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Cup 2026

Calf muscle injuries like Christian Pulisic’s can be complicated. These experts explain why

Pulisic came off at half-time of the first U.S. game and missed the second one (Photo: John Dorton/USSF/Getty Images)

Calf muscles have become a big talking point of this World Cup — with particular attention given to the left calf muscle belonging to Christian Pulisic. The 27-year-old forward was substituted at half time of the United States’ opening game of the tournament against Paraguay and, after the game (a 4-1 victory), head coach Mauricio Pochettino told reporters the substitution was largely precautionary after Pulisic “got a kick in the calf” and started to feel “tight”.

“We hope that it’s not a big issue and he can be ready for the next one,” he said.

But Pulisic was not on the pitch for the U.S.’s second group game against Australia on Friday. However, Pochettino offered some optimistic words about his star player’s recovery: “The feelings are good. Hope that it is as soon as possible that he can be ready to be selected again and to be part of the team.”

Only on Monday did he return to training with the full squad after a period of being limited to gym workouts, resistance training and light ball work, with the next U.S. game against Turkey on Thursday.

Pulisic is not the only player to be troubled by a calf injury. Neymar is yet to appear for Brazil due to an issue with his right leg, while England defender Tino Livramento had to leave the World Cup after failing to recover from his own calf issue.

To explain why calf issues can be so problematic, The Athletic consulted physiotherapist Helen van Kempen, who has worked in elite sport for the past 10 years, including with English rugby club Wasps, Welsh Lacrosse and most recently British Athletics, before founding her own clinic, Movement Performance Physiotherapy. And Dominic Rae, a Sports Medicine and Performance Specialist who is currently Head of Sports Medicine at Ten Percent Club.

How important is the calf muscle in elite soccer?

“The calf complex is more complicated and important than many realize,” says Rae. “And one of the most overlooked complexes when we talk about sports performance. The complex is made up of three muscles: the gastrocnemius, the soleus, and the plantaris, with force absorption and transfer through the Achilles tendon.

“The muscle complex is made more complicated by intramuscular tendons (aponeurosis) that act like an internal scaffold for the muscle fibers.

“When we sprint, jump, land, change direction, accelerate, decelerate, the foot is the first point of contact, so the Achilles and the calf complex very quickly become major force absorbers or producers in these movements, with up to 12 times bodyweight of force going through the complex. With any breakdown in this complex, that force has to transfer higher up the chain, leading to both increased injury risk and reduced ability to perform.”

⁠What types of calf injuries do soccer players typically sustain?

“Any of the three muscles in the calf complex can sustain tears, which can range from small myofascial injuries to full ruptures of fibers,” says Rae. “The tendons that attach the muscles to their boney attachments, or the aponeurosis (intramuscular tendons), can also both sustain tears, again, ranging from small tears to complete ruptures.”

Interestingly in the calf, and most often with the soleus, injuries become symptomatic slowly, rather than sudden big “snaps”.

“The soleus is made up more of slow-twitch muscle fibers than the gastrocnemius, which is your running-fast muscle in the calf,” explains Van Kempen. “So that’s the muscle that’s ‘on’ all day long. They’re your postural muscles, but especially for a soccer game that’s 90 minutes long, you need a lot of slow twitch muscle fibers, which are fatigue-resistant, so that they work hard throughout the game.

Stars of Soccer Christian Pulisic United States

The trailblazing USMNT talisman carrying the weight of a nation on his shoulders.

“A player coming back from that needs to really make sure that the capacity of that muscle is back again, otherwise you can fatigue towards the end of the game.”

If the strain is limited to the muscle belly, that’s a quicker recovery time than if it’s extended into the central tendon that runs through the muscle of your soleus and gastrocnemius.

“If the muscle strain has gone in towards those, that can take a lot longer to recover from” says Van Kempen. “You can get a grade 1 muscle strain, which is just the muscle belly, and a few fibers disturbed, that’s a 10 day injury and you’ll be back playing.

