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Calf Muscle Tear (Gastrocnemius Tear)

Calf (Gastrocnemius) muscle tears commonly occur in middle-aged recreational athletes while performing actions that require forceful contraction of the calf muscle (ex: basketball, hill running, tennis, etc.). Calf muscle tears have similar symptoms and occur by a similar mechanism to Achilles tendon ruptures. The difference is the location of the injury. Achilles tendon ruptures involve the actual Achilles tendon with pain located just above the back of the heel. Calf muscle tears occur higher up where the muscle belly attaches to the fascia (musculotendinous junction). Because of the similarities between the injuries, an Achilles tendon rupture must be ruled out in the diagnosis. Treatment of calf muscle tears is non-surgical. In most instances, initial treatment includes activity modification (limiting muscle- loading activities), wearing a boot (Cam Walker), and using crutches. As the muscle tear heals, physical therapy exercises are utilized to regain full range of motion and muscular strength. Significant improvement can be expected within the first two weeks, but full recovery can take up to 6-8 weeks. It may take many more months to regain muscle mass in the calf that had been atrophied (weakened) due to lack of use.

Treatment of Calf Muscle Tears

Treatment of Gastrocnemius muscle tears is usually non-surgical, and dependent upon the individual’s symptoms. In most instances, initial treatment includes activity modification (limiting muscle-loading activities), wearing a boot (Cam Walker), and using crutches. As the muscle tear heals, physical therapy exercises are utilized to regain full range of motion and muscular strength. Significant improvement can be expected within the first two weeks, but full recovery can take up to 6-8 weeks. It may take many more months to regain muscle mass in the calf. Occasionally, excessive scarring will form in the location of the tear. This can cause chronic pain in the area, or render it more likely for future tearing as the fibrotic scar tissue absorbs forces differently than regular healthy muscle tissue.

Initial (Acute Phase) Treatment Immediately after the injury (first 24-72 hours) treatment should include:

• Relative rest. Limit the use of the injured calf, by limiting standing and walking and possibly using crutches if needed.

• Ice applied to the injured area (10 minutes on, 10 minutes off and then repeat)

• Compression. Light compression with a wrap may be helpful

• Elevation. Elevate the leg at, or slightly above, the level of the heart. For example, by lying on a bed with the foot propped up by a couple pillows.

• Gentle foot and ankle range of motion (ROM) exercises can be carried out as long as the motion is relatively pain-free

• Immobilize the ankle in a neutral position. Studies have shown an increased rate of healing with the ankle braced in a neutral position.

Recovery Phase

Once pain free, the patient should progress from gentle plantar flexion (downward motion) exercises against resistance (use of resistance bands), to gradual introduction of stationary cycling, leg presses, and heel raises. Massage techniques can help to decrease swelling and prevent formation of scar tissue.

Maintenance Phase

Once pain-free strength and flexibility have returned, sport-specific activities can be introduced. The long-term goal of rehabilitation is to overcome the increased risk for re-injury by minimizing scar tissue formation and maximizing muscle strength and function. Calf strengthening and calf stretching should continue for several months.

Double Leg Heel Rises

Use your calf muscles to slowly raise both your heels off of the floor, then slowly bring your heels back to the ground and repeat again. If one leg is weaker or recovering from injury, then take the majority (70-80%) of the body weight on the uninjured side.

Perform the double leg heel rise exercises every second day (3-4 times per week). Start with a low number of repetitions (ex.5-10)and sets(3-5),and gradually work up until you are doing many repetitions (20-30) and many sets (10- 12). It can take many months to work up to doing a large number of repetitions. The calf muscle can be slow to regain strength, often requiring many months to regain most lost strength. Some patients may benefit from performing calf raises with their heels hanging off the edge of a rung of stairs. This works the calf muscle over a longer excursion.

Calf Stretch

Lean forward with your hands on the wall. Place the leg to be stretched back and keep the knee straight. Turn your foot inwards so that you feel the stretch in your calf,and not on the inside of your ankle.

A typical calf stretching routine would involve stretching for a total of 5 or more minutes each day. For example, 30 seconds a side and then alternate for a total of 5 minutes (2.5 minutes each side). Calf stretching needs to be performed regularly (ex. daily) for a minimum of 4-6 weeks before any significant effect will be noted.

April 5th 2019

 

Philip Bayliss, Registered Osteopath, 43 Thames Street, St Albans, Christchurch, NZ. ☎️03 356 1353