Muscle and Tendon Injuries of the Lower Limb
A torn hamstring, a calf that goes mid-stride, an Achilles that feels like someone kicked you — muscle strains and tendon injuries are common in sport and exercise, but they also happen during everyday activities.
The hamstrings and calf muscles are particularly vulnerable to strains and tears. The Achilles tendon can develop either a partial or a complete tear.
Severity varies considerably. Some settle quickly with appropriate rehabilitation; others need imaging, a longer programme, or specialist orthopaedic assessment. Telling those apart early is what stops a six-week problem becoming a six-month one.
This page is about tears — injuries with a moment you can point to. Tendon pain that has built up gradually, without a tearing event, is usually a tendinopathy instead: see Achilles tendinopathy or patellar tendinopathy.
Hamstring injuries
The hamstrings are a group of muscles running down the back of the thigh.
Hamstring injuries commonly occur during running, sprinting, sudden acceleration, or activities involving rapid stretching of the muscle.
Symptoms range from a mild pulling sensation to sudden severe pain. With a more significant tear there may be bruising, swelling, weakness or difficulty walking.
Most hamstring injuries are treated without surgery, and progressive rehabilitation is the mainstay of treatment.
Significant injuries close to the tendon attachment at the pelvis need particular care. Occasionally one or more hamstring tendons tear away from their attachment, and those may require MRI and specialist surgical assessment.
Calf muscle tears
Sudden pain in the calf during running, jumping or changing direction is commonly caused by injury to the gastrocnemius or soleus muscles.
People often describe feeling as though they have been kicked or struck in the back of the calf.
A tear may come with swelling and bruising, and a collection of blood or fluid called a haematoma can develop between or within the muscles.
Most calf tears recover with appropriate rehabilitation, progressing gradually from restoring comfortable movement and walking, through strengthening, and eventually back to running or sport.
Not every painful or swollen calf is a muscle tear. Deep vein thrombosis (DVT) can produce calf pain and swelling, and where it is suspected it requires urgent medical assessment.
Achilles tendon tears
The Achilles tendon connects the calf muscles to the heel and is the largest tendon in the body.
An Achilles rupture often occurs suddenly during running, jumping or pushing off. People commonly describe a sensation of being kicked in the back of the ankle, sometimes with a snap or a pop.
A complete Achilles rupture requires prompt assessment.
Treatment may be surgical or non-surgical depending on the nature of the injury and the individual patient. Early positioning and protection of the tendon are important, and a suspected acute Achilles rupture should not simply be treated as a routine calf strain.
Partial Achilles tendon tears can be more difficult to diagnose and may require imaging alongside the clinical examination.
Do I need an ultrasound scan?
Not every muscle strain requires imaging. Many straightforward muscle injuries are diagnosed clinically and treated appropriately without a scan.
Diagnostic musculoskeletal ultrasound is particularly useful when the severity or location of an injury is uncertain, when there is significant bruising or swelling, or when a tendon injury is suspected. It can help assess:
- hamstring and calf muscle injuries
- muscle and tendon fibre disruption
- Achilles tendon tears
- fluid collections and haematomas
- tendon continuity
- healing following selected injuries
Ultrasound also allows the injured area to be examined dynamically, while the muscle or tendon moves.
For some deeper or more complex injuries, MRI may provide more complete information, and may be recommended instead of, or following, ultrasound.
Haematomas and fluid collections
Bleeding following a muscle tear can produce a significant haematoma — a collection of blood within or between the muscles.
Most haematomas resolve gradually without intervention.
Occasionally a larger collection remains painful or restricts movement. In carefully selected cases, ultrasound-guided aspiration may be considered once the collection is suitable for aspiration. Using ultrasound allows the collection to be visualised and the needle guided accurately into it.
Not every haematoma should be aspirated. The decision depends on its size, location, age and ultrasound appearance, as well as your symptoms and medical history.
Physiotherapy and rehabilitation
For most muscle and tendon injuries, rehabilitation is the most important part of treatment.
Early management aims to protect the injured tissue while maintaining appropriate movement. Rehabilitation then progresses gradually through strengthening and increasing load.
For someone returning to sport, treatment progresses to running, jumping, acceleration, changes of direction and sport-specific activities.
The aim is not simply for the pain to disappear. The injured muscle or tendon needs to regain enough strength and capacity to tolerate the demands being placed on it.
Returning to sport too quickly increases the risk of doing it again.
When is further investigation or referral needed?
Further imaging or specialist assessment may be appropriate where there is:
- significant weakness or loss of function
- suspicion of a complete tendon rupture
- a significant proximal hamstring injury
- an acute Achilles tendon rupture
- extensive bruising or swelling
- a large or persistent haematoma
- an injury that is not recovering as expected
- uncertainty about the diagnosis
MRI or specialist orthopaedic assessment is sometimes more appropriate than ultrasound, and we will say so where that is the case.
What does it cost?
Every appointment lasts a full hour. Where a diagnostic scan is needed, that appointment is charged at the scan rate, which replaces the standard consultation fee rather than being added to it. Current prices are on our prices page.
Hamstring, calf and Achilles injury assessment in Weybridge
“Muscle strain” covers a wide range of injuries, from relatively minor muscle damage to significant muscle or tendon tears, and the right treatment differs accordingly.
Meyer Physio assesses and treats lower limb muscle and tendon injuries at its clinic on Baker Street in Weybridge, Surrey, combining clinical examination with diagnostic ultrasound where imaging is likely to influence treatment. The clinician who examines you is the one who scans you and takes you through rehabilitation.
The aim is to establish the location and likely severity of the injury, and determine whether rehabilitation, ultrasound monitoring, aspiration, further imaging or specialist referral is the most appropriate next step.
You can come to us directly — no GP referral is needed to book, and there is no waiting list.
Written by Suegnet Meyer, Advanced Practice Musculoskeletal Physiotherapist and MSK Sonographer. HCPC registered [PH55635]. Chartered Society of Physiotherapy member [66175]. Last reviewed: 29 October 2026.