“If you do have a significant amount of muscle fibers strained and that extends into your aponeurosis or your tendon, that can be a three month injury. We grade it 1 to grade 3 with grade 4 a complete rupture.”

⁠We know that Pulisic was kicked in the calf. What impact could that have on the muscle?

“A kick to the calf (contusion) can in itself cause a tear to muscle fibers or fascia depending on the amount and angle of force” says Rae.

“A contusion can also cause a sudden increase in blood flow/bleeding to the area. This can range from small with minimal swelling, to a full intramuscular hematoma. Aside from the obvious pain and stiffness, this increased blood and swelling in the area causes significant muscle inhibition to not just one isolated muscle, but potentially the entire complex. If we consider that the complex may take up to 12 times bodyweight in some actions, any muscular inhibition can cause a large risk of secondary injury, and a large reduction in physical performance.”

“It’s likely he’s got a bruise / hematoma in the muscle,” says Van Kempen. “So inflammation and bleeding inhibits the muscles around there, but as long as it was compressed well and they’ve managed to stint that bleeding and that’s gone away, that should be OK, but depending on how hard he got kicked, if there’s still an element of that hematoma left in the next game he’s playing it can have an effect on the performance of the calf.

“If it’s gone into his soleus or gastrocnemius, that will have an impact on his ability to absorb load on that leg and produce force from that leg — so how fast he can run and how long he’s able to sustain that that speed as well.”

“Another potential outcome of a direct blow, is direct impact on a nerve,” says Rae. “This can give a sudden sharp pain, but also reduced signal to muscle innervations, and in turn reduced ability for the muscle to function. Sometimes this subsides instantly, but in some cases, there is a prolonged period of muscle inhibition.”

⁠What is the recovery process like for an injury like that?

“The recovery for a contusion varies depending on the extent of the bleeding,” says Rae. “But a general rule is to treat the bleeding via elevation and compression while cryotherapy can be used for some vasoconstriction and pain management.”

The first priority is protection, says Van Kempen: “You compress that injury to reduce the amount of bleeding into the muscle as much as possible. It’s the familiar route of RICE: rest, ice, compress, elevate. They’ll try and start that immediately and have him doing very little, so that he can get back a lot quicker.”

Pulisic has largely been doing rehab work away from team-mates (Jamie Squire/Getty Images)

“Gentle and progressive walking and muscle specific movements will also help to ensure a hematoma can be removed,” says Rae. “Once bleeding has stopped, manual therapy based treatment can speed up the removal of swelling, and gradual strength exposure, and electro-muscular stimulation can help to ensure normal function of the muscle.”

The length of time out depends on how much muscle fiber has been disrupted, says Van Kempen: “Timescales can vary significantly between a minute muscle strain and a significant injury. If it’s only a small muscle strain then building up the strength and capacity of the muscle again will happen very quickly. If it’s a large one, that can be a very lengthy three month rehab.”

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⁠Is it an issue that is likely/possible to return once you’ve had it once?

“If the return to play from a contusion is too soon, it is common for swelling or bleeding to re-occur, and stiffness to worsen,” says Rae. “In many cases, this does not impact function during the game (when the player is warm), but following the match can lead to worse symptoms and further issues.”

“Whenever you strain a muscle, you are always more likely to injure that again,” says Van Kempen. “If you break a bone it builds back stronger, but whenever you damage soft tissue, there’s always a slight vulnerability to it. If it’s extended into the tendon, then there’s a higher chance of re-injury.

“But the better the rehab, the less likely you’ll have a recurrence.”

“In the cases of muscle or tendon tears, the risk of re-injury depends on many factors such as age of the player, how many previous injuries (and if in the same location-therefore compromising collagen/tissue quality), and the specific location within the calf complex,” says Rae.

“Intramuscular tendons carry higher re-injury rates, with myofascial injuries carrying lower re-injury rates. The specific mechanics of the athletes also play a huge part. For example, if the athlete runs in a specific way, predominantly loading a specific area of the calf, this will increase the risk of re-injury of this area, compared to a region that is exposed to less load.”

Jun 23, 2026

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