History Taking, Training Load Review, Observation and Palpation

Gastrocnemius strains tend to follow acceleration, deceleration or sudden knee extension, while soleus strains occur during steady-state running and almost half have no clear inciting event. Because the soleus gives poorer pain feedback, pain is a less reliable guide in its rehabilitation. Imaging studies suggest past calf strains may leave lasting changes in muscle architecture, which is a reason to rehabilitate fully. The history should cover the four to six weeks before injury: changes in volume, intensity, elevation, surface and shoes, new heavy calf training, sleep and recovery. A quick look at a runner's Strava often shows the spike. In one case, a holiday with hilly loops added more climbing than the runner had done in nearly a year. Observation looks for atrophy, side-to-side differences during a heel raise, Achilles thickening and a Haglund's deformity. Bruising and swelling are uncommon. A disrupted gait or needing days to walk normally points to a longer recovery, and a wider area of tenderness on palpation suggests greater severity and can be measured to track progress.