Massage therapy · Kitchener–WaterlooGastrocnemius Tendinopathy

Gastrocnemius tendinopathy is a type of injury caused by repetitive strain or overloading of the tendon. Unlike a traumatic injury, which is caused by an accident or trauma, repetitive strain injuries are associated with small amounts of stress to the tissues. If these aren't addressed, they can build up slowly over time and cause pain.

The gastrocnemius does not have a tendon of its own at the heel: its tendon joins with the tendon of the soleus muscle to form the Achilles tendon (Dorset Musculoskeletal Matters, n.d.). For this reason, tendon pain at the lower end of the gastrocnemius is usually assessed and treated as Achilles tendinopathy. Tendinopathy develops when a tendon (the structure attaching the muscle to the bone) is overloaded and is unable to adapt to the load placed on it (Dorset Musculoskeletal Matters, n.d.; Challoumas, Biddle and Millar, 2020).

Gastrocnemius Tendinopathy Anatomy

How to Treat Gastrocnemius Tendinopathy

Exercises that gradually load and strengthen the tendon and calf muscles are the most effective treatment (Dorset Musculoskeletal Matters, n.d.; Challoumas, Biddle and Millar, 2020). They may feel uncomfortable to begin with and can take around three months to make a difference (Dorset Musculoskeletal Matters, n.d.). I can show you how to do these, progress them, and help you get back to running or sport. See the My Approach tab for how I work.

Reduce the Load on the Tendon

At first, it is important to reduce the activity that has caused the problem. Total rest, however, can make matters worse by causing weakness (Dorset Musculoskeletal Matters, n.d.). Switching to activities that put less weight through the heel, such as swimming or cycling, can help you keep fit in the meantime.

Tips

• I can assess your calf and Achilles tendon and help plan your exercise programme.
• Sometimes it can be hard to tell the difference between sciatica (pain from an irritated nerve in the lower back) and a calf problem, as sciatica can cause pain down the back of the leg (NHS, 2024). So seek medical advice in case the pain is actually coming from higher up.
• Return to running or sport gradually, and work with your coach to ensure good technique in sport.
• Make sure your shoes are supportive, suitable for your activity, fit properly and are not worn out (Dorset Musculoskeletal Matters, n.d.).
• Increase your training gradually. Tendons take longer than muscles to adapt to a new activity (Dorset Musculoskeletal Matters, n.d.).
• If you are unsure how to do your exercises, or if your symptoms do not settle or get worse after 12 weeks, speak to your family doctor, nurse practitioner or a physiotherapist (Dorset Musculoskeletal Matters, n.d.). I'm also happy to go through your exercises with you again at any visit.

Calf tendon pain responds best to the right amount of load: not complete rest, and not pushing through pain. My aim is to settle the tendon down, then build up your calf and tendon gradually so they cope with walking, running and sport again.

I start by assessing how your knee, ankle and foot move, testing your calf strength with the knee straight and bent, and watching how you walk, run or climb stairs. I also check the nerves to your leg, because pain from the lower back can feel like a calf problem.

Load Management

• Cutting back the activities that aggravate it while keeping you active with things like cycling or swimming
• Using the next morning as our guide: if pain and stiffness are stable or improving as we add load, we're on track; if they're climbing, we ease off

Strength and Loading

• We start with pain-free holds: rising onto your toes and holding still
• Then slow calf raises with the knee straight, to target this muscle, then lowering slowly on the sore side, then single-leg raises
• Work for the hips and thighs so the whole leg shares the load
• A home programme and, when you're ready, gym-based work such as weighted calf raises

Hands-On Treatment

• Work through the calf and the rest of the leg to ease tension pulling on the tendon, including myofascial and trigger point work
• Once it's past the early irritable stage, cross-fibre work on tight spots, followed by gentle stretching and a short cool application
• Taping for short-term support, and I'll show you how to tape it yourself

Back to Running and Sport

1. Challoumas, D., Biddle, M. and Millar, N.L. (2020) 'Recent advances in tendinopathy', Faculty Reviews, 9, 16. doi: 10.12703/b/9-16.
2. Dixon, J.B. (2009) 'Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries', Current Reviews in Musculoskeletal Medicine, 2(2), pp. 74–77. doi: 10.1007/s12178-009-9045-8.
3. Dorset Musculoskeletal Matters (NHS Dorset) (n.d.) Ankle pain – Achilles tendon pain (tendinopathy). Available at: https://www.mskdorset.nhs.uk/ankle-pain/ankle-pain-achilles-tendon-pain/ (Accessed: 7 October 2026).
4. NHS (2024) Sciatica. Available at: https://www.nhs.uk/conditions/sciatica/ (Accessed: 7 October 2026).