Medial Gastrocnemius Strain Treatment & Management
- Author: Anthony J Saglimbeni, MD; Chief Editor: Sherwin SW Ho, MD more...
Acute Phase
Rehabilitation Program
Physical Therapy
Initial treatment of a medial calf injury includes relative rest, ice, compression, elevation (RICE), and early weight bearing, as tolerated. The initial treatment should continue for 24-72 hours. Ice therapy is best instituted over a damp elastic wrap, which also provides compression. Preventing the limb from hanging dependently prevents further swelling. The use of crutches with a feathering gait and bilateral heel lifts is indicated if normal gait is compromised. Active foot and ankle ROM can be carried out if there is pain-free ROM.
Medical Issues/Complications
Pain management should include analgesics as indicated. Caution should be used with nonsteroidal anti-inflammatory drugs (NSAIDs) during the acute injury phase, as these agents can predispose the patient to increased bleeding and hematoma formation in the initial days after an injury. Theoretically, cyclooxygenase-2 (COX-2) inhibitors may provide pain control without the risk of bleeding in acute injuries, which is a concern with traditional NSAIDs.
Other Treatment
Ankle/foot bracing should be used to keep the ankle in a position of maximal tolerable dorsiflexion. Studies have shown an increased rate of healing with this intervention.
Recovery Phase
Rehabilitation Program
Physical Therapy
Ice therapy and active resistance dorsiflexion exercises can be undertaken until the athlete is pain free. Then, light plantar flexion exercises against resistance are initiated. Progression of therapy includes reduction in heel-lift height and gradual introduction of stationary cycling, leg presses, and heel raises. At this stage, ultrasonography, used with or without phonophoresis, and muscle stimulation are also applicable. Massage techniques can help with the removal of interstitial fluid. Apply compression dressing from the metatarsal heads to the gastrocnemius for the first 2 weeks. Partial weight-bearing ambulation should begin as soon as tolerable to maximize the contact of the sole of the foot to the ground, then progress to increased cyclic loading, advanced proprioception and balance training, and eventual full weight-bearing ambulation, with dynamic change of speed and direction as tolerable.
Maintenance Phase
Rehabilitation Program
Physical Therapy
Once the athlete is pain free with full and symmetric ROM and full strength is regained, sports-specific activities can be resumed. Strengthening and stretching of the injured area should continue for several months to overcome the increased risk for reinjury due to the deposition of scar tissue that is involved in the healing process.
Brown DE. Ankle and leg injuries. In: Walsh W, Shelton GL, eds. The Team Physician's Handbook. Vol 1. Philadelphia, Pa: Hanley & Belfus; 1990:448-9.
Canale T, ed. Campbell's Operative Orthopaedics. 8th ed. St. Louis, Mo: Mosby; 1998:1413-25.
Glazer JL, Hosey RG. Soft-tissue injuries of the lower extremity. Prim Care. Dec 2004;31(4):1005-24. [Medline].
Johnson MD. Physiology of musculoskeletal growth. In: Sallis RE, Massimino R, eds. ACSM's Essentials of Sports Medicine. Vol 1. St. Louis, Mo: Mosby; 1997:534-8.
Pedowitz R, Saglimbeni A. The leg. In: Safran MR, McKeag DB, Van Camp SP, eds. Manual of Sports Medicine. Vol 1. Philadelphia, Pa: Lippincott-Raven; 1998:460-6.
Taunton J, Smith C, Magee DJ. Leg, foot and ankle injuries. Athletic Injuries and Rehabilitation. Vol 1. Philadelphia, Pa: WB Saunders Co; 1996:730-6.
Yilmaz C, Orgenc Y, Ergenc R, Erkan N. Rupture of the medial gastrocnemius muscle during namaz praying: an unusual cause of tennis leg. Comput Med Imaging Graph. Dec 2008;32(8):728-31. [Medline].
Darby J, Hodson-Tole EF, Costen N, Loram ID. Automated Regional Analysis of B-Mode Ultrasound Images of Skeletal Muscle Movement. J Appl Physiol. Oct 27 2011;[Medline].
Lindberg F, Öhberg F, Granåsen G, Brodin LÅ, Grönlund C. Pennation angle dependency in skeletal muscle tissue doppler strain in dynamic contractions. Ultrasound Med Biol. Jul 2011;37(7):1151-60. [Medline].
Koulouris G, Ting AY, Jhamb A, Connell D, Kavanagh EC. Magnetic resonance imaging findings of injuries to the calf muscle complex. Skeletal Radiol. Oct 2007;36(10):921-7. [Medline].
Legome E, Pancu D. Future applications for emergency ultrasound. Emerg Med Clin North Am. Aug 2004;22(3):817-27. [Medline].
Kwak HS, Han YM, Lee SY, Kim KN, Chung GH. Diagnosis and follow-up US evaluation of ruptures of the medial head of the gastrocnemius ("tennis leg"). Korean J Radiol. Jul-Sep 2006;7(3):193-8. [Medline]. [Full Text].
Abellaneda S, Guissard N, Duchateau J. The relative lengthening of the myotendinous structures in the medial gastrocnemius during passive stretching differs among individuals. J Appl Physiol. Jan 2009;106(1):169-77. [Medline].
Shin DD, Hodgson JA, Edgerton VR, Sinha S. In vivo intramuscular fascicle-aponeuroses dynamics of the human medial gastrocnemius during plantarflexion and dorsiflextion of the foot. J Appl Physiol. Jul 16 2009;epub ahead of print. [Medline].
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