [45]
Clinical Bottom Line
Pain in the calf muscle is often due to a strain, however, there are other conditions which could cause similar symptoms, including deep vein thrombosis and achilles tendinopathy or rupture. Healing time is hugely variable depending on the severity of the strain and individual response to treatment.
Conservative management consisting of a graded exercise program usually has the desired outcome for grade I and II strains, but in the case of rupture, surgery is required. Strength and conditioning exercises are essential to re-load the tissues and promote return to activity.
References
- ↑ Wikimedia Commons contributors, "File:1123 Muscles of the Leg that Move the Foot and Toes b.png," Wikimedia Commons, the free media repository, https://commons.wikimedia.org/w/index.php?title=File:1123_Muscles_of_the_Leg_that_Move_the_Foot_and_Toes_b.png&oldid=276846515 (accessed July 25, 2018).
- ↑ 2.0 2.1 2.2 2.3 Green B, Pizzari T. Calf muscle strain injuries in sport: a systematic review of risk factors for injury. British journal of sports medicine. 2017 Aug 1;51(16):1189-94.
- ↑ Abe T , Fukashiro S , Harada Y , et al . Relationship between sprint performance and muscle fascicle length in female sprinters. J Physiol Anthropol Appl Human Sci 2001;20:141–7.
- ↑ 4.0 4.1 Bengtsson H, Ekstrand J, Hägglund M. Muscle injury rates in professional football increase with fixture congestion: an 11-year follow-up of the UEFA Champions League injury study. British journal of sports medicine. 2013 Aug 1;47(12):743-7.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Halabchi, F., Tavana, M. M., Seifi, V., & Mahmoudi Zarandi, M. (2024). Medial Gastrocnemius Strain: Clinical Aspects and Algorithmic Approach. Medical journal of the Islamic Republic of Iran, 38, 55. https://doi.org/10.47176/mjiri.38.55
- ↑ 6.0 6.1 6.2 Hsu D, Chang KV. Gastrocnemius Strain [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534766/
- ↑ 7.0 7.1 7.2 7.3 7.4 Brukner P, Khan K. Clinical sports medicine.3rd ed. Sydney: McGraw Hill, 2006.
- ↑ 8.0 8.1 Palastanga N, Field D, Soames R. Anatomy and human movement: structure and function. 5th Ed.Edinurgh: Elsevier,2006.
- ↑ 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 Dixon JB. Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Current reviews in musculoskeletal medicine. 2009 Jun 1;2(2):74-7.
- ↑ 10.0 10.1 Spina AA. The plantaris muscle: anatomy, injury, imaging, and treatment. The Journal of the Canadian Chiropractic Association. 2007 Jul;51(3):158.
- ↑ Edgerton VR, Smith JL, Simpson DR. Muscle fibre type populations of human leg muscles. The Histochemical Journal. 1975 May;7:259-66.
- ↑ Bordoni B, Varacallo MA. Anatomy, Bony Pelvis and Lower Limb, Gastrocnemius Muscle. 2023 Apr 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 30422541.
- ↑ Cibulka M, Wenthe A, Boyle Z, Callier D, Schwerdt A, Jarman D, Strube MJ. Variation in medial and lateral gastrocnemius muscle activity with foot position. International journal of sports physical therapy. 2017 Apr;12(2):233.
- ↑ Brukner P, Khan K, Cook J, Cools A, Crossley KH. 6 ed. McGraw-Hill Education; Australia: 2017. Brukner & Khan's Clinical Sports Medicine.
- ↑ 15.0 15.1 Alves C, Jenkins SM, Rapp A. StatPearls.
- ↑ Orchard JW, Alcott E, James T, Farhart P, Portus M, Waugh SR. Exact moment of a gastrocnemius muscle strain captured on video. British journal of sports medicine. 2002 Jun 1;36(3):222-3.
- ↑ Pull MR, Ranson C. Eccentric muscle actions: Implications for injury prevention and rehabilitation. Physical Therapy in Sport. 2007 May 1;8(2):88-97.
- ↑ 18.0 18.1 Green B, Pizzari T. Calf muscle strain injuries in sport: a systematic review of risk factors for injury. British journal of sports medicine. 2017 Aug 1;51(16):1189-94.
- ↑ Shields CL. , Redix L, Brewster CE. Acute tears of the medial head of the gastrocnemius. Foot Ankle. 1985;5(4):186.
- ↑ 20.0 20.1 20.2 Nsitem V. Diagnosis and rehabilitation of gastrocnemius muscle tear: a case report. The Journal of the Canadian Chiropractic Association. 2013 Dec;57(4):327.
