Giannis Antetokounmpo left the Milwaukee Bucks’ game against the Detroit Pistons on December 3rd after straining his right calf in the first quarter. The two-time MVP had just assisted on AJ Green’s layup less than three minutes into the game when he headed back up the court and slipped. Antetokounmpo went down clutching his right leg. MRI imaging confirmed the diagnosis of a calf strain, and he is set to return to the game in 2-4 weeks.
What is a “calf strain” and how can we distinguish this injury from an Achilles tendon rupture?
On physical exam, symptoms present very common to an Achilles tendon rupture including tenderness to the calf, a pop sensation to the back of the leg, pain during running or push off, and pain with plantarflexion. However, a positive Thompson test or complete lack of plantarflexion when the calf is squeezed can distinguish a rupture from strain. Additionally, ultrasound or an MRI can provide further definitive evidence of rupture versus strain.
Calf strains can be graded by the following criteria:
Treatment by Phase
Acute Phase (First 48–72 hours)
POLICE principle
- Protect – stop aggravating activity
- Optimal Loading – gentle movement, no pain
- Ice – 15–20 min, 2–4×/day
- Compression – elastic wrap or sleeve
- Elevation – above heart level
Subacute Phase (Days 3–14)
Focus: restore motion and strength
- Pain-free range of motion
- Gentle calf stretching
- Isometric calf contractions
- Light cycling or pool walking
Rehabilitation Phase
Progress gradually:
- Eccentric calf strengthening
- Seated → standing calf raises
- Balance and proprioception work
- Sport-specific drills (running, cutting)
Return-to-Activity Criteria
Before full return:
- Full, pain-free range of motion
- Equal calf strength vs. uninjured side
- Able to jog, sprint, and jump without pain
- No tenderness on exam
Key Takeaways:
- Most calf strains heal without surgery
- Early controlled loading improves outcomes
- Rushing return increases re-injury risk
- Achilles injury must always be ruled out