- ↑ 21.0 21.1 Hsu D, Chang KV. Gastrocnemius Strain. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534766/
- ↑ Kwak H-S, Han Y-M, Lee S-Y, Kim K-N, Chung GH. Diagnosis and Follow-up US Evaluation of Ruptures of the Medial Head of the Gastrocnemius (“Tennis Leg”). Korean Journal of Radiology. 2006;7(3):193-198.
- ↑ Watura C, Harries W. Isolated tear of the tendon to the medial head of gastrocnemius presenting as a painless lump in the calf. Case Reports. 2009 Jan 1;2009:bcr0120091468.
- ↑ Flecca D, Tomei A, Ravazzolo N, Martinelli M, Giovagnorio F. US evaluation and diagnosis of rupture of the medial head of the gastrocnemius (tennis leg). Journal of ultrasound. 2007 Dec 1;10(4):194-8.
- ↑ Ellen, Mark I., Jeffrey L. Young, and James L. Sarni. "3. Knee and lower extremity injuries." Archives of physical medicine and rehabilitation 80.5 (1999): S59-S67.
- ↑ Meininger, Alexander K., and Jason L. Koh. "Evaluation of the injured runner." Clinics in sports medicine 31.2 (2012): 203-215.
- ↑ Bauersachs RM. Clinical presentation of deep vein thrombosis and pulmonary embolism. Best practice & research Clinical haematology. 2012 Sep 1;25(3):243-51.
- ↑ 28.0 28.1 Meek WM, Kucharik MP, Eberlin CT, Naessig SA, Rudisill SS, Martin SD. Calf strain in athletes. JBJS reviews. 2022 Mar 1;10(3):e21.
- ↑ Mastaglia FL. Tibial nerve entrapment in the popliteal fossa. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine. 2000 Dec;23(12):1883-6.
- ↑ Knight CA., et al. (juni 2001). “Effect of Superficial Heat, Deep Heat, and Active Exercise Warm-up on the Extensibility of the Plantar Flexors.” Physical Therapy, Vol 81 (6), pp. 1206-1214.
- ↑ Ellen, Mark I., Jeffrey L. Young, and James L. Sarni. "3. Knee and lower extremity injuries." Archives of physical medicine and rehabilitation 80.5 (1999): S59-S67.
- ↑ Stager, Andrew, and Douglas Clement. "Popliteal artery entrapment syndrome." Sports Medicine 28.1 (1999): 61-70.
- ↑ Munakomi S, Foris LA, Varacallo M. Spinal stenosis and neurogenic claudication.
- ↑ Meru AV, Mittra S, Thyagarajan B, Chugh A. Intermittent claudication: an overview. Atherosclerosis. 2006 Aug 1;187(2):221-37.
- ↑ Patel SK, Surowiec SM. Intermittent claudication.
- ↑ Marc Roig Pull and Craig Ranson, Eccentric muscle actions: Implications for injury prevention and rehabilitation, Physical Therapy in Sport 8 (2007), no. 2, 88 – 97.
- ↑ Dixon JB. Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Current reviews in musculoskeletal medicine. 2009 Jun 1;2(2):74-7.
- ↑ prohealthsys. Gastrocnemius Muscle Test Vizniak. Available from: https://www.youtube.com/watch?v=kDU1J1kCMhk last accessed [19.09.2017]
- ↑ Cheng Y, Yang HL, Sun ZY, Ni L, Zhang HT. Surgical treatment of gastrocnemius muscle ruptures. Orthopaedic surgery. 2012 Nov;4(4):253-7.
- ↑ 40.0 40.1 40.2 40.3 40.4 40.5 Pedret C, Rodas G, Balius R, Capdevila L, Bossy M, Vernooij RW, Alomar X. Return to play after soleus muscle injuries. Orthopaedic journal of sports medicine. 2015 Jul 22;3(7):2325967115595802.
- ↑ 41.0 41.1 Dubois B, Esculier JF. Soft-tissue Injuries Simply Need PEACE and LOVE. British Journal of Sports Medicine [Internet]. 2020;54(2):bjsports-2019-101253. Available from: https://bjsm.bmj.com/content/54/2/72
- ↑ Bartholdy C, Zangger G, Hansen L, Ginnerup‐Nielsen E, Bliddal H, Henriksen M. Local and systemic changes in pain sensitivity after 4 weeks of calf muscle stretching in a nonpainful population: A randomized trial. Pain Practice. 2016 Jul;16(6):696-703.
- ↑ 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 Jan 15;8(1).
- ↑ AskDoctorJo. Calf pain or strain stretches & exercises. Available from: https://www.youtube.com/watch?v=XibsfBav_04 Last accessed [29.09.2017]
- ↑ Mattiussi, A. M., Shaw, J., Cohen, D. D., Price, P., Brown, D. D., Pedlar, C., & Tallent, J. (2022). Reliability, variability, and minimal detectable change of bilateral and unilateral lower extremity isometric force tests. Journal of Sport and Exercise Science.